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Cited by 495Social and Intergroup PsychologyCultural Competency in Health CareRacial and Ethnic Identity Research

Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology

Open access
Burgess, Diana, van Ryn, Michelle, Dovidio, John, Saha, Somnath·2007·Journal of General Internal Medicine
DOI 10.1007/s11606-007-0160-1PMC PMC2219858
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Abstract

The paper sets forth a set of evidence-based recommendations for interventions to combat unintentional bias among health care providers, drawing upon theory and research in social cognitive psychology. Our primary aim is to provide a framework that outlines strategies and skills, which can be taught to medical trainees and practicing physicians, to prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters. These strategies and skills are designed to: 1) enhance internal motivation to reduce bias, while avoiding external pressure; 2) increase understanding about the psychological basis of bias; 3) enhance providers' confidence in their ability to successfully interact with socially dissimilar patients; 4) enhance emotional regulation skills; and 5) improve the ability to build partnerships with patients. We emphasize the need for programs to provide a nonthreatening environment in which to practice new skills and the need to avoid making providers ashamed of having racial, ethnic, or cultural stereotypes. These recommendations are also intended to provide a springboard for research on interventions to reduce unintentional racial bias in health care.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper proposes a social-cognitive framework of five strategies to help health care providers prevent unconscious racial stereotypes from negatively affecting clinical encounters. It argues that interventions should build internal motivation, understanding, confidence, emotional regulation, empathy/perspective taking, and partnership building, while cautioning that these recommendations have not yet been tested in health care.

Key findings

  • The paper recommends five intervention targets: (1) enhance internal motivation to reduce bias while avoiding external pressure; (2) increase understanding of the psychological basis of bias; (3) enhance providers’ confidence in interacting with socially dissimilar patients; (4) enhance emotional regulation skills; and (5) improve the ability to build partnerships with patients.
  • It warns that stereotype suppression can produce a “rebound effect,” increased social distancing, and depletion of cognitive resources; it recommends recognizing stereotypes and using counter-strategies rather than trying to actively suppress them.
  • It highlights individuation, positive emotion, perspective taking/affective empathy, and common ingroup/partnership building as promising mechanisms from social-cognitive research; it notes that empathy has been shown to decline over medical training and physicians’ careers, suggesting interventions may need repetition.
  • It states that the recommendations are based on empirical work mostly not conducted in health care providers and settings, and should undergo rigorous evaluation before widespread adoption.

Methods

  • Design: conceptual/recommendation paper, not an empirical study; it sets forth evidence-based recommendations drawing on theory and research in social cognitive psychology.
  • Data or sample: Not stated in the paper; no primary data, sample, or systematic review is described.
  • Main analysis: narrative synthesis of theory and prior research, organized around a conceptual model (Figure 1) emphasizing motivation, information, skills, and emotion in interracial interaction.

Limitations

  • Paper-stated: most supporting empirical work was not conducted in health care providers and settings; future interventions need rigorous evaluation, including attention to unintended consequences.
  • Paper-stated: changing habits may temporarily increase cognitive burden, strategies take time and practice to become automatic, and the recommendations are not comprehensive or necessarily stand-alone programs.
  • Evident from the text: there are no primary data or formal systematic review, and the proposed strategies remain untested in health care, so their effectiveness and potential harms are unknown.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s11606-007-0160-1

Cites

132 of 132 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 120 cited sources checked · 0 supported · 0 flagged

  • Premisecitation
    § Abstract

    Providers interact less effectively with minority than with white patients.

    “(3) providers interact less effectively with minority than with white patients.32–37”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [32] Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15. source

      Not checked in the free run.

    • cites [33] Cooper-Patrick L, Powe NR, Jenckes MW, Gonzales JJ, Levine DM, Ford DE. Identification of patient attitudes and preferences regarding treatment of depression. J Gen Intern Med. 1997;12(7):431–8. source

      Not checked in the free run.

    • cites [34] Hooper EM, Comstock LM, Goodwin JM, Goodwin JS. Patient characteristics that influence physician behavior. Med Care. 1982;20(6):630–8 source

      Not checked in the free run.

    • cites [35] Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90. source

      Not checked in the free run.

    • cites [36] Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21(suppl 1):S21–7. source

      Not checked in the free run.

    • cites [37] Cooper LA, Roter D. Patient–provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, D.C.: The National Academies Press; 2003:552–93.

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  • Interpretationreasoning
    § Abstract

    Cross-cultural communication programs are likely to have only limited effects on the unconscious cognitive processes that result in stereotype activation and application.

    “These programs, however, typically focus on improving providers’ cross-cultural communication skills and, as such, are likely to have only limited effects on the unconscious cognitive processes that result in stereotype activation and application.”
    Quote in the paperSubstantial claim
  • Premisecitation
    § Abstract

    Application of stereotypes by health care providers frequently occurs outside conscious awareness.

    “(2) application of such stereotypes frequently occurs outside conscious awareness26–31”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [26] Banaji M, Greenwald AG. Implicit stereotyping and prejudice. In: Zanna MP, Olson JM, eds. The Psychology of Prejudice, The Ontario Symposium, vol. 7: 55–76.

      Not checked in the free run.

    • cites [27] Devine PG, Monteith MJ. Automaticity and control in stereotyping. In: Chaiken S, Trope Y, eds. Dual-process Theories in Social Psychology. New York: Guilford Press; 1999:339–60

      Not checked in the free run.

    • cites [28] Dovidio JF, Gaertner SL. On the nature of contemporary prejudice: The causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske, ST eds. Racism: The problem and the Response. Newbury Park, CA: Sage; 1998.

      Not checked in the free run.

    • cites [29] Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. source

      Not checked in the free run.

    • cites [30] Fazio RH, Jackson JR, Dunton BC, Williams CJ. Variability in automatic activation as an unobtrusive measure of racial attitudes: a bona fide pipeline? J Pers Soc Psychol. 1995;69(6):1013–27. source

      Not checked in the free run.

    • cites [31] Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107(1):101–26. source

      Not checked in the free run.

  • Premisecitation
    § Abstract

    Whites spontaneously associate different health conditions with Whites and Blacks.

    “Whites spontaneously associate different health conditions with Whites and Blacks. 41”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Hunt JS, Rothmann TL, Rothman AJ, Iyer SN, McGorty EK. Implicit and explicit associations between health problems and social groups. Psychol Health. In press.

      Not checked in the free run.

  • Premisecitation
    § Abstract

    Health care providers hold stereotypes based on patient race, class, sex, and other characteristics that influence their interpretation of behaviors and symptoms and their clinical decisions.

    “There is significant evidence that (1) health care providers hold stereotypes—based on patient race, class, sex, and other characteristics4–17—that influence their interpretation of behaviors and symptoms, and their clinical decisions17–25”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [4] van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50(6):813–28. source

      Not checked in the free run.

    • cites [5] van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(suppl):I 140–51.

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    • cites [6] Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19(11):1154–9. source

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    • cites [7] Kelly CE. Bringing homophobia out of the closet: antigay bias within the patient–physician relationship. Pharos Alpha Omega Alpha Honor Med Soc. 1992;55(1):2–8.

      Not checked in the free run.

    • cites [8] Kelly JA, St Lawrence JS, Smith S, Hood HV, Cook DJ. Medical students’ attitudes toward AIDS and homosexual patients. J Med Educ. 1987;62(7):549–56.

      Not checked in the free run.

    • cites [9] Kelly JA, St Lawrence JS, Smith S, Jr., Hood HV, Cook DJ. Stigmatization of AIDS patients by physicians. Am J Public Health. 1987;77(7):789–91. source

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    • cites [10] Lewis G, Croft-Jeffreys C, David A. Are British psychiatrists racist? Br J Psychiatry. 1990;157:410–15. source

      Not checked in the free run.

    • cites [11] Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24(4):351–7. source

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    • cites [12] Porter JR, Beuf AH. The effect of a racially consonant medical context on adjustment of African-American patients to physical disability. Med Anthropol. 1994;16(1):1–16. source

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    • cites [13] Rosenthal MP, Diamond JJ, Rabinowitz HK, et al. Influence of income, hours worked, and loan repayment on medical students’ decision to pursue a primary care career. JAMA. 1994;271(12):914–7. source

      Not checked in the free run.

  • May combine two claims. 22
  • Classified as probably not a substantial claim. 2

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    Premisecitation
    § Abstract

    Whites tend to have unconscious stereotypes of Whites as intelligent, successful, and educated, and of Blacks as aggressive, impulsive, and lazy.

    “Whites tend to have unconscious stereotypes of Whites as intelligent, successful, and educated, and of Blacks as aggressive, impulsive, and lazy,40”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Wittenbrink B, Judd CM, Park B. Evidence for racial prejudice at the implicit level and its relationship with questionnaire measures. J Pers Soc Psychol. 1997;72(2):262–74. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    Overt expressions of prejudice and negative racial stereotypes have declined substantially over time as norms condemning bias and endorsing racial equality have become stronger and more widespread across the population.

    “overt expressions of prejudice and negative racial stereotypes have declined substantially over time, as norms condemning bias and endorsing racial equality have become stronger and more widespread across the population.38,39”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Schuman H, Steeh C, Bobo L, Krysan M. Racial attitudes in America: Trends and interpretations, 2nd ed. Cambridge, MA: Harvard University Press; 1997.

      Not checked in the free run.

    • cites [39] Bobo L. Racial attitudes and relations at the close of the twentieth century. In: Smelser NJ, Wilson WJ, Mitchell F, eds. Racial trends and their consequences. Washington, DC: National Academy Press; 2001:264–301.

      Not checked in the free run.

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    Premisecitation
    § Abstract

    Even consciously egalitarian people may hold negative ethnic and racial stereotypes and attitudes of which they may not be fully conscious.

    “even consciously egalitarian people may hold negative ethnic and racial stereotypes and attitudes,26–31 of which they may not be fully conscious.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [26] Banaji M, Greenwald AG. Implicit stereotyping and prejudice. In: Zanna MP, Olson JM, eds. The Psychology of Prejudice, The Ontario Symposium, vol. 7: 55–76.

      Not checked in the free run.

    • cites [27] Devine PG, Monteith MJ. Automaticity and control in stereotyping. In: Chaiken S, Trope Y, eds. Dual-process Theories in Social Psychology. New York: Guilford Press; 1999:339–60

      Not checked in the free run.

    • cites [28] Dovidio JF, Gaertner SL. On the nature of contemporary prejudice: The causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske, ST eds. Racism: The problem and the Response. Newbury Park, CA: Sage; 1998.

      Not checked in the free run.

    • cites [29] Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. source

      Not checked in the free run.

    • cites [30] Fazio RH, Jackson JR, Dunton BC, Williams CJ. Variability in automatic activation as an unobtrusive measure of racial attitudes: a bona fide pipeline? J Pers Soc Psychol. 1995;69(6):1013–27. source

      Not checked in the free run.

    • cites [31] Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107(1):101–26. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    Unconscious biases are habits of mind, learned over time through repeated personal experiences and cultural socialization, and are highly resistant to change.

    “as unconscious biases are “habits of mind”,31,45 learned over time through repeated personal experiences and cultural socialization, they are highly resistant to change.46”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [31] Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107(1):101–26. source

      Not checked in the free run.

    • cites [45] Devine PG, Monteith MJ. The role of discrepancy-associated affect in prejudice reduction. In: Mackie DM, Hamilton DL, eds. Affect, Cognition and Stereotyping: Interactive Processes In Intergroup Perception. Orlando, FL: Academic Press; 1993:317–44. source

      Not checked in the free run.

    • cites [46] Kawakami K, Dovidio JF, Moll J, Hermsen S, Russin A. Just say no (to stereotyping): effects of training in the negation of stereotypic associations on stereotype activation. J Pers Soc Psychol. 2000;78(5):871–88. source

      Not checked in the free run.

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    Premisecitation
    § Abstract

    People tend to have less empathy for others perceived as dissimilar, including members of other social categories, which typically results in low rapport.

    “People tend to have less empathy for others perceived as dissimilar,77 including members of other social categories,67 which typically result in low rapport.29,35,37,69”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [77] Krebs D. Empathy and altruism. J Pers Soc Psychol. 1975;32:1134–46. source

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    • cites [67] Plant E, Devine PG. The antecedents and implications of interracial anxiety. Pers Soc Psychol Bull. 2003;29(6):790–801. source

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    • cites [29] Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. source

      Not checked in the free run.

    • cites [35] Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90. source

      Not checked in the free run.

    • cites [37] Cooper LA, Roter D. Patient–provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, D.C.: The National Academies Press; 2003:552–93.

      Not checked in the free run.

    • cites [69] Dovidio JF, Gaertner SE, Kawakami K, Hodson G. Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology. 2002;8(2):88–102. source

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  • May combine two claims.

    Premisecitation
    § Abstract

    Experiments testing the impact of instructions to avoid stereotyping have shown very short-term benefit with a rebound effect, in which the stereotype later recurred at a higher rate than among control groups who were not instructed to suppress.

    “Experiments testing the impact of instructions to avoid stereotyping have shown very short-term benefit with a “rebound effect,” in which the stereotype later recurred at a higher rate than among the control groups who were not instructed to suppress.61–64”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [61] Macrae C, Bodenhausen GV, Milne AB, Jetten J. Out of mind but back in sight: stereotypes on the rebound. J Pers Soc Psychol. 1994;67(5):808–17. source

      Not checked in the free run.

    • cites [62] Macrae CN, Bodenhausen GV, Milne AB. Saying no to unwanted thoughts: self-focus and the regulation of mental life. J Pers Soc Psychol. 1998;74(3):578–89. source

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    • cites [63] Wenzlaff RMW, Daniel M. Thought suppression. Annu Rev Psychol. 2000;51:59–91. source

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    • cites [64] Wyer NA, Sherman JW, Stroessner SJ. The roles of motivation and ability in controlling the consequences of stereotype suppression. Pers Soc Psychol Bull. 2000;26(1):13–25. source

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning
    § Abstract

    Use of stress-reducing techniques to enhance emotional well-being before patient encounters may help reduce racial bias.

    “Additionally, when time and circumstances allow, the use of stress-reducing techniques to enhance emotional well-being before patient encounters may help reduce racial bias.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Stress and negative emotions may increase stereotyping.

  • May combine two claims.

    Interpretationnone given
    § Abstract

    Much of contemporary racism occurs unintentionally, fueled by unconscious prejudice and stereotypes.

    “As we have discussed earlier, much of contemporary racism occurs unintentionally, fueled by unconscious prejudice and stereotypes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Abstract

    Enhancing provider empathy is a particularly promising strategy for increasing the effectiveness of patient-provider interactions generally, and especially for interracial interactions.

    “Enhancing provider empathy is a particularly promising strategy for increasing the effectiveness of patient–provider interactions generally, and especially for interracial interactions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    Whites often feel anxious when interacting with Blacks because of a lack of positive experiences with interracial encounters, leading them to avoid such interactions.

    “Psychological research has shown that Whites often feel anxious when interacting with Blacks, because of a lack of positive experiences with interracial encounters, leading them to avoid such interactions.67”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Plant E, Devine PG. The antecedents and implications of interracial anxiety. Pers Soc Psychol Bull. 2003;29(6):790–801. source

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  • May combine two claims.

    Premisecitation
    § Abstract

    In several studies, White subjects in whom positive emotions were induced more accurately recognized Black faces, suggesting that positive emotional states can lead to lower levels of racial categorization.

    “For instance, in several studies, White subjects in whom positive emotions were induced more accurately recognized Black faces, suggesting that positive emotional states can lead to lower levels of racial categorization.74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Johnson KJF, Barbara L. “We All Look the Same to Me”: positive emotions eliminate the own-race bias in face recognition. Psychol Sci. 2005;16:875–81. source

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    Premisecitation
    § Abstract

    Positive emotional states have been shown to broaden the scope of attention and the tendency to attend to new information, a mental state consistent with greater levels of individuation and lower levels of categorization.

    “More generally, positive emotional states have been shown to broaden the scope of attention and the tendency to attend to new information,76 a mental state that is consistent with greater levels of individuation and lower levels of categorization.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] Sexton K, Adgate JL, Church TR, et al. Children’s exposure to environmental tobacco smoke: using diverse exposure metrics to document ethnic/racial differences. Environ Health Perspect. 2004;112(3):392–7. source

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  • May combine two claims.

    Interpretationcitation
    § Abstract

    Providers who experience higher levels of positive emotion during clinical encounters may be less likely to categorize patients in terms of their racial, ethnic, or cultural group and more likely to view patients in terms of their individual attributes.

    “Recent research suggests that providers who experience higher levels of positive emotion during clinical encounters may be less likely to categorize patients in terms of their racial, ethnic, or cultural group and more likely to view patients in terms of their individual attributes (i.e., individuation).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § Abstract

    In the clinical encounter, White providers may engage in avoidance behaviors and spend less time with non-White patients, leading to poorer patient-provider relationships.

    “In the context of the clinical encounter, this may translate into White providers’ engaging in avoidance behaviors and spending less time with non-White patients, leading to poorer patient–provider relationships.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    Techniques that lead people to recognize their unconscious biases include exercises where they compare what they would do and what they should do in intergroup circumstances, and procedures such as the Implicit Association Test that can reveal unconscious prejudice and stereotypes.

    “Techniques that lead people to recognize their unconscious biases include exercises where they are prompted to compare what they would do and what they should do in a variety of intergroup circumstances,45 and recently developed procedures (such as the Implicit Association Test52,53) that can reveal unconscious prejudice and stereotypes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [45] Devine PG, Monteith MJ. The role of discrepancy-associated affect in prejudice reduction. In: Mackie DM, Hamilton DL, eds. Affect, Cognition and Stereotyping: Interactive Processes In Intergroup Perception. Orlando, FL: Academic Press; 1993:317–44. source

      Not checked in the free run.

    • cites [52] Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–80. source

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    • cites [53] Nosek BA. Moderators of the relationship between implicit and explicit evaluation. J Exp Psychol Gen. 2005;134:565–84. source

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  • May combine two claims.

    Premisecitation
    § Abstract

    Suppressing stereotypes requires effort, which can deplete cognitive resources and adversely affect the ability to solve problems and make correct decisions.

    “In addition, suppressing stereotypes requires effort,65 which can deplete cognitive resources and adversely affect the ability to solve problems and make correct decisions.66”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [65] Shelton JN, Richeson JA, Salvatore J, Trawalter S. Ironic effects of racial bias during interracial interactions. Psychol Sci. 2005;16:397–402. source

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    • cites [66] Richeson JA, Shelton JN. When prejudice does not pay: effects of interracial contact on executive function. Psychol Sci. 2003 14:287–90. source

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  • May combine two claims.

    Premisecitation
    § Abstract

    Positive emotion has been shown to lead to the use of more inclusive social categories, so that people are more likely to view themselves as part of a larger group, which can facilitate empathy and increase the capacity to see others as members of a common ingroup as opposed to outgroup.

    “Positive emotion has also been shown to lead to the use of more inclusive social categories, so that people are more likely to view themselves as being part of a larger group,28,75 which can facilitate empathy and increase the capacity to see others as members of a common “ingroup,” as opposed to “outgroup.”43”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [28] Dovidio JF, Gaertner SL. On the nature of contemporary prejudice: The causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske, ST eds. Racism: The problem and the Response. Newbury Park, CA: Sage; 1998.

      Not checked in the free run.

    • cites [75] Dovidio JF, Gaertner SL, Isen AM, Lowrance R. Group representations and intergroup bias: positive affect, similarity, and group size. Pers Soc Psychol Bull. 1995;21(8):856–65. source

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    • cites [43] Dovidio JF, Gaertner SL. Aversive racism. In: Zanna MP, ed. Advances in Experimental Social Psychology. Vol 36. San Diego, CA: Academic Press; 2004:1–51.

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  • May combine two claims.

    Premisecitation
    § Abstract

    In general, people retain information in a more detailed fashion, remember more positive information, and are more forgiving of behaviors for ingroup compared to outgroup members.

    “In general, people retain information in a more detailed fashion, remember more positive information, and are more forgiving of behaviors for ingroup compared to outgroup members.102–104”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [102] Hewstone M. The ‘ultimate attribution error’? A review of the literature on intergroup causal attribution. Eur J Soc Psychol. 1990;20:311–35. source

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    • cites [103] Howard JW, Rothbart M. Social categorization and memory for in-group and out-group behavior. J Pers Soc Psychol. 1980;38(2):301–10. source

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    • cites [104] Park B, Rothbart M. Perception of out-group homogeneity and levels of social categorization: memory for the subordinate attributes of in-group and out-group members. J Pers Soc Psychol. 1982;42(6):1051–68. source

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  • May combine two claims.

    Premisecitation
    § Abstract

    Empathy has been shown to decline over the course of medical training and the course of physicians' medical careers, suggesting that interventions to increase empathy might need to be repeated over time to be effective.

    “Unfortunately, empathy has been shown to decline over the course of medical training91–94 and the course of physicians’ medical careers,85 suggesting that interventions to increase empathy might need to be repeated over time to be effective.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [91] Bellini LM, Baime M, Shea J. Variation of mood and empathy during internship. JAMA. 2002;287:3143–46. source

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    • cites [92] Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005;80(2):164–7. source

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    • cites [93] Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. J Med Educ. 1981;56(12):1004–10.

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    • cites [94] Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38(9):934–41. source

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    • cites [85] Carmel S, Glick SM. Compassionate-empathic physicians: personality traits and socio-organizational factors that enhance or inhibit this behavior pattern. Soc Sci Med. 1996;43(8):1253–61. source

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  • May combine two claims.

    Interpretationreasoning
    § Abstract

    Partnership-building between provider and patient would be expected to produce a more positive and responsive orientation of the provider to the patient, and a more open and cooperative orientation of the patient to the provider.

    “Partnership-building between provider and patient would not only be expected to produce a more positive and responsive orientation of the provider to the patient, but also a more open and cooperative orientation of the patient to the provider.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given
    § CONCLUSION

    The initial stages of changing old habits and developing new skills are likely to temporarily result in greater cognitive burden for providers during clinical encounters.

    “Second, it is important to recognize that the initial stages of changing old habits and developing new skills are likely to temporarily result in greater cognitive burden for providers during clinical encounters.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Abstract

    Perspective taking arouses affective empathy, and affective empathy facilitates adopting the other's perspective.

    “In practice, perspective taking and affective empathy are closely related: perspective taking arouses affective empathy, and affective empathy facilitates adopting the other’s perspective.79”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Batson CD. Altruism and prosocial behavior. In: Gilbert DT, Fiske ST, Lindzey G, eds. The Handbook of Social Psychology, No. 2. New York, NY: McGraw-Hill; 1998:282–316.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    Controlled laboratory studies instructing subjects to adopt a perspective associated with another person and his or her situation have been shown to reduce bias toward a range of stigmatized groups, including Blacks, and to inhibit the activation of unconscious stereotypes and prejudices.

    “Controlled laboratory studies instructing subjects to adopt a perspective associated with another person and his or her situation have been shown to reduce bias toward a range of stigmatized groups,81 including Blacks,82,83 and to inhibit the activation of unconscious stereotypes and prejudices.84”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [81] Batson CD, Polycarpou MP, Harmon-Jones E, et al. Empathy and attitudes: can feeling for a member of a stigmatized group improve feelings toward the group? J Pers Soc Psychol. 1997;72(1):105–18. source

      Not checked in the free run.

    • cites [82] Dovidio JF, ten Vergert M, Stewart TL, et al. Perspective and prejudice: antecedents and mediating mechanisms. Pers Soc Psychol Bull. 2004;30(12):1537–49. source

      Not checked in the free run.

    • cites [83] Finlay KA, Stephan WG. Improving intergroup relations: the effects of empathy on racial attitudes. J Appl Soc Psychol. 2000;30(8):1720–37. source

      Not checked in the free run.

    • cites [84] Galinsky AD, Moskowitz GB. Perspective-taking: decreasing stereotype expression, stereotype accessibility, and in-group favoritism. J Pers Soc Psychol. 2000;78(4):708–24. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    Perspective taking and affective empathy ultimately produce more positive orientations toward the other person and a greater interest in the other's welfare.

    “Both ultimately produce more positive orientations toward the other person and a greater interest in the other’s welfare.86”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] Batson CD, Kobrynowicz D, Dinnerstein JL, Kampf HC, Wilson AD. In a very different voice: unmasking moral hypocrisy. J Pers Soc Psychol. 1997;72(6):1335–48. source

      Not checked in the free run.

24 of 24

  • The paper relies on this without support.

    There has been relatively little discussion to date of how to mitigate the negative impact of unconscious racial stereotyping among health care providers.

    “In fact, there has been relatively little discussion to date of how to mitigate the negative impact of unconscious racial stereotyping among health care providers, despite the acknowledged need to do so.32–35”

  • The paper relies on this without support.

    The proposed strategies have not yet been tested in the realm of health care.

    “It is important to note that these proposed strategies have not yet been tested in the realm of health care and should undergo rigorous evaluation before widespread adoption.”

  • The paper relies on this without support.

    The cognitive strategy of categorization that gives rise to stereotyping and racial prejudice is a normal aspect of human cognition.

    “current understanding posits that the cognitive strategy of categorization that gives rise to stereotyping and racial prejudice is a normal aspect of human cognition.”

  • The paper relies on this without support.

    Stress and negative emotions may increase stereotyping.

    “simply being aware that stress and negative emotions may increase stereotyping could make providers more vigilant about when their interactions with patients are likely to be biased.”

  • The paper relies on this without support.

    In the United States, race, ethnicity, and sex represent automatically activated categories that form the basis for ingroup–outgroup differentiation.

    “In the United States, race, ethnicity, and sex represent automatically activated categories that form the basis for ingroup–outgroup differentiation.”

  • The paper relies on this without support.

    Most of the empirical work underlying the recommendations has not been conducted in health care providers and settings.

    “First, although our recommendations are based on empirical work, most of that work has not been conducted in health care providers and settings.”

  • The paper relies on this without support.

    The recommended social-cognitive strategies can prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters.

    “our recommended strategies are not intended to change these associations directly,47 but rather to give providers strategies and skills to prevent unconscious attitudes and stereotypes from influencing the course and outcomes of clinical encounters in negative ways.”

  • The paper relies on this without support.

    Efforts such as enhancing empathy and partnership building are relevant to reducing provider bias.

    “Efforts such as enhancing empathy and partnership building are relevant not only to reducing provider bias but to improving patient–provider relationships in general.”

  • The paper relies on this without support.

    Efforts such as enhancing empathy and partnership building are relevant to improving patient–provider relationships in general.

    “Efforts such as enhancing empathy and partnership building are relevant not only to reducing provider bias but to improving patient–provider relationships in general.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The presence of implicit biases among healthcare professionals and the effect on quality of clinical care is a cause for concern.

    “The presence of implicit biases among healthcare professionals and the effect on quality of clinical care is a cause for concern [13–15].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [13]

  • There is emerging evidence that a broad range of social psychological interventions are likely to reduce implicit bias among providers.

    “There is emerging evidence that there are a broad range of social psychological interventions that are likely to reduce implicit bias among providers [76].”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [76]

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Bobo L. Racial attitudes and relations at the close of the twentieth century. In: Smelser NJ, Wilson WJ, Mitchell F, eds. Racial trends and their consequences. Washington, DC: National Academy Press; 2001:264–301.
  2. Hunt JS, Rothmann TL, Rothman AJ, Iyer SN, McGorty EK. Implicit and explicit associations between health problems and social groups. Psychol Health. In press.
  3. Bargh J. The cognitive monster: The case against controllability of automatic stereotype effects. In: Chaiken S, Trope Y, eds. Dual Process Theories in Social Psychology. New York: Guilford Press; 1999:361–82.
  4. Fiske ST, Lin M, Neuberg SL. The continuum model: ten years later. In: Trope SCY, ed. Dual Process Theories in Social Psychology. New York: Guilford; 1999:211–54.
  5. Dovidio JF, Gaertner SL, Stewart TL, Esses VM, ten Vergert M. From intervention to outcomes: processes in the reduction of bias. In: Stephan WG, Vogt P, eds. Intergroup Relations Programs: Practice, Research, and Theory. New York Teachers College Press; 2004:243–65.

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Related

Authors
Burgess, D., van Ryn, M., Dovidio, J., & Saha, S.
Affiliations
  • University of Minnesota (US)
  • Yale University (US)
  • Oregon Health & Science University (US)
Corresponding author
Burgess, Diana
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2007-03-03
Volume
22
Issue
6
Pages
882-887
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-007-0160-1
PMC
PMC2219858
OpenAlex
W2011893684
Semantic Scholar
af83f6d663f2f8ef53290a246c6ad777273432ed
Cited by
495
References
130
Citations by year
2026: 13 · 2025: 49 · 2024: 28 · 2023: 27 · 2022: 51 · 2021: 44 · 2020: 34 · 2019: 35 · 2018: 30 · 2017: 25 · 2016: 24 · 2015: 22 · 2014: 24 · 2013: 24 · 2012: 12
FWCI
40.49
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Funders
U.S. Department of Veterans Affairs
Topics
  • Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Keywords
racial bias, healthcare workers, social cognitive psychology, bias reduction interventions, medical trainees, physician-patient interaction, emotion regulation, patient partnership, intrinsic motivation
MeSH terms
Attitude of Health Personnel, Delivery of Health Care, Health Personnel, Humans, Physician-Patient Relations, Prejudice, Race Relations, Social Perception, Stereotyping

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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