Research on implicit attitudes has raised questions about how well people know their own attitudes. Most research on this question has focused on the correspondence between measures of implicit attitudes and measures of explicit attitudes, with low correspondence interpreted as showing that people have little awareness of their implicit attitudes. We took a different approach and directly asked participants to predict their results on upcoming IAT measures of implicit attitudes toward five different social groups. We found that participants were surprisingly accurate in their predictions. Across four studies, predictions were accurate regardless of whether implicit attitudes were described as true attitudes or culturally learned associations (Studies 1 and 2), regardless of whether predictions were made as specific response patterns (Study 1) or as conceptual responses (Studies 2–4), and regardless of how much experience or explanation participants received before making their predictions (Study 4). Study 3 further suggested that participants’ predictions reflected unique insight into their own implicit responses, beyond intuitions about how people in general might respond. Prediction accuracy occurred despite generally low correspondence between implicit and explicit measures of attitudes, as found in prior research. All together, the research findings cast doubt on the belief that attitudes or evaluations measured by the IAT necessarily reflect unconscious attitudes.

PURPOSEWe investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships. METHODSWe administered a telephone survey to 2,908 patients, stratifi ed by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales.RESULTS Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians' implicit bias (P = .98).CONCLUSIONS This is among the fi rst studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our fi ndings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this fi nding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias. Ann Fam Med 2013;11:43-52. doi:10.1370/afm.1442. INTRODUCTIONP rimary care clinicians serve as the cornerstone of the health care system and are required to possess many skills. Patient-centeredness is 1 of 6 key dimensions of high-quality health care, 1 and if clinicians are to provide such care, they must be able to engage patients in a collaborative partnership.The importance of the clinician-patient relationship is underscored by demonstrated links between the quality of the relationship and a number of processes and outcomes of care, including patients' adherence to medical advice, [2][3][4][5][6] decision to remain with a clinician, 7 satisfaction with care, 3 and clinical outcomes of care. 3,8,9 Ethnic/racial minorities appear to be at a disadvantage in this aspect of health care. [10][11][12][13][14][15][16][17] In addition to cultural and language barriers, there have been long-standing concerns that clinician bias may contribute to lowerquality clinical relationships. 44 CL INICIA NS' BIA S PR EDIC T S C A R E PERCEP T IONSBut also, "[there is] strong but circumstantial evidence for the role of bias, stereotyping, prejudice, and clinical uncertainty" in the genesis of health disparities. The observation that clinicians are unlikely to directly express ethnic/racial bias yet may still deliver care that is infl uenced by...

Objectives This study assessed implicit and explicit bias against both Latinos and African Americans, among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area. Methods 210 PCPs and 190 CMs from three health care organizations in the Denver metro area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively. Results With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs to have slightly weaker ethnic/racial bias than CMs. Conclusions This research provides the first evidence of implicit bias against Latinos in health care, as well as confirming prior findings of implicit bias against African Americans. The lack of substantive differences in bias between the experienced PCPs and CMs suggests a wider societal problem. At the same time, the wide range of implicit bias suggests that bias in healthcare is neither uniform nor inevitable, and important lessons may be learned from providers who do not exhibit bias.

The Federally Qualified Health Centers (FQHCs) that provide the foundation for America's safety net system have developed inventive approaches toward patient care through the expanded services required to meet the demands of increasingly complex patient populations. In reaction to the evidence outlining the benefits of behavioral health integration, many FQHCs are including behavioral health providers on their treatment teams. This article provides background information about FQHCs, details the current presence of behavioral health within FQHCs, and describes how the Affordable Care Act (ACA) is supporting integration through initiatives such as Meaningful Use and Patient-Centered Medical Home. Psychologists can contribute to the patient-centered care philosophy that underlies the health center program by (a) helping practices implement the behavioral health components of medical home requirements, (b) establishing clinical workfiows for the management of complex patients, (c) expanding the workforce through clinical training programs, (d) strengthening the evidence base for the treatment of comorbid medical and behavioral conditions, and (e) designing evaluation protocols to illuminate the relative impact of different integrated primary care models.

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