Takeaway
Healthcare professionals must be vigilant against implicit bias, particularly racial bias, which can lead to delayed diagnosis and poorer outcomes for marginalized patient populations.
Lifelong Learning in Clinical Excellence | December 9, 2024 | 2 min read
By Lillie Shockney, RN, MS, Johns Hopkins Medicine
Sarah, a Caucasian woman, presented to her healthcare professional with a suspicious lump in her breast. The doctor, concerned, ordered a mammogram immediately. The results confirmed a malignant tumor, and Sarah was promptly referred to a breast surgeon.
Aisha, an African American woman, experienced similar symptoms. However, the doctor, despite her concerns, delayed ordering a mammogram, attributing her symptoms to benign fibrocystic changes. This delay, rooted in racial biases that often lead to underdiagnosis of breast cancer in Black women, proved costly. By the time the cancer was finally diagnosed, it had metastasized, significantly reducing her chances of survival.
Unconscious bias, a subtle yet pervasive force, can significantly impact the diagnosis and treatment of breast cancer. While we may not consciously harbor discriminatory beliefs, implicit biases can shape our perceptions and behaviors, leading to disparities in care.
Stereotyping and affinity bias
Bias often stems from societal stereotypes, cultural norms, and personal experiences that are deeply ingrained. We all know about stereotyping: assigning specific characteristics or behaviors to individuals based on their group membership. For instance, in my specialty of breast cancer care, assuming that older women are more likely to have benign breast changes.
Less well known is affinity bias, the preference for people who are similar to us in terms of background, interests, or values. This can result in favoring certain patients over others, potentially leading to disparities in care.
The impact on care
Unconscious bias can affect care in many ways including:
1. Delayed diagnosis
Implicit biases can lead to delays in diagnosis, as healthcare professionals may be less likely to suspect cancer or other illnesses in certain patient populations.
2. Poorer patient outcomes
Disparities in diagnosis and treatment can ultimately lead to poorer patient outcomes, including higher rates of mortality and morbidity.
Mitigating bias
To address unconscious bias in care, we must adopt a multifaceted approach:
1. Self awareness
Recognizing our own biases is the first step toward mitigating their impact. Self-reflection, mindfulness exercises, and implicit bias training can help us identify and challenge our assumptions.
2. Diverse healthcare teams
Exposure to different viewpoints, experiences, and perspectives within a medical team can help reduce bias.
3. Evidence-based guidelines
Adhering to evidence-based guidelines can help minimize the influence of personal biases and ensure that all patients receive excellent care.
4. Patient-centered care
Prioritizing patient-centered care involves actively listening to all patients’ concerns, respecting their preferences, and involving them in decision-making.
By taking these steps, we can work toward reducing unconscious bias and ensuring equitable access to high-quality care for all.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.