Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients
- PMID: 17594129
- PMCID: PMC2219763
- DOI: 10.1007/s11606-007-0258-5
Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients
Abstract
Context: Studies documenting racial/ethnic disparities in health care frequently implicate physicians' unconscious biases. No study to date has measured physicians' unconscious racial bias to test whether this predicts physicians' clinical decisions.
Objective: To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.
Design, setting, and participants: An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.
Main outcome measures: IAT scores (normal continuous variable) measuring physicians' implicit race preference and perceptions of cooperativeness. Physicians' attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians' explicit racial biases by questionnaire.
Results: Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians' prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).
Conclusions: This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians' unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.
Figures
Comment in
-
Implicit bias among physicians.J Gen Intern Med. 2009 Jan;24(1):137-40; author reply 141. doi: 10.1007/s11606-008-0821-8. J Gen Intern Med. 2009. PMID: 18937014 Free PMC article. No abstract available.
Cited by 235 articles
-
Racial Differences in Long-Term Cardiovascular Outcomes: The Need to Move From Description to Action.JACC Cardiovasc Interv. 2020 Jul 13;13(13):1596-1598. doi: 10.1016/j.jcin.2020.05.043. JACC Cardiovasc Interv. 2020. PMID: 32646702 Free PMC article.
-
The Evolution of Social Beliefs 1960-2016 in the United States and Its Influence on Empathy and Prosocial Expression in Medicine.Adv Med Educ Pract. 2020 Jun 29;11:437-446. doi: 10.2147/AMEP.S246658. eCollection 2020. Adv Med Educ Pract. 2020. PMID: 32636695 Free PMC article.
-
Selected Abstracts From the Proceedings of the 2017 Society of Teachers of Family Medicine Conference on Medical Student Education.PRiMER. 2019 Feb 5;3:5. doi: 10.22454/PRiMER.2019.299161. eCollection 2019. PRiMER. 2019. PMID: 32537576 Free PMC article.
-
Patient Representation in Medical Literature: Are We Appropriately Depicting Diversity?Plast Reconstr Surg Glob Open. 2019 Dec 26;7(12):e2563. doi: 10.1097/GOX.0000000000002563. eCollection 2019 Dec. Plast Reconstr Surg Glob Open. 2019. PMID: 32042543 Free PMC article.
-
The Impact of Health Equity Coaching on Patient's Perceptions of Cultural Competency and Communication in a Pediatric Emergency Department: An Intervention Design.J Patient Exp. 2019 Dec;6(4):257-264. doi: 10.1177/2374373518798111. Epub 2018 Sep 9. J Patient Exp. 2019. PMID: 31853480 Free PMC article.
References
-
- Smedley BD, Stith AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: Institute of Medicine; 2003.
-
- {'text': '', 'index': 1, 'ids': [{'type': 'PubMed', 'value': '11529699', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/11529699/'}]}
- Kressin NR, Petersen LA. Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research. Ann Intern Med. 2001;135(5):352–66. - PubMed
-
- {'text': '', 'index': 1, 'ids': [{'type': 'PubMed', 'value': '11789635', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/11789635/'}]}
- Petersen LA, Wright SM, Peterson ED, Daley J. Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction. Med Care. 2002;40(1 suppl):I86–96. - PubMed
-
- {'text': '', 'index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/BF02598987', 'is_inner': False, 'url': 'https://doi.org/10.1007/bf02598987'}, {'type': 'PubMed', 'value': '9016420', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/9016420/'}]}
- Allison JJ, Kiefe CI, Centor RM, Box JB, Farmer RM. Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. J Gen Intern Med. 1996;11(12):736–43. - PubMed
-
- {'text': '', 'index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJM200004133421505', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejm200004133421505'}, {'type': 'PubMed', 'value': '10760310', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/10760310/'}]}
- Canto JG, Allison JJ, Kiefe CI, et al. Relation of race and sex to the use of reperfusion therapy in medicare beneficiaries with acute myocardial infarction. N Engl J Med. 2000;342(15):1094–100. - PubMed
Publication types
MeSH terms
LinkOut - more resources
-
Full Text Sources
-
Medical
-
Research Materials
-
Miscellaneous