Diverse Perspectives & Advocacy

Addressing Implicit Bias in Healthcare

Esther Forté, SRNA, BSN, RN
October 7, 2020
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Over the last few months, we have become more aware of the social injustices faced amongst Black people... not only in society at large, but also in healthcare. A few weeks ago, Ashley Sayles, MSN, RN, CPNP-PC shared one side of healthcare in her blog post entitled, “Being the Only Black Nurse on the Unit,” and she mentioned how Black patients are not always treated the same as white patients.

Unfortunately, this is the sad truth. Black patients are often labeled as “difficult” or “aggressive.” Certain statements are made such as, “they just want more drugs,” “they are so uneducated,” or even, “they’re so ghetto.” Instead of getting the same care that we ALL should receive, it is often drastically different. Ultimately, Black and Brown patients are usually not shown the same amount of care or compassion as white patients. 

Some examples of this can mean life or death, while others may seem less critical, but are by no means unimportant. For example, I was talking with a nurse who worked at a NICU, and she told me about a time where a white nurse was taking care of a Black infant, and this nurse stated that she doesn’t wash black babies’ hair because she doesn’t know what to do with it. 

I was shocked and appalled. 

You may also recall that a few months ago, a nurse created a TikTok video mocking Black mothers in labor? We are well aware of the alarming death rates amongst Black maternal mothers in childbirth–Black women are 2.5 times more likely to die due to maternal causes than white mothers–so this was no laughing matter. 

I’ve even personally, as a patient, witnessed first-hand how dismissive a white provider's attitude toward me was when I had a concern during my own pregnancy.

My Own Experience as a Black Patient

When I found out I was pregnant, it was important to me to find a Black OBGYN for the duration of my pregnancy, and I did. I was coming in for my last ultrasound visit at about 30 weeks pregnant, and I noticed that the ultrasound was taking longer than usual. Toward the end of the sonogram, the ultrasound tech commented that my baby’s head appeared smaller than my previous sonogram. 

Now, you can imagine, as an ICU nurse, I understood anatomy and physiology. Although neonatal and OB isn’t my specialty, I remember the basics of what I studied in nursing school. I had a million thoughts running through my head, frantically thinking the worst-case scenario. 

My husband and I were brought back to the exam room as we waited for the midwife to come in. After a few minutes, she finally came in. She wasn’t who I usually saw, but I proceeded to ask her questions regarding the ultrasound. She immediately brushed my concerns to the side and didn’t even bother to address them, and yes, she was of a different race. 

There could have been many reasons why my daughter had a smaller head, and yes, it could have been minor, but as my provider, I would expect you to address my concerns and give me a reason why. 

We ultimately escalated the issue and requested to see the physician, who happened to be Black. I immediately felt at ease because she took the time to explain all the possible reasons as to why my daughter’s head was smaller. Now, imagine if I was in labor and I “felt something was wrong.” Would my provider actually listen to me, or would I constantly be brushed aside and told everything is okay to avoid the bigger issue at hand?

Implicit Bias in the Hands of Healthcare Providers

Healthcare providers' attitudes and behaviors have been recognized as one of the many factors that contribute to health disparities. In healthcare, this is commonly known as implicit bias, which consists of thoughts and feelings that exist outside of conscious awareness, and hence are difficult to acknowledge and control, consciously (but still make impact the way to act or behave). 

Negative implicit biases about people of color may contribute to health inequities and disparities in healthcare. I recently read an article regarding implicit biases among healthcare workers. It concluded that most healthcare providers appeared to have positive attitudes toward white patients; conversely, they showed implicit bias against Black patients. 

profile photograph of black man looking ahead implicit bias in healthcare

Racial implicit bias is one of the principal forces that facilitates health inequities. These implicit biases can affect the care given to Black patients as well as the patients’ perception of their provider. Unfortunately, some providers are not aware of their own implicit biases, and it is crucial that as healthcare workers, we become aware of our implicit bias.

So, how do we start addressing the issue? 

How Do We Address the Issue of Implicit Bias in Healthcare?

We must become aware of our own implicit biases

Harvard University developed a test that measures implicit bias. Harvard’s Race Implicit Association Test is designed to observe and measure implicit bias and measures the strength of association between a photograph of a person (a Black person or a white person of any gender), and an evaluation (good or bad). 

Once you have your results, EDUCATE YOURSELF! Do your own research, read a book, understand where your implicit bias is rooted. I encourage you to become more mindful of how you interact with people of a different race, how you may diagnose a patient, your treatment recommendations, or the way you examine a patient. 

Hire More Black Providers

This is key! People tend to gravitate to people that look like them, come from similar backgrounds, and share the same values. When I went into labor, I knew there was a chance that I may or may not get my favorite provider, Brittany. 

However, when I walked into the laboring suite and saw she was my midwife, I was so happy. I felt a sense of calmness, and I knew I was in good hands. There’s an unspoken camaraderie among Black people. We all understand how society views us, so we tend to look out for each other and have each other’s “back,” especially when it comes to Black healthcare professionals.

As I’m writing this, I’m attempting to provide insight into how it feels when you walk into a patient’s room, and they see you, a BLACK provider with the credentials behind your name. It automatically makes that patient feel at ease, and that patient feels: “I know you got me!"

Overall, I believe it's essential for all of us to become aware and know that implicit bias does exist in healthcare, but it takes all of us to continue to remember why we do this every day - WE WANT TO HELP OTHERS! We need to strive to continue to show the same level of care and compassion to ALL our patients, including the Black and Brown patients (and patients of any minority for that matter).

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