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Physician implicit attitudes and stereotypes about race and quality of medical care.
Med Care. 2008 Jul; 46(7):678-85.MC

Abstract

BACKGROUND

Recent reports speculate that provider implicit attitudes about race may contribute to racial/ethnic health care disparities.

OBJECTIVES

We hypothesized that implicit racial bias exists among pediatricians, implicit and explicit measures would differ and implicit measures may be related to quality of care.

RESEARCH DESIGN

A single-session, Web survey of academic pediatricians in an urban university measured implicit racial attitudes and stereotypes using a measure of implicit social cognition, the Implicit Association Test (IAT). Explicit (overt) attitudes were measured by self-report. Case vignettes were used to assess quality of care.

RESULTS

We found an implicit preference for European Americans relative to African Americans, which was weaker than implicit measures for others in society (mean IAT score = 0.18; P = 0.01; Cohen's d = 0.41). Physicians held an implicit association between European Americans relative to African Americans and the concept of "compliant patient" (mean IAT score = 0.25; P = 0.001; Cohen's d = 0.60) and for African Americans relative to European Americans and the concept of "preferred medical care" (mean IAT score =-0.21; P = 0.001; Cohen's d = 0.64). Medical care differed by patient race in 1 of 4 case vignettes. No significant relationship was found between implicit and explicit measures, or implicit measures and treatment recommendations.

CONCLUSIONS

Pediatricians held less implicit race bias compared with other MDs and others in society. Among pediatricians we found evidence of a moderate implicit "perceived patient compliance and race" stereotype. Further research is needed to explore whether physician implicit attitudes and stereotypes about race predict quality of care.

Authors+Show Affiliations

University of Washington, School of Social Work, Seattle, Washington 98105-6299, USA. sabinja@u-washington.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

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

18580386

Citation

Sabin, Janice A., et al. "Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care." Medical Care, vol. 46, no. 7, 2008, pp. 678-85.
Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678-85.
Sabin, J. A., Rivara, F. P., & Greenwald, A. G. (2008). Physician implicit attitudes and stereotypes about race and quality of medical care. Medical Care, 46(7), 678-85. https://doi.org/10.1097/MLR.0b013e3181653d58
Sabin JA, Rivara FP, Greenwald AG. Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care. Med Care. 2008;46(7):678-85. PubMed PMID: 18580386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physician implicit attitudes and stereotypes about race and quality of medical care. AU - Sabin,Janice A, AU - Rivara,Frederick P, AU - Greenwald,Anthony G, PY - 2008/6/27/pubmed PY - 2008/8/15/medline PY - 2008/6/27/entrez SP - 678 EP - 85 JF - Medical care JO - Med Care VL - 46 IS - 7 N2 - BACKGROUND: Recent reports speculate that provider implicit attitudes about race may contribute to racial/ethnic health care disparities. OBJECTIVES: We hypothesized that implicit racial bias exists among pediatricians, implicit and explicit measures would differ and implicit measures may be related to quality of care. RESEARCH DESIGN: A single-session, Web survey of academic pediatricians in an urban university measured implicit racial attitudes and stereotypes using a measure of implicit social cognition, the Implicit Association Test (IAT). Explicit (overt) attitudes were measured by self-report. Case vignettes were used to assess quality of care. RESULTS: We found an implicit preference for European Americans relative to African Americans, which was weaker than implicit measures for others in society (mean IAT score = 0.18; P = 0.01; Cohen's d = 0.41). Physicians held an implicit association between European Americans relative to African Americans and the concept of "compliant patient" (mean IAT score = 0.25; P = 0.001; Cohen's d = 0.60) and for African Americans relative to European Americans and the concept of "preferred medical care" (mean IAT score =-0.21; P = 0.001; Cohen's d = 0.64). Medical care differed by patient race in 1 of 4 case vignettes. No significant relationship was found between implicit and explicit measures, or implicit measures and treatment recommendations. CONCLUSIONS: Pediatricians held less implicit race bias compared with other MDs and others in society. Among pediatricians we found evidence of a moderate implicit "perceived patient compliance and race" stereotype. Further research is needed to explore whether physician implicit attitudes and stereotypes about race predict quality of care. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/18580386/Physician_implicit_attitudes_and_stereotypes_about_race_and_quality_of_medical_care_ L2 - http://dx.doi.org/10.1097/MLR.0b013e3181653d58 DB - PRIME DP - Unbound Medicine ER -