Examining when implicit biases influence clinical care

It’s not something that many are comfortable thinking about, but everyone has biases. Clinicians should be particularly diligent in examining whether a snap decision was based on intuition or shaped by implicit bias. V. Faye Jones, MD, PhD, MSPH, professor of pediatrics at the University of Louisville in Kentucky makes the case that addressing these concerns can lead to better care for many children in her session at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition.

Jones opened with a case of a 10-year-old Black girl and her mother who visited the office because the girl’s teacher wanted her on medication because she is “loud and bossy.” The mother sees no difference between her daughter and other children and there is no documentation of the girl having behavior problems in the practice’s records, which go back 7 years. The case illustrated a common issue that faces Black children, which is the erasure of childhood. She referenced a study that found adult participants perceived Black girls as needing less nurturing and protection; requiring less support and comfort; more independent; and more knowledgeable about adult topics such as sex.

Although bias has a negative connotation, it is just one way for us to survive in the world by finding patterns, seeking shortcuts to solve problems, and making decisions based on past experiences. This ability is one way that allows us to sort through the millions of stimuli that we’re exposed to at any given moment to a more manageable number that we can absorb. However, bias can also lead to negative outcomes in medical care. A study showed that pediatric residents have similar level of implicit bias to Black children as they have toward Black adults. This bias can impact interactions between clinician and child, with Black and Hispanic children being less likely to be asked questions about their health than their White peers. Furthermore, bias can play a significant role in pain medication with many non-White children receiving suboptimal pain management in comparison to White children with similar conditions. Black and Hispanic children are less likely to undergo imaging during emergency department visits. To examine your implicit biases, Jones recommended using the collection of implicit biases test from Harvard University.

When tackling implicit bias on the personal level, one should:

• Recognize that he or she is biased and work to accept this fact
• Become capable of self-reflection about these biases
• Strive to become less decisive in decision-making and engage in “constructive uncertainty”
• Work to be comfortable with the awkwardness and discomfort that biases may cause and explore those feelings
• Engage with groups that may be considered “others” and spend time with positive models from those groups
• Earnestly seek feedback and use that feedback to continue improvement

She closed the session with recommendation to make in practice including educating the self and others in the practice on implicit bias and its impact; ensuring that the staff in the practice is reflective of the patients they serve; create accountability measures along with timelines; and examine the images used in patient handouts, posters, and other images to ensure its reflective of the community and isn’t reinforcing stereotypes.

Reference

1. Jones VF. Is it clinician intuition or implicit bias?. American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 11, 2021.