Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care

Sabin, Janice A.; Rivara, Frederick P.; Greenwald, Anthony G.

doi:10.1097/mlr.0b013e3181653d58

Cited by 275 publications

(259 citation statements)

References 32 publications

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“…A widely cited report by Green and colleagues 13 found that resident clinicians with greater implicit bias were less likely to recommend thrombolytic therapy for a hypothetical black patient with myocardial infarction, but this did not occur when the patient was described as white. On the other hand, a study 18,19 on pediatric decision-making showed that some of the hypothetical decisions were associated with implicit bias, but others were not. Finally, a study 20 with medical students failed to find any relation between hypothetical clinical decisions and the students' implicit bias.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] Evidence on the effects of clinician implicit bias on medical decisions in hypothetical scenarios has been mixed. 13,[18][19][20] The linkage between clinician implicit bias and more technical processes and outcomes of care has not been Electronic supplementary material The online version of this article (doi:10.1007/s11606-014-2795-z) contains supplementary material, which is available to authorized users. directly investigated.…”

Section: Introductionmentioning

confidence: 99%

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An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control

et al. 2014

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BACKGROUND: Few studies have directly investigated the association of clinicians' implicit (unconscious) bias with health care disparities in clinical settings. OBJECTIVE: To determine if clinicians' implicit ethnic or racial bias is associated with processes and outcomes of treatment for hypertension among black and Latino patients, relative to white patients. RESEARCH DESIGN AND PARTICIPANTS: Primary care clinicians completed Implicit Association Tests of ethnic and racial bias. Electronic medical records were queried for a stratified, random sample of the clinicians' black, Latino and white patients to assess treatment intensification, adherence and control of hypertension. Multilevel random coefficient models assessed the associations between clinicians' implicit biases and ethnic or racial differences in hypertension care and outcomes. MAIN MEASURES: Standard measures of treatment intensification and medication adherence were calculated from pharmacy refills. Hypertension control was assessed by the percentage of time that patients met blood pressure goals recorded during primary care visits. KEY RESULTS: One hundred and thirty-eight primary care clinicians and 4,794 patients with hypertension participated. Black patients received equivalent treatment intensification, but had lower medication adherence and worse hypertension control than white patients; Latino patients received equivalent treatment intensification and had similar hypertension control, but lower medication adherence than white patients. Differences in treatment intensification, medication adherence and hypertension control were unrelated to clinician implicit bias for black patients (P=0.85, P= 0.06 and P=0.31, respectively) and for Latino patients (P=0.55, P=0.40 and P=0.79, respectively). An increase in clinician bias from average to strong was associated with a relative change of less than 5 % in all outcomes for black and Latino patients. CONCLUSIONS: Implicit bias did not affect clinicians' provision of care to their minority patients, nor did it affect the patients' outcomes. The identification of health care contexts in which bias does not impact outcomes can assist both patients and clinicians in their efforts to build trust and partnership.KEY WORDS: hypertension; healthcare disparities; discrimination; implicit bias; race/ethnicity; quality. J Gen Intern Med 29(7):987-95

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control

et al. 2014

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show abstract

“…Green and colleagues 45 found that resident clinicians with greater implicit bias were less likely to recommend thrombolytic therapy for a hypothetical black patient with myocardial infarction, but this did not occur when the patient was described as white. On the other hand, research on pediatric decision making 49,50 showed that some hypothetical decisions were associated with implicit bias but others were not. However, a study 51 with medical students failed to find any relation between clinical decisions in the hypothetical scenarios and the students' implicit bias.…”

Section: Race/ethnicity Racism and Cvdmentioning

confidence: 99%

Social Determinants of Risk and Outcomes for Cardiovascular Disease

Havranek¹,

Mujahid²,

Barr³

et al. 2015

Circulation

1,109

732

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“…7 Although Sabin et al found less implicit race bias among pediatricians compared with other physicians, implicit (but not explicit) bias was still present, linking compliance with being White. 26 Sabin et al also examined implicit race bias in physicians as a whole using data from Harvard's Project Implicit© website, which allows volunteers to take various versions of the IAT online. 27 Overall, the 2,535 website participants who reported having an MD degree showed significant pro-White bias.…”

Section: Physicians and Implicit Biasmentioning

confidence: 99%

Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities

2013

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Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care

Cited by 275 publications

References 32 publications

An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control

An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control

Social Determinants of Risk and Outcomes for Cardiovascular Disease

Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities

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