Change Your World Week Winter 2021 (Archived)

WHAT IS IMPLICIT BIAS AND WHAT CAUSES IT?

Implicit bias is shared by everyone to some degree and is likewise targeting all groups of people. Implicit bias is based on race, sex, age, sexuality, and a plethora of other traits. Implicit bias is caused by interactions and perceptions of people, this causes people to assign stereotypes or assumptions to groups of people without couscous effort, it is both instinctual and reactional.  

WANT AN EXAMPLE?

It may be easier to understand how this occurs naturally with an example, racial implicit bias may play out like this: you are a white man walking down the sidewalk, you see a black man walking ahead of you, you move to the sidewalk across the street because you for some reason worry that he has a weapon, despite having no factual reason to come to this conclusion. This can be explained by the portrayal of African Americans in our media, which paint people of that racial group as violent. 

WHAT IS THE PROBLEM WITH IMPLICIT BIAS- WHY FOCUS ON HEALTHCARE IMPLICIT BIAS?

The problem of not recognizing Implicit bias is noticeable in all fields and careers however in the careers like the healthcare system, it is a true matter of life and death. Here are the facts,

•  Studies done by the National Academy of Medicine, that included 400 hospitals in the United States, exposed that African American patients suffering with heart disease are less likely to receive quality or modern medical solutions and are often discharged before their white counterparts, despite being in an unhealthy condition.
•  They also found that women of color are less likely to receive proper care than white women, often being denied care or given scientifically ineffective drugs for conditions such as bipolar disorder. In the case of bipolar disorder, women of color would receive antipsychotics, which are an outdated and ineffective drug against the disorder in addition to causing long-term negative effects on the person (Bridges).  
•        scholars identifying that the quality of healthcare provided to people of color contributes to the lower life expectancy within this minority group. 
• The Centers for Disease Control and Prevention found that black women in the U.S are 3 times more likely to experience pregnancy related mortality than white women, finding that they were treated differently and were often given unnecessary drug screenings and that the marital status of the couple were often questioned.

HOW CAN WE TELL OUR BIAS? 

• Medical staff were asked to complete a test in which Dayna Bowen Matthew, author of Just Medicine: A Cure for Racial Inequality in American Healthcare (2015), explains further shows the implicit bias of medical staff using the IAT. 
• The IAT test helps uncover the unconscious individual bias held by our health staff.

HOW CAN WE STOP THE EFFECTS OF IMPLICIT BIAS:

• Implicit Bias Training and Education 

Dr. Debra Furr- Holden, professor at Michigan State University, and Char’ly Snow, director of Flint Center for Health equity Solutions, describe this situation with implicit bias in the medical field to be like a blind spot when you are driving; they clarify that “We all learned in driver’s ed: you have a blind spot. It’s that area just behind you, just on the side of your car. Well, how do you address a blind spot? Well, we all got trained: you look over your shoulder... So, I think of implicit bias as a blind spot. It’s there, it’s impactful based on people’s actions, but people need the training to look over their shoulder and be vigilant and be on the hunt for it"(Staff).  

Unconscious bias describes associations or attitudes that alter one’s perceptions and therefore often go unrecognized by the individual, whereas bias is based on one’s discriminatory beliefs and values which can be targeted in nature. bias actively goes against the very ethos of medical professionals to serve all human beings regardless of identity. Unconscious bias can also affect healthcare professionals in many ways, including patient-clinician interactions, hiring and promotion, and their own professional interactions. Unconscious or implicit bias describes associations or attitudes that reflexively alter our perceptions, thereby affecting behavior, interactions, and decision-making.

• The National Academy of Medicine notes that bias, stereotyping, and prejudice may play an important role in persisting healthcare disparities and that addressing these issues should include recruiting more medical professionals from underrepresented communities.
• Implicit bias may unconsciously influence the way information about an individual is processed, leading to unintended disparities that have real consequences in medical school admissions, patient care, faculty hiring, promotion, and opportunities for growth.

The IAT has been extensively studied as an inexpensive tool that provides feedback on an individual biases for self-reflection. The IAT calculates how quickly people associate different terms with each other. To determine unconscious race bias, the race IAT asks the subject to sort pictures (of white and black people) and words (good or bad) into pairs. 

•  in one part of the Race IAT, participants must associate good words with white people and bad words with black people.
• In another part of the Race IAT, they must associate good words with black people and bad words with white people. 

This unconscious associations can be identified even in individuals who outwardly express egalitarian beliefs According to Project Implicit, the Race IAT has been taken >4 million times between 2002 and 2017, and 75% of test takers demonstrate an automatic white preference, meaning that most people (including a small group of black people) automatically associate white people with goodness and black people with badness. Wi​​​th the ability to measure unconscious bias within the everyday lives of people, the possibility to create a policy that can lessen the effects of bias in the healthcare profession has shown itself. A policy to require students in medical programs to take a race IAT test  and to learn about their bias's and prevention methods before graduating from the would greatly reduce the amount implicit bias in healthcare. We can also reinforce this with including similar bias and diversity training education before taking the IAT test. Important points that should be emphasized when using the IAT as part of diversity training include.

•  people should be aware of their own biases and reflect on their behaviors individually.
•  the IAT can suggest generally how groups of people with certain results may behave, rather than how each individual will behave.
• On its own, the IAT is not a sufficient tool to mitigate the effects of bias, because if there is to be any chance of success, an active cultural/behavioral change must be engaged in tandem with bias awareness and diversity training.

 Our policy solution targets implicit bias by creating training and education within colleges to teach future medical professionals how to recognize bias in the healthcare setting and measure the bias implicit bias by using the race IAT test. As of now there have not been any states in the U.S that have put in action a policy quite like ours, not only do I think that it will benefit society, but I also believe that this policy could better the individual by creating a more un-hostile environment in the health care setting.

          A different perspective for this topic is that multiple factors can play roles in why doctors or nurses may not be able to help or treat a patient as well as the patient or the medical staff may like to. Health insurance, patient religion, allergies, DNR orders, and Patient bias are all things that cause restrictions on the amount of medical treatment the doctor is able to give, adding to patient-doctor conflicts. This adds to the reoccurring issues with patients believing doctors and nurses are biased to help them to their full capabilities.

• Research has shown, “Third, many participants reported traditional barriers to medical care 58.4%.” (Taber, 2014). Are one of the main reasons people said they do not like seeking medical attention. This means 58% of Americans' issues with receiving proper care stems from their own insurance restrictions and medical cost

Doctors undergo intense studying and rigorous schooling before they even have a chance to become a registered doctor. During medical school students sign a code of medical ethics These are a few of the ethical rules All doctors must sign. Agreeing to have their best intent when treating any patient who requires medical attention.

• “I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights,
• II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities,
• III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient,
• IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law,
• VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.” (Ama.org). These are a few of the ethical rules All doctors must sign. Agreeing to have their best interest when treating any patient who requires medical attention. 

Another huge reason a patient may receive a lack of care or feel less prioritized by medical staff is because of how people in the health care get treated by patients; in 2017 there was a survey given to physicians asking about altercations they have had with patients. The results show the lack of respect and bias towards doctors in the medical field. Possibly leading you to wonder if maybe it's patients' own biases against doctors. Make them believe their health isn't being treated as a priority. 

• “Survey found that 59% of responding physicians had been degraded, belittled, or harassed by patients based on their social identity characteristics, such as their race, gender, sexual orientation, religion, or ethnicity.” (Paul-emile).

A lot of distrust and hostility has been made against the health care workers by individuals seeking medical attention as well. In this same survey, it showed evidence of how doctors are effect by patent bias Aswell,

• “Black and Asian physicians were most likely to experience patient bias, which affected 70% of black physicians and 69% of Asian physicians. More than simply rude or disruptive, this patient behavior can include inappropriate conduct, comments, jokes, and innuendo as well as epithets, slurs, negative stereotyping, displays of offensive material, unwelcome physical contact, or verbal abuse.” (Paul-emile).

This shows the lack of respect and bias towards doctors in the medical field. Possibly leading you to wonder if maybe it's patients' own biases against doctors making them believe their health isn't being treated as a priority. 

There a few ways you can get involved, the one we suggest is writing a letter to your college board of trustees or the Healthcare Degree Program leaders!  

Here we have a letter explaining our issue, why it matters and what we as students want to do about it! It is concise and direct, outlining the results and anticipated outcomes that these leaders are looking to enact during their time with delta, things such a civility education and student success.

To the valued members of the Delta Board of Trustees,

As Delta College students, we would like to discuss with you how we feel implicit bias Prevention should be done in our school to improve our inclusive nature both as a college and as a people. Implicit bias is the automatic and instinctual bias we have against people different from us and often causes us to treat those people differently, assume or fear things we wouldn't if they were like us. Implicit bias can be triggered with race, sex, gender, sexual orientation, ethnicity, background-- even accents. This is a major problem in our society as it causes harm through unprofessional-ism and differing treatment. Implicit bias is proven to be in all professions explored in Dayna Bowen Matthew's book, Just Medicine: A Cure for Racial Inequality in American Healthcare (2015) with a focus on the medical field, which will be our initial primary focus as well.  We would like to see implicit bias training done as part of the required courses for students going into the health field. This would include learning what implicit bias is, how it affects our modern society and what ways we can prevent and notice our own implicit bias using the IAT test. This solution is intertwined with existing core classes, meaning minimum change or strain on college educators and the existing material and help students think civically about their community. Implicit bias training would create beneficial results, some of which include our students becoming more inclusive professionals and setting Delta College apart from other institutions. 

Implicit bias is ingrained in all people within our youth and is a natural process in our society, in order to create a more inclusive medical experience we need to bypass this process. Studies show from the National Academy of Medicine that in the medical field today, out of 400 hospitals in the United States, African American patients suffering with heart disease are less likely to receive quality or modern medical solutions and are often discharged before their white counterparts, despite being in an unhealthy condition. This is not often due to direct racism, but rather an implicit bias- this is the problem that an education would help solve by exposing students to the problem before they get in the field to repeat these statistics.

  Implicit bias Training has been recently experimented with in many workplace environments, including medical offices, the problem however is that these training programs have short term results, this is because they were introduced to it temporarily. Implicit bias training is most successful when done repeatedly and started early. With workplaces beginning to pursue implicit bias training, having workers exposed and experienced in implicit bias training during college both allows for a better understanding of the topic in the workplace during the start of their careers. In addition, this would allow for more substantial retained knowledge on implicit bias as a topic and as it affects them, which puts our students ahead of their competition and creates more long-term success in these workplace training programs. That is just how it affects the students, the medical patients would benefit just as much, if not more. 

The long-term effects on the community by implementing this at Delta College includes implicit  bias among co-workers would be decreased as well as lower the amount of impact implicit bias has on the level of minority groups hired in the medical profession, the health and experience of patients, the collective increased knowledge of Delta professors, staff and students and many other positive solutions yet to come to light.

We hope you will consider our proposition for the curriculum of our healthcare core classes and would like to thank you for your work with Delta and dedication to student interests.

Thank you,

A Delta staff member, Professor Trent Wade, has seen and experienced implicit bias both in the medical field and in daily life as a member of the Deaf community,  expresses this about his experiences with implicit bias, "Subtle as they may be, you just know it because you have experienced it rather too often."   

    Implicit Bias exists everywhere we go and manifests in many different ways, after learning a bit about Implicit Bias, can you remember a time you have witnessed this happen to someone else- has it ever happened to you?