Race, Ethnicity, and Residency

Post #4: Implicit Bias and Personal Reflection

See the prior posts introducing this topic, exploring the scientific myth of race, and elaborating why race is still very real.  This discussion is not meant to be comprehensive, nor are the listed resources, but I hope it can shed some light on race, science, and racial medicine.  Please contact me with any comments or additional sources.

“One wishes that Americans – white Americans – would read, for their own sakes, this record and stop defending themselves against it.  Only then will they be enabled to change their lives.  The fact that they have not yet been able to do this – to face their history to change their lives – hideously menaces this country.  Indeed, it menaces the entire world.”  James Baldwin, “White Man’s Guilt” in The Price of the Ticket

The last two posts provided examples of egregious racist acts and policies within science and broader society, and how they are intertwined and still very much with us today.  A study of medical residents in 2016 demonstrated the racial biases we carry into the hospital, which demonstrates a form of implicit bias:  “People – all people – hold some implicit biases.  A bias is a negative attitude about one group of people relative to another group of people.  However, the distinguishing feature of an implicit bias is the negative association operates unintentionally or unconsciously.”

The quote above is from the book Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew.  She details the history of racial healthcare laws and policies that formed the framework for much of our inequality today, but also argues the importance of individual implicit bias at the level of the physician-patient encounter and how that influences the overall healthcare system. 

If you haven’t, take the Implicit Association Test (IAT):  https://implicit.harvard.edu/implicit/.  This widely used and validated test has revealed the harm of our implicit biases in many different arenas including prosecuting attorneys in the criminal justice system, the jury selection process, employment hiring and promotion decisions, and school disciplinary actions.  Police officers with higher IAT scores (white favored implicit biases) more readily shoot unarmed Blacks than unarmed whites during video game simulations.

Healthcare workers are not exceptional and test no differently than the rest of the population.  In her book, Dr. Matthew presents “The Biased Care Model” [figure below] and details six mechanisms by which health care providers’ racial and ethnic biases contribute to disparate health outcomes.  Her argument is compelling and well worth the read.  If you remain unconvinced on the role of implicit bias in racial inequity, specifically in healthcare and explicitly at the level of the individual provider, then please consider reviewing these or other resources.

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“When racist ideas resound, denials that those ideas are racist typically follow.  When racist policies resound, denials that those policies are racist also follow.  Denial is in the heart of racism, beating across ideologies, races, and nations.  It is beating within us.” Ibram X Kendi, “How to be an Antiracist“

Even if it is not explicit, most (if not all) of us carry implicit racist biases.  That can be hard to accept, since we believe ourselves to be good and honest people.  But what I’ve tried to argue to this point is we are a product of a long history of racist ideas, policies, science, and socialization that is deeply entrenched within ourselves.  Denying this truth is harmful, but so is ignoring it.  If we believe racial equity is important in our greater profession and in our own office, then it requires constant vigilance against our own biases.  As stated by Michelle Alexander in The New Jim Crow: Mass Incarceration in the Age of Colorblindness, “This system of control depends far more on racial indifference (defined as a lack of compassion and caring about race and racial groups) than racial hostility – a feature it actually shares with its predecessors.”

The final post on this topic will explore some actionable items related to all of this, with the intent of creating accountability for our programmatic response.