Bridging racial differences in the clinical encounter: How implicit bias and stereotype threat contribute to health care disparities in the dermatology clinic

Abstract

Background Positive interactions that build good relationships between patients and providers demonstrate improved health outcomes for patients. Yet, racial minority patients may not be on an equal footing in having positive interactions. Stereotype threat and implicit bias in clinical medicine negatively affect the quality of care that racial minorities receive. Dermatology, one of the least racially diverse specialties in medicine, further falls short in providing patients with options for race-concordant visits, which are noted to afford improved experiences and outcomes. Objective This study aimed to analyze implicit bias and stereotype threat in a dermatology clinical scenario with the goal of identifying actions that providers, particularly those that are not racial minorities, can take to improve the quality of the clinical interactions between the minority patient and provider. Methods We illustrate a hypothetical patient visit and identify elements that are susceptible to both stereotype threat and implicit bias. We then develop an action plan that dermatologists can use to combat stereotype threat and implicit bias in the clinical setting. Results The details of an action plan to combat the effect of stereotype threat and implicit bias are as follows: 1) Invite practices that increase representation within all aspects of the patient visit (from wall art to mission statements to creating a culture that embraces difference and not just diversity); 2) employ communication techniques targeted to invite and understand the patient perspective; and 3) practice making empathic statements to normalize anxiety and foster connection during the visit. Conclusion Knowledge of stereotype threat and implicit bias and their sequelae, as well as an understanding of steps that can be taken preemptively to counteract these factors, create opportunities to improve clinical care and patient outcomes in racial minority patients.

Art of prevention: Atopic dermatitis in women and families of color-prevalence, recognition, and prevention

“…Inviting your patient’s input is an essential component to implementing active communication skills that foster the development of a healthy patient-doctor relationship. 19 Herein, we present practical interventions that can be used when diagnosing skin of color patients with AD based upon prior successful clinical experiences and a review of the literature.…”

A new model for categorizing cognitive biases and debiasing strategies in dermatology

“…Studies have shown that healthcare workers may hold conscious and unconscious negative stereotypes of non‐White patients 13 . Strategies to reduce implicit bias include using a more diverse provider group to reflect that of the population (more non‐White dermatologists) and investing in workforce diversity, equity, and inclusion 14 . In addition, metacognition should be harnessed when taking a history to ensure one is not inappropriately stereotyping the patient (see Table 1).…”

American Contact Dermatitis Society Position Statement: Dermatitis and Skin of Color

“…For example, research has shown that negative stereotypes among physicians may affect the care received by non-White patients. 17 These implicit biases also occur in dermatology, [18][19][20] and may manifest as less time spent with patients, less positive interactions, and less patient understanding of the care that is provided. 18,21,22 Increasing diversity within the dermatology workforce, improving clinical education, and increasing awareness of implicit biases by promoting an environment of cultural competence should lessen the unconscious reliance on stereotypes and improve dermatologic care of SOC patients.…”