July 20th, 2007

wood cat

Implicit Associations Regarding Race and Medical Care

The Boston Globe has an article today about implicit associations regarding race and their effects on medical care:

Researchers have known for years that African-Americans in the midst of a heart attack are far less likely than white patients to receive potentially life-saving treatments such as clot-busting drugs, a dramatic illustration of America's persistent healthcare disparities. But the reasons behind such stark gaps in care for heart disease, as well as cancer and other serious illnesses, have remained murky, with blame fixed on doctors, hospitals, and insurance plans.

In the new study, trainee doctors in Boston and Atlanta took a 20-minute computer survey designed to detect overt and implicit prejudice. They were also presented with the hypothetical case of a 50-year-old man stricken with sharp chest pain; in some scenarios the man was white, while in others he was black.

"We found that as doctors' unconscious biases against blacks increased, their likelihood of giving [clot-busting] treatment decreased," said the lead author of the study, Dr. Alexander R. Green of Massachusetts General Hospital. "It's not a matter of you being a racist. It's really a matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way media has presented things."

[ . . . ]

"Years of advanced education and egalitarian intentions are no protection against the effect of implicit attitudes," said Dr. Thomas Inui, president of the Regenstrief Institute Inc. in Indianapolis, which studies vulnerable patient groups. "When do they surface? When we're involved with high-pressure, high-stakes decision-making, when there's a lot riding on our decisions but there isn't a lot of time to make them, that's when the implicit attitudes that are not scientific rise up and grab us."

[ . . . ]

The best way to combat those impulses is by acknowledging them, specialists said, suggesting that medical personnel take a test to measure unconscious bias, such as one at implicit.harvard.edu.

"The great advantage of being human, of having the privilege of awareness, of being able to recognize the stuff that is hidden, is that we can beat the bias," said Mahzarin R. Banaji, a Harvard psychologist who helped design a widely used bias test.

The article goes on to acknowledge that the problem of healthcare disparities is much more complex than that, but I wanted to highlight this because I think it's a good illustration of the problems of unconscious bias and what can be done about it.

I'm putting the methodology sections behind a cut, because the Globe's articles tend to go away very quickly. However, you can read up on implicit association tests and try them yourself: background information on Project Implicit, including a FAQ, and demo tests.

I encourage people not to turn the tests into a meme where you post your results. I found it really hard to take even a test I thought I'd do "well" on, and I'm still gearing myself up to take a test that might come out differently. Self-awareness is the goal, here, and I can't imagine that memifying the tests will help.

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