The impact of racism on clinician cognition, behavior, and clinical decision making
Open accessAbstract
Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians' behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians' behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations.
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More recent research documents the persistence of racial inequities in the quality and intensity of care.
“More recent research documents the persistence of racial inequities in the quality and intensity of care [65,66].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [66]
Higher implicit bias scores among physicians are associated with biased treatment recommendations in the care of black patients, although the pattern is not uniform.
“Research reveals that higher implicit bias scores among physicians is associated with biased treatment recommendations in the care of black patients [66], although the pattern is not uniform [72].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [66]
Implicit biases may affect not only medical decision making but also the quality of communication and nonverbal behavior.
“Implicit biases may affect not only medical decision making but also the quality of communication and nonverbal behavior [66].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [66]
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- Authors
- van Ryn, M., Burgess, D. J., Dovidio, J. F., Phelan, S. M., Saha, S., Malat, J., Griffin, J. M., Fu, S. S., & Perry, S.
- Affiliations
- University of Minnesota (US)
- Yale University (US)
- Oregon Health & Science University (US)
- University of Cincinnati (US)
- ORCID
- Venue
- Du Bois Review: Social Science Research on Race
- Publisher
- Cambridge University Press (CUP)
- Published
- 2011
- Volume
- 8
- Issue
- 1
- Pages
- 199-218
- ISSN
- 1742-058X (ISSN-L)
- 1742-0598
- PMC
- PMC3993983
- OpenAlex
- W2166878213
- Cited by
- 303
- References
- 59
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 30 · 2023: 39 · 2022: 35 · 2021: 35 · 2020: 16 · 2019: 27 · 2018: 24 · 2017: 11 · 2016: 24 · 2015: 15 · 2014: 13 · 2013: 4 · 2012: 4
- FWCI
- 23.48
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Du Bois Review Social Science Research on Race (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL085631)
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- racism, implicit racial bias, clinical decision-making, racial disparities in health care, Black patients, patient behavior, bias interventions
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