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Cited by 409Patient-Provider Communication in HealthcareRacial and Ethnic Identity ResearchCultural Competency in Health Care

Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients

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Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., Wright, L. A., Bronsert, M. +3 more·2013·The Annals of Family Medicine
DOI 10.1370/afm.1442PMC PMC3596038
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Abstract

PURPOSE: We investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships. METHODS: We administered a telephone survey to 2,908 patients, stratified by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales. RESULTS: Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians' implicit bias (P = .98). CONCLUSIONS: This is among the first studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our findings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias.

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  • Three studies found a significant correlation between high levels of physicians' implicit bias against blacks on IAT scores and interaction that was negatively rated by black patients.

    “Three studies found a significant correlation between high levels of physicians’ implicit bias against blacks on IAT scores and interaction that was negatively rated by black patients [23, 24, 44]”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [44]

  • In some studies, the attitudes of patients towards healthcare professionals were recorded and used to evaluate clinical interaction.

    “In some studies, the attitudes of patients towards healthcare professionals were recorded and used to evaluate clinical interaction [23, 24, 44].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [44]

  • The review shows clearer evidence for a relationship between implicit bias and negative effects on clinical interaction.

    “As our review shows, there is clearer evidence for a relationship between implicit bias and negative effects on clinical interaction [23, 24, 44].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [44]

  • Four studies included participants who were not trained physicians or nurses and failed to report separate results for these categories of participants.

    “Four studies included participants who were not trained physicians or nurses and failed to report separate results for these categories of participants [42, 44, 49, 50].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [44]

    The Study Population and Data Collection: Clinicians section describes participants as adult primary care clinicians but does not identify their professional qualifications. The Results section reports findings for clinicians together, without establishing that any were neither trained physicians nor nurses. I searched for clinician types and separate results by profession; our copy does not establish that this study was one of the four described. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • Racial and weight-related biases are documented to affect healthcare interactions.

    “Both racial and weight-related biases are documented to influence healthcare interactions (18–20).”

    From Regional trends and disparities in newer <scp>GLP1</scp> receptor agonist initiation among real‐world adult patients eligible for obesity treatment (2025) · cites this paper as [20]

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Research works printed but not linked: 1

  1. Montgomery JE, Irish JT, Wilson IB, et al. Primary care experi- ences of Medicare benefi ciaries, 1998 to 2000. J Gen Intern Med. 2004;19(10):991-998.

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Authors
Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., Wright, L. A., Bronsert, M., Karimkhani, E., Magid, D. J., & Havranek, E. P.
Affiliations
  • University of Colorado Boulder (US)
  • Kaiser Permanente (US)
  • University of Colorado Denver (US)
  • Denver Health Medical Center (US)
ORCID
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2013-01-01
Volume
11
Issue
1
Pages
43-52
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.1442
PMC
PMC3596038
OpenAlex
W2137471755
Cited by
409
References
67
Citations by year
2026: 15 · 2025: 27 · 2024: 34 · 2023: 39 · 2022: 43 · 2021: 56 · 2020: 40 · 2019: 38 · 2018: 26 · 2017: 30 · 2016: 24 · 2015: 16 · 2014: 14 · 2013: 7
FWCI
36.64
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Kaiser Permanente
  • University of Colorado Boulder
  • University of Colorado Denver
  • National Heart, Lung, and Blood Institute (HL088198, R01HL088198)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords
implicit bias, explicit bias, patient-centered care, patient perception of care, Black patients, Hispanic patients, clinician-patient relationship, health disparities, racial disparities in health care, provider communication, clinician trust
MeSH terms
Adolescent, Adult, Black or African American, Colorado, Female, Hispanic or Latino, Humans, Male, Middle Aged, Physician-Patient Relations, Models, Statistical, Patient Satisfaction, Patient-Centered Care, Health Care Surveys, Cultural Competency, Healthcare Disparities, Young Adult, Physicians, Primary Care, Racism

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