Unconscious Bias in Healthcare
Unconscious biases are unsupported assumptions we make, which happen outside of our awareness. Research suggests that we have these because it is easier for our brains to categorise people and things using observable criteria and stereotypes, rather than using more time and effort to consciously evaluate every single analysis we make. When we were cavemen, this was beneficial for making decisions, for example- see something we deem scary- run. Now that we don't have to run away from lions we can afford to take more time and mental energy with our decision-making, but this "lion-run" mechanism is still hard-wired within us, and so unconscious bias prevails.
In the medical world, a healthcare provider (HCP) having unconscious biases towards patients could lead to them receiving bad healthcare, for instance by being given an incorrect diagnosis or generally being treated poorly. These biases are shaped by the HCP’s own background, culture and personal experiences.
HCPs can unconsciously make assumptions based on aspects of a patient such as race, gender, age, weight, cultural background and more. Occasionally, these aspects can indeed be a cause of, or contributor to, certain illnesses. For example, being obese can significantly increase risk of heart disease; Sickle Cell Anaemia is most likely to affect people of African, Caribbean, Middle Eastern, Eastern Mediterranean and Asian origin; White people are more likely to suffer from Atrial Fibrillation; men are more likely to have Autism; and women are more likely to have Multiple Sclerosis.
However, there are times when these aspects are not relevant to the patient’s health. Knowing these statistics can influence HCPs to make assumptions about a person’s health, especially considering that they have to make fast decisions in today’s climate of short appointment times and under-staffing in the NHS. Studies have shown that obese individuals are viewed by many HCPs as "awkward, unattractive, noncompliant, sloppy, weak-willed and lazy" and have “brought their problems on themselves," (Watman, 2018). This will inherently affect how the HCP communicates with and treats the obese patient. Often, their symptoms are dismissed and their illnesses are assumed to be due to their obesity, even when their weight is not related to the illness. In addition, Samarrai (2016) found that a "substantial number of White medical students... hold false beliefs about biological differences between black and white people." Some false beliefs they held were that black peoples' skin is thicker, that their blood coagulates more quickly, that they age more slowly, and that their nerve endings are not as sensitive. This has lead to Black Americans being less likely than White Americans to receive medication for pain, as they are deemed as experiencing pain to a lesser degree, and are also deemed as more likely to become addicted to the medication.
By training HCPs on being self-aware and noticing their own unconscious biases we can decrease as much as possible the likelihood of patient neglect or mistreatment. This means training them on their communications skills and making sure they are asking the right questions that may go against their assumptions about patients. Remembering to ask an elderly patient about drug-use, a Muslim patient about their sexuality, and a female patient about her career, will make all the difference in building a good doctor-patient relationship and ensuring that the patient feels listened to and valid.
References Used
https://www.mindtools.com/pages/article/avoiding-unconscious-bias.htm
https://www.obesityaction.org/community/article-library/weight-bias-and-discrimination-a-challenge-for-healthcare-providers/ (Watman, 2018)
https://news.virginia.edu/content/study-links-disparities-pain-management-racial-bias (Samarrai, 2016)