Becker's Hospital Review

31 EXECUTIVE BRIEFING SPONSORED BY T he COVID-19 pandemic has exacerbated health disparities along racial and ethnic lines. In response, healthcare organizations are reexamining their role in contributing to these inequities and assessing potential action steps to address this vast and urgent challenge. This work is driving more healthcare leaders toward an essential realization: One of the most subtle and dangerous ways in which the medical profession perpetuates health inequities is through the practice of implicit bias. Becker's Hospital Review recently spoke with Khadeja Haye, MD, TeamHealth's national medical director of obstetrics and gynecology, about ways implicit bias makes its way into medicine and why physicians must practice self-awareness in order to prevent such bias from contaminating patient care. Implicit bias in clinical settings affects those already discriminated against in society Implicit bias refers to a set of deeply held beliefs and attitudes that lead one to act favorably or dismissively toward people based on their ethnicity, nationality, gender, religion or other social group. Because implicit bias is generally subconscious, people who exhibit various behaviors as a result of implicit bias are often not even aware that their behavior is affected by bias. In an environment such as healthcare, where human judgment and health-related vulnerabilities coexist, implicit bias can have serious consequences. "How that [manifests] in healthcare is when you're interacting with patients; your perception of those patients and your beliefs about what the patient is presenting with is shaped by those implicit biases," Dr. Haye said. She cited the example of popular culture references that associate members of certain ethnic communities with drug-seeking behavior and how those influences may inform the way some physicians perceive the clinical presentations of patients from those communities. A common pattern of implicit bias in healthcare — and particularly in Dr. Haye's specialty of obstetrics — can be observed around pain management. "There have been studies showing that Hispanic and Black women tend to be perceived as having less pain, so their pain is not treated in the same fashion or as often as their white counterparts, even though their pain score and their reported pain may be similar," Dr. Haye said. She added that the implicit bias that often underlies such behavior stems from an inaccurate belief that Black and Hispanic patients either have a higher pain threshold or are drug seeking. As a result of their implicit biases, some clinicians may be less likely to prescribe a needed medication or to order a CT scan or an X-ray, even when those interventions are clinically justified and necessary. This failure to provide the appropriate tests or medications could result in a misdiagnosis or delayed care — and eventually to systemic disparities in health outcomes, such as those observed in maternal mortality rates. "That's why it's really important to become self-aware of implicit bias, so that we can hopefully avoid those pitfalls," Dr. Haye said. Self-awareness can go a long way toward eliminating implicit bias Dr. Haye pointed out that while implicit bias is well understood in the abstract, more emphasis needs to be placed on internalizing what it means for each individual physician. "Understanding the definition of bias is one thing, but the next step is being aware of it and then taking the time to reflect," she said. "We all have personal biases and oftentimes they are steeped in privilege. If you have the benefit of a certain privilege, you may not take the time to even realize that you may have had experiences that shaped certain preconceived notions about someone else." The path to health equity: How to address implicit bias in medicine and better understand health disparities "We all have personal biases and oentimes they are steeped in privilege. If you have the benefit of a certain privilege, you may not take the time to even realize that you may have had experiences that shaped certain preconceived notions about someone else." Khadeja Haye, MD, National Medical Director of Obstetrics and Gynecology, TeamHealth

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