Efforts underway to identify, counteract medical bias
Healthcare organizations are trying to make headway against ingrained patterns of inequitable care, an NEJM commentary notes.
Implicit biases about race, ethnicity, sexual orientation and other personal features can influence whether patients are effectively diagnosed and treated.
A commentary published over the weekend in the New England Journal of Medicine identifies steps being taken by providers and healthcare organizations to identify and counteract these biases.
“The main goal is not to have people feel overwhelmed by the topic, but to consider, ’What can I do?’” said the author, Janice Sabin, a research associate professor of biomedical informatics and medical education at University of Washington School of Medicine.
“I’ve offered ideas on what people can do right now,” she said. “It’s really important to identify actionable items for people and organizations to take.”
Her suggestions include:
- Utilizing an online bias reporting tool similar to one used at UW Medicine in Seattle. It enables anyone who experiences or witnesses healthcare discrimination, microaggression or harassment to report it. In addition to evaluating and referring reports for follow-up, UW Medicine issues a report that describes the type of incident and the groups involved, such as patients, caregivers, staff, visitors and others — with the goal of targeting areas that need improvement.
- Taking an online course on implicit bias as part of a comprehensive educational program. This course was found to significantly increase bias awareness among clinicians “regardless of the strength of their implicit racial and gender-based biases,” Sabin’s commentary notes.
- Learning how bystanders can address or interrupt microaggression and how to eliminate stigmatizing words such as “noncompliant” or “aggressive” from medical chart notes and patient communications.
Racial and ethnic groups in the United States experience higher rates of illness and death with common health conditions, including, diabetes, hypertension, obesity, asthma and heart disease, according to the Centers for Disease Control and Prevention.
“It’s quite possible that stereotypes can drive decision-making without you realizing it as a provider,” Sabin said. “Implicit bias can contribute to differences in care and health outcomes.”
Technology is being developed by the University of Washington and the University of California San Diego to investigate a new approach to address hidden healthcare bias by improving patient-doctor communication in primary care.
This approach monitors body language for signs of bias and provides feedback to make patients and doctors aware of opportunities to adjust their communication style. Researchers are partnering closely with patients and doctors to ensure this approach is guided by their experiences and needs.
It’s not only what people say during a clinical interaction, but also their actions that can create a negative impression, Sabin said, for instance, a healthcare provider moving farther away from a patient or not maintaining eye contact.
“If patients feel like they weren’t listened to, then they don’t go back” for medical treatment," Sabin said.
Training clinicians to be positive role models and having zero-tolerance policies for negative comments are key first steps to combat racial bias in health care, she added. “We have to be responsible for what we say and do. We can all do something to combat bias right now.”
– Written by Sharon Salyer