The Implicit Bias in Delivering Healthcare

Our human brain, the most powerful organ in the universe, is just remarkable! Humans are constantly striving to understand what we don’t already know. As a species, we remain unsatisfied to accept things the way they are, so we strive to be informed and make judgement from our existing knowledge. If something doesn’t match or mesh with a particular presumption, we intrinsically attempt to bridge the gap between what we know and what we want to know.

As healthcare providers, we often assume our clinical judgement based on clinical standards of care; a criteria that we are trained with as healthcare providers. For example, if a patient is prescribed but fails to take mediation, we are trained to assume that the patient is not compliant. Our judgment about a patient starts the moment they walk through our door, as we begin to assess not just their overall health, but how forthcoming or accurate they are about their history. Our mind is readily able to fill in all kinds of underlying details that we only think we know. Implicit associations (unconscious, uncontrollable, or a rational processes) influence our judgement and cause bias.

In healthcare, we must think carefully about bias. To fulfill our goal of delivering impartial care, healthcare professionals must remain wary of negative evaluations they make that are linked to any particular characteristic. This all boils down to an internal challenge we experience when we start assuming, going back to human nature and our innate desire to fill blanks with our imagination, which we trick ourselves into believing is the truth. Whether or not we can fully train our brains to avoid this tendency remains … unknown.

It seems that we allow these biases because we are sometimes correct. Just as I want my personal doctor to have accurate information when providing my care, as a healthcare provider I want to know as much as possible about the patients under my care, so that my recommendations are also based on the best available information.

With a cognizant mind and countless years of training, it’s important to note that we are after all still human, and prone to follow our internal biases. When practicing, there is no guarantee that our mind and medical judgement of the patient won’t be influenced by their hemoglobin A1C level or forearm tattoo or the way they present to us in the clinic. It is an automatic reflex that we consciously process and overlook. It is precisely then, at these times, that we as healthcare providers are challenged by our automatic thinking. The only recommendation to overcome this challenge that I find works for me is to stop and reflect. It’s during these reflections where I am able to distinguish between what I can see clearly and what I only guess I see.