What is unconscious bias?
Unconscious bias is an automatic and unintentional thought about a person, idea, or thing that can impact thoughts, decisions, and actions. Before we delve further into unconscious bias and its’ impact in healthcare, lets start by defining a few key terms around the subject.
is an automatic and unintentional thought about a person, idea, or thing that can impact thoughts, decisions, and actions.
are unintentional actions or words that discriminate against a group of people. Microaggressions may occur because of unconscious biases.
People can have unconscious biases about others based on race, ethnicity, gender, age, socioeconomic status, education levels, sexual orientation, and more.
When this bias is 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.
Why does unconscious bias matter in medicine?
Unconscious 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.
CareAlign believes health equity is a top priority, and we are taking action. Our CEO, Dr. Subha Airan-Javia, and colleagues did research on stigmatizing language in patient charts. They found that the words “compliance” and “cooperative” decreased in frequency as patient age increased, but the words “agitated” and “refused” increased in frequency for patients over 80. They also found that the words “compliance” and “cooperative” were used more frequently in notes for transgender patients than cis-gender patients.