Perpetuating Health Disparities: The Effects of Provider Implicit Bias on Patient Health Outcomes

A Research Brief by: Bhavna Guduguntla

BGMany studies have proven the association between provider implicit bias and the resultant negative effects on patient health outcomes. Implicit bias acts on an unconscious level, meaning an individual is usually unaware that it exists. It can be activated quickly and unknowingly by situational cues, and can silently influence verbal and non-verbal behavior, perception, and memory. While individuals may consciously reject prejudice or pejorative notions about disadvantaged groups, they may harbor implicit biases toward these groups due to societal norms that often reinforce negative stereotypes normalize discriminatory behaviors. The negative consequences of implicit bias disproportionately affects individuals in marginalized and minority groups, which are defined by characteristics including: race/ethnicity, gender, socioeconomic status, age, mental illness, weight, intravenous drug use, disability status, previous incarceration, HIV/AIDS status, and intersectionality (overlapping marginalized identities).

Provider implicit bias manifests as non-timely diagnosis, disparate treatment recommendations, fewer questions asked of the patient, fewer tests performed, and behavioral change (i.e. micro-aggressions and nonverbal cues). These changes affect patient health by increasing patient stress, harming patient-provider interactions and trust, and worsening patient adherence and compliance due to reduced provider trust. Worrying about how a provider will treat them adds undue stress on individuals in already difficult situations (i.e. belonging to a marginalized group), compounded by the stress of an inherent power imbalance between patient and provider. Interestingly, provider implicit bias is not the only type of bias that may negatively affect patient health outcomes. Negative encounters within a clinical setting setting prior to seeing a physician can also prime patients to expect discriminatory behavior or perceive bias in otherwise routine behavior.

General trends show that implicit bias affects health outcomes of adults through higher incidence, mortality, and advanced staging at diagnosis for various cancers. Implicit bias affects health outcomes of children through disparities in infant mortality rates, chronic disease, organ transplantation, and leukemia-related deaths. These patterns are not just present in the United States, but are also persistent in the United Kingdom, New Zealand, Australia, Canada, South Africa, and Brazil.

By incorporating a comprehensive training curriculum, health systems may correct for the negative effects of provider implicit bias by that teaching employees how to recognize, mitigate, and ultimately overcome their implicit biases. Studies have shown that specialized hospital in-classroom training results in a 9% decrease in employee implicit bias. To this end, in order for education-based interventions to be successful, curricula must account for how patients' lived experiences influences their perception of verbal and nonverbal cues. Training must also prioritize patient-centered interactions, reminding providers to acknowledge a patient first before glancing at their charts or computer, and further encouraging them to keep a respectful, open line of communication.

In conclusion, mitigating the effects of provider implicit bias is imperative in resolving health inequities due to the disproportionate effect on marginalized groups. Through a health management approach, health systems, hospitals, and medical schools must incorporate training that builds awareness of the ubiquitous nature of health disparities, teaches providers how implicit bias may affect their clinical decision making and patient interactions, and trains them to recognize and reduce the presence of these processes.