Implicit and Explicit Bias in Healthcare

1. Understanding Implicit and Explicit Bias

For example, most people find sharper quality knives to be better and more useful, and this is certainly true for the chefs interviewed last week. All three of them were very clear in stating that they believed that a sharp knife is not only more predictable and precise, but it’s also safer – and I think they’re right too. However, I think most people ignore that this might not actually be the case, and just assume that their belief in the superiority of a sharp knife is entirely rational. This is where implicit bias comes into play. Implicit bias – also known as unconscious bias – is a bias that we are unaware of, and which happens outside of our control. It’s a bias that happens automatically and is triggered by our brain making quick judgments and assessments of people and situations, influenced by our background, cultural environment, and personal experiences. One of the simplest ways to think about this is to consider the triangle that Daniel Kahneman outlines in his best-selling book on psychology, Thinking, Fast, and Slow. When your brain first recognizes something (the so-called “fast brain”), it may well make an automatic judgment without you even realizing it. This fast judgment is then given to the slower, more reasoned part of your brain to approve, meaning that the immediate implicit bias is confirmed and potentially reinforced by explicit bias – a bias that you intentionally control and are aware of, and which is usually formed by beliefs and experiences. Many explicit biases are shaped by implicit biases, making them closely linked. For example, a person might hold an implicit bias about a certain type of person which, when left unchallenged and automatically appraised by the fast brain, can solidify into a more permanent, conscious bias. In the realm of healthcare, immunizations and treatments are too often based on studies of only one sex, and this is just one example of how gender bias can creep into medicine. However, the potential for introducing implicit and explicit biases is much more widespread, with the concept and its impacts fully realizing themselves in the complex and information-laden terrains of clinical practice and healthcare services. Although understanding and challenging bias is important in everyday circumstances, nowhere is it more important than in healthcare – where human life and standards of living are involved. By recognizing the presence, impact, and methods to challenge and mitigate both implicit and explicit biases, a fairer, more just form of health provision and care may be realized. This is something that not only benefits patients but also healthcare professionals who are able to perform their duties with equipoise, clinical objectivity, and a clear conscience.

1.1 Definition of Implicit Bias

“Implicit and Explicit Bias in Healthcare” explores the concept and impact of biases in the healthcare field. The first section defines implicit and explicit bias, providing a foundation for understanding their significance. The next section delves into personal experiences with implicit bias, discussing its effects on behavior, realization, and emotional response. The following section focuses on observing others’ biases, including recognizing and responding to them, and the lessons learned from these observations. The importance of self-reflection and awareness is emphasized in the fourth section, highlighting the significance and benefits of bringing awareness to biases. The fifth section explores the impact of challenging biases on health equity and how it can enhance overall population health outcomes. Mitigating bias is examined in the sixth section, discussing strategies to mitigate bias and its application in both community and professional settings. Aligning thoughts and actions with values is discussed in the seventh section, emphasizing the importance of ensuring alignment and avoiding the influence of biases on thoughts and actions. Finally, the last section outlines the steps to address implicit and explicit bias, including personal steps and addressing bias at the population level. Overall, this comprehensive guide aims to help healthcare professionals and individuals navigate biases to promote equity and improve healthcare outcomes.

1.2 Definition of Explicit Bias

Explicit bias refers to the attitudes and beliefs that people hold about a group and its members, which is consciously based upon the individual’s moral values and the properties of any outgroup. This type of bias usually takes the form of direct behaviors, from subtle alienation to active discrimination. If left unchecked, unlike implicit bias, explicit bias can manifest into hate speech, hate crimes, and even genocide. Nonetheless, this does not mean that implicit bias is less harmful than explicit bias. Actually, the powerful and pervasive nature of implicit bias sometimes can lead to a more harmful area. On the other hand, implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. According to the research in social psychology, unconscious biases that we hold influence our behaviors through the activation of the stereotype that we hold for any of those different social groups that we unconsciously. Such biases can actually cause situations of which we are not even aware. For example, people who hold an implicit bias against a minority community may speak in a different manner and may act quite professionally, yet they unconsciously give more support to the treatment regimens that are associated with less effectiveness, orally and personally, rather than those with high effectiveness but maybe injectable. These acts, in a very subtle way, will lead to health disparities due to the failure of minimizing implicit bias. Finally, implicit bias is considered an automatic attitude because it is an unconscious mental state that promotes discriminatory behaviors. Most of the time, implicit biases tend to hold contrary to our consciously held beliefs of equality and a sense of commitment to fairness. This creates a kind of discrepancy between the intention and the action because, until and unless we are made aware of the existence, it lies submerged and hidden in our minds. However, explicit bias is always considered to be a conscious malevolent intention. This is in a way that most of the discriminatory actions or behaviors committed by the individual are a result of his/her conscious intentional will to commit.

2. Personal Experience with Implicit Bias

2.1 Impact of Implicit Bias on Behavior

2.2 Realization of Implicit Bias

2.3 Emotional Response to Implicit Bias

3. Observing Others’ Biases

3.1 Recognition of Implicit or Explicit Biases

3.2 Response to Others’ Biases

3.3 Lessons Learned from Observations

4. Importance of Self-Reflection and Awareness

4.1 Significance of Self-Reflection

4.2 Benefits of Bringing Awareness to Biases

5. Challenging Biases for Health Equity

5.1 Impact of Challenging Biases on Population Health Outcomes

5.2 Enhancing Health Equity through Bias Challenges

6. Mitigating Bias in Community and Professional Life

6.1 Strategies to Mitigate Bias

6.2 Application of Bias Mitigation in Community

6.3 Application of Bias Mitigation in Professional Life

7. Aligning Thoughts and Actions with Values

7.1 Ensuring Alignment with Values and Beliefs

7.2 Avoiding Influence of Biases on Thoughts and Actions

8. Steps to Address Implicit and Explicit Bias

8.1 Personal Steps to Address Bias

8.2 Addressing Bias in the Population as a Whole