At CareAlign, we have implemented changes to our platform to ensure that stigmatizing language in charts and labs does not affect the patient’s level of care.
terms around the subject.
When unconscious biases are acted upon, it can lead to microaggressions and discrimination. Oftentimes, underrepresented or minority groups that do not traditionally hold positions of power are most impacted by unconscious biases.
Implicit biases become a bigger issue when they impact how we perceive, talk about, write about, and act towards a person, thing, or idea. This impacts how you interact with the person, and how you talk about the person to other people. Discrimination and prejudicial behavior are obviously wrong, and we don’t think we need to explain that further. But there are other ways that unconscious bias impacts people that we want to mention.
Implicit bias can lead to self-fulfilling prophecies for those being biased against. Self-fulfilling prophecy is when a person or group's expectation of another person or group serves to actually bring about the expected behavior.
There’s an interesting study about this done at a grocery store. At the grocery store, cashiers from minority and majority groups have about the same job performance. But when cashiers from minority groups are working with managers who are biased, the cashiers spend less time at work and are slower at doing their job. On days when managers are unbiased, the minority group cashiers do their job significantly better than majority cashiers. They found that this was related to the hiring practice, because biased managers believe that minority cashiers underperform on the job, and they therefore create higher hiring standards for minority cashiers. You can read the full study here
This shows an example of biased behaviors leading to self-fulfilling prophecy. The minority cashiers know the biased managers think they are worse at the job than the other cashiers, so they don’t perform as well as they normally do. While this is a very specific example, it can be applied to other situations in which people are biased against others.
Implicit biases can impact people’s mental health. One study found a correlation between microaggressions and poorer mental health for American Indian/Alaska Native patients. Other studies have found discrimination-related stress is associated with mental health issues in both adults and children. Implicit biases can have a wide-ranging negative impact on those receiving the biased actions and words.
Implicit biases can impact how clinicians interact with patients, and the type of care that patients receive. Clinicians often work in stressful environments with lots of time constraints where they need to be efficient and make quick decisions. When people are tired, pressured, or anxious and need to make quick judgment calls, they often rely on their autonomic nervous system to make decisions. This sometimes means that bias and stereotypes unintentionally impact decisions, leading to unfair treatment of people in minority groups. But this bias can also perpetuate in how clinicians talk (or write) about patients.
One study looked at medical students and residents attitudes towards a patient and treatment plans prescribed for a patient. Some of these clinicians saw a note with neutral language, while the other note used stigmatizing language that did things that subtly portrayed the patient negatively. They found that seeing the stigmatizing language note was associated with more negative attitudes towards the patient and less aggressive pain management.
Another study looked at the type of stigmatizing language in charts, and found that the most common stigmatizing language fell into a few categories: questioning patient credibility, disapproval of patient reasoning or self-care, stereotyping by race or social class, portraying the patient as difficult, and emphasizing physician authority over the patient. Not only do clinicians carry their own biases that could potentially impact care, but they can also pick up biases from stigmatizing languages in patient charts or through conversations with clinicians about a common patient.
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