Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA,
J Gen Intern Med. 2013 Nov;28(11):1504-10. doi: 10.1007/s11606-013-2441-1. Epub 2013 Apr 11.
Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.
尽管医疗行业致力于平等对待所有患者,但医疗保健方面的差异仍然普遍存在。文化刻板印象可能不是有意识地认可的,但它们的存在会影响个体信息的处理方式,并导致决策中的无意识偏见,即所谓的“内隐偏见”。所有社会群体都容易受到这些偏见的影响,包括医生。研究表明,内隐偏见可能通过影响医生的行为并导致医疗待遇在种族、族裔、性别或其他特征方面产生差异,从而导致医疗保健方面的差异。我们回顾了内隐偏见的起源,引用了证明医生中存在内隐偏见的研究,并描述了证明临床决策中存在内隐偏见的研究。然后,我们提出了减少偏见的策略,即有意识地从患者的角度看待问题,并将注意力有意地集中在患者个人的信息上,而不是他们的社会群体。我们得出结论,如果所有医生都承认自己容易受到内隐偏见的影响,并在提供患者护理时有意地从患者的角度和个体角度看待问题,那么内隐偏见对医疗保健差异的影响可能会降低。我们还得出结论,增加非裔美国/黑人医生的数量可以减少内隐偏见对医疗保健差异的影响,因为他们表现出的内隐种族偏见明显较少。