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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].”
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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].”
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“Both racial and weight-related biases are documented to influence healthcare interactions (18–20).”
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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).”
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Cited by
Sorted by citations
Implicit bias in healthcare professionals: a systematic review
FitzGerald, C., & Hurst, S. (2017) · BMC Medical Ethics · doi:10.1186/s12910-017-0179-8 · Cited by 2,556
“In some studies, the attitudes of patients towards healthcare professionals were recorded and used to evaluate clinical interaction [23, 24, 44].”
BackgroundMethodResultInfluentialHall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302903 · Cited by 2,176
“Black patients perceived poorer treatment in domains such as patient centeredness, contextual knowledge of the patient, and patient---provider communication from providers who demonstrated implicit bias against Blacks on the IAT; Latino patients in the same study did not perceive poorer treatment in these domains, alt…”
ResultHavranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwood, D. W., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000228 · Cited by 1,472
Self-citationMaina, I. W., Belton, T. D., Ginzberg, S. P., Singh, A., & Johnson, T. J. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.05.009 · Cited by 824
“Additionally, Black patients rated providers with higher pro-White bias more poorly 231 on multiple measures including interpersonal treatmnt, supportive communication, and patient 232 centeredness (Blair et al., 2013b; Penner et al., 2016a).”
BackgroundRacial and Ethnic Disparities in the Quality of Health Care
Fiscella, K., & Sanders, M. R. (2016) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-032315-021439 · Cited by 517
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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