Do Physicians' Implicit Views of African Americans Affect Clinical Decision Making?
Open accessAbstract
BACKGROUND: Total knee replacement (TKR) is a cost-effective treatment option for severe osteoarthritis (OA). While prevalence of OA is higher among blacks than whites, TKR rates are lower among blacks. Physicians' implicit preferences might explain racial differences in TKR recommendation. The objective of this study was to evaluate whether the magnitude of implicit racial bias predicts physician recommendation of TKR for black and white patients with OA and to assess the effectiveness of a web-based instrument as an intervention to decrease the effect of implicit racial bias on physician recommendation of TKR. METHODS: In this web-based study, 543 family and internal medicine physicians were given a scenario describing either a black or white patient with severe OA refractory to medical treatment. Questionnaires evaluating the likelihood of recommending TKR, perceived medical cooperativeness, and measures of implicit racial bias were administered. The main outcome measures included TKR recommendation, implicit racial preference, and medical cooperativeness stereotypes measured with implicit association tests. RESULTS: Subjects displayed a strong implicit preference for whites over blacks (P < .0001) and associated "medically cooperative" with whites over blacks (P < .0001). Physicians reported significantly greater liking for whites over blacks (P < .0001) and reported believing whites were more medically cooperative than blacks (P < .0001). Participants reported providing similar care for white and black patients (P = .10) but agreed that subconscious biases could influence their treatment decisions (P < .0001). There was no significant difference in the rate of recommendation for TKR when the patient was black (47%) versus white (38%) (P = .439), and neither implicit nor explicit racial biases predicted differential treatment recommendations by race (all P > .06). Although participants were more likely to recommend TKR when completing the implicit association test before the decision, patient race was not significant in the association (P = .960). CONCLUSIONS: Physicians possessed explicit and implicit racial biases, but those biases did not predict treatment recommendations. Clinicians' biases about the medical cooperativeness of blacks versus whites, however, may have influenced treatment decisions.
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Several studies published after 2013 indicated a null relationship between levels of implicit bias and clinical decision-making.
“Several studies post 2013 (thus after our cut-off date) have also indicated a null relationship between levels of implicit bias and clinical decision-making [52–54].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [52]
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- Authors
- Oliver, M. N., Wells, K. M., Joy-Gaba, J. A., Hawkins, C. B., & Nosek, B. A.
- Affiliations
- Virginia Commonwealth University (US)
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2014-03-01
- Volume
- 27
- Issue
- 2
- Pages
- 177-188
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2137147259
- Cited by
- 152
- References
- 46
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 16 · 2023: 15 · 2022: 26 · 2021: 17 · 2020: 20 · 2019: 9 · 2018: 6 · 2017: 8 · 2016: 13 · 2015: 2 · 2014: 4
- FWCI
- 29.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Keywords
- implicit racial bias, total knee arthroplasty, osteoarthritis, racial disparities in health care, African American patients, Implicit Association Test, bias interventions
- MeSH terms
- Adult, Attitude of Health Personnel, Black or African American, Decision Making, Family Practice, Female, Humans, Internal Medicine, Male, Middle Aged, Patient Compliance, Physicians, Surveys and Questionnaires, United States, Health Care Surveys, Arthroplasty, Replacement, Knee, Osteoarthritis, Knee, Healthcare Disparities, Self Report, Racism
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