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Archive December 2020 XXI, No. 12

Diversity, Equality & Inclusion: Understanding Implicit Bias

Providers who recognize their prejudices provide more equitable care.

Heena Santry

Heena Santry, MD


LISTEN AND LEARN Awareness of unconscious assumptions and empathy improve interactions with patients.

Healthcare professionals are expected to practice cultural humility and provide patient-centered care to diverse individuals who have different cultural backgrounds than their own. Culture, however, is far broader than what many of us typically think of as cultural differences due to country of origin. For example, a white male Christian provider who grew up in affluence needs to practice cultural humility when caring for women, Muslims, non-whites, or those who are impoverished. While one may not know exactly what it's like to bear characteristics that do not apply to oneself, providers must be open-minded to understand the role of "culture," whatever its source, in patient disease presentation, illness experience and recovery trajectory. A critical step in cultural humility is understanding the insidious role of implicit bias in our everyday thoughts and actions.

We all have implicit bias shaped by our personal, social and cultural experiences. These unconscious stereotypes and prejudices influence our reactions to circumstances. We are unaware of such automatic assumptions about people and situations that in turn impact our decision-making and shape our daily actions. Having an implicit bias doesn't make someone a racist or mean a person is prejudiced against individuals who are unlike oneself. It does mean our lived experiences have resulted in unavoidable subconscious conditioning that can contribute to racial and socioeconomic disparities in health outcomes and systemic barriers to health equity. One of the biggest threats to equitable patient care occurs when healthcare professionals believe they don't have implicit bias, and that they treat every patient equally.

For several generations, providers have been making clinical decisions based on automatic assumptions about patients' social, cultural or economic backgrounds. The earliest research on the impact of implicit bias on patient care centered on race, and showed that when black and white patients presented with chest pain suggestive of a potential heart attack, white patients were far more likely to receive timely access to life-saving cardiac interventions. Additional research has shown the same race-based treatment patterns existing for a number of diseases. Implicit bias isn't only about race, however. It impacts assumptions, and consequently actions, about numerous characteristics, including gender, body size, sexual preference, religion and health behaviors. While we can't rid ourselves of implicit bias, taking the time to recognize it and checking one's assumptions can go a long way in combatting the effects on health outcomes.

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