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Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients
Open accessAbstract
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 [23, 24, 44]”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [44]
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“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]
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“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]
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“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]
Experimental — accuracy not yet measuredIn the citing paper
“Both racial and weight-related biases are documented to influence healthcare interactions (18–20).”
From Regional trends and disparities in newer GLP1 receptor agonist initiation among real‐world adult patients eligible for obesity treatment (2025) · cites this paper as [20]
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“These biases can impact how patients communicate with healthcare providers and their willingness to seek treatment for obesity, potentially leading to underutilization of effective treatments like newer AOM (18–20).”
From Regional trends and disparities in newer GLP1 receptor agonist initiation among real‐world adult patients eligible for obesity treatment (2025) · cites this paper as [20]
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Additional file 2 of Racism in healthcare: a scoping review
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Additional file 1 of Racism in healthcare: a scoping review
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“…directly to medical decision making have shown that, across a wide variety of health care providers (nurses, internal and family medicine physicians, surgeons, pain management specialists, etc.), the relationship between these biases and treatment recommendations is small and unreliable [13–20].”
Racial and ethnic disparities among older adults with autism spectrum disorder: a scoping review
Yuan, J., Guo, T., Rozear, H., Dupre, M. E., Malhotra, R., & Xu, H. (2026) · Aging & Mental Health · doi:10.1080/13607863.2026.2612742
“These disparities may be partly attributable to provider bias, as some clinicians may be more attuned to identifying and managing comorbidities in White patients than in patients from other racial or ethnic backgrounds (Blair et al., 2013; Hall et al., 2015).”
Pilot investigation into the influence of racial implicit bias on physician clinical reasoning
González, C. M., Deno, M. L., Ark, T. K., Helft, M., Connor, D. M., Kalet, A. L., Burgess, D. J., Samuel, M. T., Fisher, M. R., & Durning, S. J. (2026) · Diagnosis · doi:10.1515/dx-2025-0123
Sabat, L., Barfejani, A. H., Chow, G. S.-Y., Zuckerman, M., Lee, J. W., Edwards, H., & Krisciunas, G. P. (2026) · Head & Neck · doi:10.1002/hed.70197 · Cited by 1
Implicit Bias and Recognition of Biases Among Vascular Surgeons
Howard, K. A., Witrick, B., Clark, A., Atkinson, K., Morse, A., Kapoor, P., McGinigle, K. L., Minc, S. D., Alabi, O., Hicks, C. W., et al. (2026) · Journal of Surgical Research · doi:10.1016/j.jss.2026.02.004
“18 Furthermore, issues of bias may be further compounded by a physicians’ lack of recognition because an individual’s implicit biases can be outside of their awareness.”
Negative Descriptors of Patients With Sickle Cell Disease in the Electronic Health Record
Wesevich, A., Vangelatos, A., Sun, M., Tung, E. L., & Peek, M. E. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.6458
Nasr, D. (2026) · Thunderbird International Business Review · doi:10.1002/tie.70139
Metadata
- 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
- 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
- diamond
- doi.org
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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