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Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients.
J Gen Intern Med 2007; 22(9):1231-8JG

Abstract

CONTEXT

Studies documenting racial/ethnic disparities in health care frequently implicate physicians' unconscious biases. No study to date has measured physicians' unconscious racial bias to test whether this predicts physicians' clinical decisions.

OBJECTIVE

To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.

DESIGN, SETTING, AND PARTICIPANTS

An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.

MAIN OUTCOME MEASURES

IAT scores (normal continuous variable) measuring physicians' implicit race preference and perceptions of cooperativeness. Physicians' attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians' explicit racial biases by questionnaire.

RESULTS

Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians' prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).

CONCLUSIONS

This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians' unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.

Authors+Show Affiliations

The Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 901, Boston, MA 02114, USA. argreen@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17594129

Citation

Green, Alexander R., et al. "Implicit Bias Among Physicians and Its Prediction of Thrombolysis Decisions for Black and White Patients." Journal of General Internal Medicine, vol. 22, no. 9, 2007, pp. 1231-8.
Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231-8.
Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., & Banaji, M. R. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine, 22(9), pp. 1231-8.
Green AR, et al. Implicit Bias Among Physicians and Its Prediction of Thrombolysis Decisions for Black and White Patients. J Gen Intern Med. 2007;22(9):1231-8. PubMed PMID: 17594129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. AU - Green,Alexander R, AU - Carney,Dana R, AU - Pallin,Daniel J, AU - Ngo,Long H, AU - Raymond,Kristal L, AU - Iezzoni,Lisa I, AU - Banaji,Mahzarin R, Y1 - 2007/06/27/ PY - 2006/10/30/received PY - 2007/06/01/accepted PY - 2007/03/23/revised PY - 2007/6/28/pubmed PY - 2007/9/29/medline PY - 2007/6/28/entrez SP - 1231 EP - 8 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 22 IS - 9 N2 - CONTEXT: Studies documenting racial/ethnic disparities in health care frequently implicate physicians' unconscious biases. No study to date has measured physicians' unconscious racial bias to test whether this predicts physicians' clinical decisions. OBJECTIVE: To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes. DESIGN, SETTING, AND PARTICIPANTS: An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient. MAIN OUTCOME MEASURES: IAT scores (normal continuous variable) measuring physicians' implicit race preference and perceptions of cooperativeness. Physicians' attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians' explicit racial biases by questionnaire. RESULTS: Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians' prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009). CONCLUSIONS: This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians' unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/17594129/Implicit_bias_among_physicians_and_its_prediction_of_thrombolysis_decisions_for_black_and_white_patients_ L2 - https://dx.doi.org/10.1007/s11606-007-0258-5 DB - PRIME DP - Unbound Medicine ER -