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Implicit Bias Q&A with Dr. Nicole Christian-Brathwaite

Nicole Christian-Brathwaite, MD, Medical Director at Riverside Community Care, recently had her article “Implicit Bias: What every pediatrician should know about the effect of bias on health and future directions” published in the journal, Pediatric and Adolescent Healthcare.  In this Q&A, Dr. Christian-Brathwaite discusses her paper and the role implicit bias might have in one’s treatment.

What is implicit bias?

Implicit bias is discriminating without being aware that you are discriminating. Implicit bias refers to societal attitudes or stereotypes that unconsciously affect our individual understanding, actions, and decisions. Implicit association causes people to have attitudes about others based on factors such as age, gender, race/ethnicity, weight, and appearance. These biases create unfavorable and favorable assessments without a person’s awareness or control.

What are some of the negative effects of implicit bias?

In the U.S., people who are racial and ethnic minorities experience higher rates of morbidity and mortality on average. In 2003, a pivotal study by the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care found that implicit bias and other discriminatory processes contribute to significantly more negative health outcomes for minorities. Even when the discrimination is not explicit, if a patient perceives discrimination in their healthcare, it can lead to decreased utilization of health and social services, delays in seeking treatment, and decreased adherence to medications.

Do you see implicit bias in behavioral health treatment as well as medical?

There is significant evidence showing that minority patients receive poorer quality of care despite similar disease severity, clinical presentation, and insurance. Research has shown that black patients are nearly three times more likely than non-Hispanic whites to receive a diagnosis of schizophrenia. African Americans and Native Americans are overrepresented in inpatient and emergency room settings. African Americans and Latinos are less likely than white patients to receive guideline-adherent treatment when suffering from anxiety and depression. African Americans suffering from mental illness are more likely to receive what is described as “minimally adequate” treatment.

What can doctors and clinicians do to reduce their implicit bias?

There needs to be a systemic and overall “debiasing” in health care. Doctors and all healthcare professionals need to increase exposure to individuals from diverse backgrounds, allowing for counter-stereotypes. Institutions need to invest in long term trainings to reduce bias. Trainings should involve multicultural awareness, increased self-awareness about biases, the history of bias and culture, and education on how to address and manage patients from various cultural backgrounds.  The most widely used tool, the IAT (Implicit Association Test) is quite useful for exploring and better understanding personal biases.

Do you think the medical and behavioral health professions are making strides in educating about implicit bias?

There seems to be increased awareness, but more could be done in regards to a systematic implementation and commitment to making long term changes. I’m hopeful that ongoing research and education will improve knowledge of disparities and will encourage more institutions and individuals to prioritize understanding, thereby reducing disparities.

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