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Racial Disparities in Care
The Emerging Understanding of the Role of Unconscious and Implicit Stereotyping on Provider Decision-Making
This has been an area with some really exciting research. An article garnering a lot of attention is from the Disparities Solutions Center in Boston. Titled “Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients," it is available on-line in the September 2007 Journal of General Internal Medicine.
The Committee on Diversity is working with the Disparities Solutions Center on a project exploring this issue. Titled "Heads Up!", the project will place "ad" signs on the inside of shuttle buses that transport clinicians and clinicians-in-training at a major academic medical center. "Heads Up!" will pilot the use of "priming" techniques, where clinicians are exposed to brief informational interventions, in order to decrease the impact of unconscious and implicit stereotyping. We all do it, and some of the research is showing that recognizing it can reduce the impact of the stereotyping.
We encourage you to explore this issue more in the articles below, and also encourage you to spend some time looking at this Web site, https://implicit.harvard.edu/implicit/. There are some fascinating self-assessment tools, offering another way for PAs and other clinicians to assess and try to understand the role of our own unconscious stereotyping on our practice.
Suggested Reading on Unconscious and Implicit Stereotyping
Green A, Carney D, Pallin D, et al. Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients. J Gen Intern Med. 2007 Sep;22(9):1231-8.
Betancourt J. Not me! Doctors, decisions, and disparities in health care. Cardiovas Rev Rep. 2004;25(3):105–9.
Burgess D, van Ryn M, Crowley-Matoka M, Malat J. Understanding the Provider Contribution to Race/Ethnicity Disparities in Pain Treatment: Insights from Dual Process Models of Stereotyping. Pain Medicine. 2006;7(2):119-34.
van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93(2):248–55.
van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(1 suppl):I140–51.
Physicians for Human Rights. The right to equal treatment. Available at http://www.phrusa.org/research/domestic/race/race_report/index.
html. Cited 12 Nov 2005.
Bogart LM, Catz SL, Kelly JA, Benotsch EG. Factors influencing physicians’ judgments of adherence and treatment decisions for patients with HIV disease. Med Decis Making. 2001;21(1):28–36.
Devine PG. Stereotypes and prejudice: their automatic and controlled components. J Pers Soc Psychol. 1989;56(1):5–18.
Dovidio JF, Gaertner SL, Kawakami K, Hodson G. Why can’t we just get along? Interpersonal biases and interracial distrust. Cultur Divers Ethnic Minor Psychol. 2002;8(2):88–102.
Last Revised: 9/5/07
