The Impact of Racism on Clinician Cognition, Behavior and Clinical Decision Making

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

Unintended Bias in Health Care Strategies for Providing More Equitable Care

Research shows that unintentional bias on the part of physicians can influence the way they treat patients from
certain racial and ethnic groups. Most physicians are unaware that they hold such biases, which can unknowingly
contribute to inequalities in health care delivery. This article explains why a person’s thoughts and behaviors may
not align, and provides strategies for preventing implicit biases from interfering with patient care.

The mixed impact of medical school on medical students’ implicit and explicit weight bias

Context Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. Objectives This study was designed to assess medical school factors that influence change in…

Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health?

Abstract: There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing…

Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study

In this study, authors sought to characterize race and gender disparities in mental health in a national sample of first year medical students early in their medical school experience. METHOD: This study used cross-sectional baseline data of Medical Student CHANGES, a large national longitudinal study of a cohort of medical students surveyed in the winter…

The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey

BACKGROUND The stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese. OBJECTIVE The purpose of our study was to assess the frequency…

Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study

PURPOSE: A recent Institute of Medicine report concluded that lesbian and gay individuals face discrimination from health care providers and called for research on provider attitudes. Medical school is a critical juncture for improving future providers’ treatment of sexual minorities. This study examined both explicit bias and implicit bias against lesbian women and gay men among…

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study

Abstract OBJECTIVE: Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group ofstudents untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students‘ attitudes toward the value of physician empathy in clinical encounters. METHODS: First year students…

Medical School Experiences Associated with Change in Implicit Racial Bias

Examine the association between change in student implicit racial bias towards African Americans and student reports on their experiences with 1) formal curricula related to disparities in health and health care, cultural competence, and/or minority health; 2) informal curricula including racial climate and role model behavior; and 3) the amount and favorability of interracial contact…

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and…