The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma

Abstract

Objectives: We examined the association between pediatricians' attitudes about race and treatment recommendations by patients' race.

Methods: We conducted an online survey of academic pediatricians (n = 86). We used 3 Implicit Association Tests to measure implicit attitudes and stereotypes about race. Dependent variables were recommendations for pain management, urinary tract infections, attention deficit hyperactivity disorder, and asthma, measured by case vignettes. We used correlational analysis to assess associations among measures and hierarchical multiple regression to measure the interactive effect of the attitude measures and patients' race on treatment recommendations.

Results: Pediatricians' implicit (unconscious) attitudes and stereotypes were associated with treatment recommendations. The association between unconscious bias and patient's race was statistically significant for prescribing a narcotic medication for pain following surgery. As pediatricians' implicit pro-White bias increased, prescribing narcotic medication decreased for African American patients but not for the White patients. Self-reported attitudes about race were associated with some treatment recommendations.

Conclusions: Pediatricians' implicit attitudes about race affect pain management. There is a need to better understand the influence of physicians' unconscious beliefs about race on pain and other areas of care.

FIGURE 1—

Relationship between physicians’ implicit bias and decisions regarding pain treatment with (a, c, e) oxycodone or (b, d, f) ibuprofin, by race of the patient: University of Washington Physician Survey 2005, September-October 2005.