Clinicians' implicit ethnic/racial bias and perceptions of care among Black and Latino patients

Abstract

Purpose: We investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships.

Methods: We administered a telephone survey to 2,908 patients, stratified by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales.

Results: Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians' implicit bias (P = .98).

Conclusions: This is among the first studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our findings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias.

Figure 1

Predicted ratings of clinicians as a function of their implicit bias (IAT) score and their patients’ ethnicity/race. White patients always served as the reference group (data not shown). IAT = Implicit Association Test.

Figure 2

Predicted composite scale ratings by black, Latino, and white (reference) patients for individual clinicians with specific IAT scores. IAT = Implicit Association Test. Note: The lines show the overall (unconditional) estimate of the relation between clinician implicit bias scores and predicted patient ratings. The symbols show the individual (conditional) estimates for each clinician with a specific IAT score by each ethnic/racial patient group.

Figure 3

Predicted ratings of clinicians by younger and older black patients, as a function of clinicians’ implicit bias score on the Black:White IAT. IAT = Implicit Association Test.