Under the Radar: How Unexamined Biases in Decision-Making Processes in Clinical Interactions Can Contribute to Health Care Disparities

Abstract

Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to healthcare disparities. Biases are complex but systematic, differing by racial/ ethnic group and not limited to love–hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group’s overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health.

Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study

“…However, implicit bias requires a longer period before a shift is noted [10,11]. Our results followed a similar pattern, where overt discrimination against LGBT individuals was low in prevalence, while measures of the inclusiveness of the environment showed that there is room for improvement.…”

“…This has been accompanied by a significant decline in explicit bias (discrimination, hate speech) and negative attitudes towards sexual and gender minorities [9]. With shifts in society’s attitude towards minorities, explicit bias becomes socially unacceptable, while implicit bias remains widespread [10,11]. Implicit bias refers to individuals’ perception and stereotypes without conscious intention.…”

The role of weight self-stigma on the quality of life of women with overweight and obesity: A multi-group comparison between binge eaters and non-binge eaters

“…Research has been consistently demonstrating that weight discrimination is associated with eating disordered attitudes and behaviors (Durso, Latner, & Hayashi, 2012;Puhl & Latner, 2007), avoidance of physical activity (e.g., Faith, Leone, Ayers, Heo, & Pietrobelli, 2002), psychopathological symptoms (e.g., Ashmore, Friedman, Reichmenn, & Musante, 2007;Puhl & Heuer, 2009), poorer health care, reduced treatment compliance, medical care avoidance (Dovidio & Fiske, 2012;Lillis, Hayes, Bunting, & Masuda, 2009;Puhl & Heuer, 2010) and may lead to weight gain (Sutin & Terracciano, 2013). Weight stigma may even hold a negative impact on the efficacy of weight loss treatments (Carels, et al, 2009;Puhl & Heuer, 2009).…”

LGBT Professionals’ Workplace Experiences in STEM-Related Federal Agencies

“…[26][27] In addition to these processes, LGBT employees may face forms of disadvantage that arise out of pressures to "pass" as heterosexual, go "stealth" (transgender individuals who hide their transgender status) or otherwise "cover" (or downplay) their LGBT status out of fear of negative repercussions at work. [28][29] Passing or going stealth does not inoculate LGBT employees from negative workplace experiences, however.…”