Hall et al. (2015) stated that implicit bias is the attitudes or stereotypes that unconsciously affect our understanding, actions, and decisions. Explicit bias is thoughts and feelings people deliberately think about and can make conscious reports about.
A biased manner can affect healthcare professionals’ behavior toward patients, which may result in alternative treatment choices. Unintentionally, healthcare professionals might have kept the patients longer in the waiting room than usual or delayed treatment. Healthcare professionals might have approached those patients with more authoritative stances that “decrease the likelihood that patients will feel heard and valued by their providers, failing to provide interpreters when needed, doing more or less thorough diagnostic work, recommending different treatment options for patients based on assumptions about their treatment adherence capabilities, and granting special privileges, such as allowing some families to visit patients after hours while limiting visitation for other families” (Hall et al., 2015).
I am in the family nurse practitioner program. When homeless patients come to ER, most healthcare professionals’ first response is, “They are here again?” while shaking their heads. Even before asking for any health-related questions, the diagnosis of homeless patients is already made, and, somewhat literally, their discharge planning begins when they walk in. Such actions under bias may have resulted in less collaboration among healthcare professionals, less respect toward the patients, verbal dominance during encounters, and disparities in treatment options. Green et al. (2007) found that healthcare professionals are less likely to recommend thrombolysis treatment and ideal pain management; however, physical health outcomes appeared uninfluenced by bias.
I identify my behavior as an implicit bias. When homeless patients come under my care, I try to accommodate what I can. I bring them food, juices, jellos, and socks. I have been doing it so much that my behavior toward homeless patients has become more of a reflex response to their requests. I make them happy as much as possible so they do not cause further problems because they tend to become quite challenging when they don’t get what they want.
To reduce the bias, starting from myself, we all need to change our thoughts toward homeless patients. Some of the homeless patients are difficult to deal with. They may be genuinely tricky; however, “what recognized is that people who are difficult for one doctor may not be difficult for another doctor. And so it would appear that the variable is not the patient, but rather it’s the doctor” (Beckman, 2003). Also, systemic intervention, rather than individual intervention, would be necessary for those healthcare professionals in more time-pressured and critical care sectors. With systemic intervention, there is less room for healthcare professionals to impose any form of bias on the patients.
Such bias has been building up since I started working in the ER. However, from time to time, I recall those patients in mind and see if I have missed anything. Did I mistreat them? Did my bias lead to any healthcare disparities? Did I assess the patient with professionalism in mind? To be honest, I cannot say yes to all of them because they come, they get what they want, and it repeats again in a few days to weeks later. Based on such thoughts, healthcare disparities could have happened unintentionally. When those patients asked for pain medicine, I might have overlooked the seriousness of a patient’s symptoms. I could have transmitted the message to the ER doctor with less urgency,whic, which may have resulted in a delay, or the ER doctor could have ordered less potent pain medicine than the patient might have needed. “If healthcare professionals begin to doubt what a particular patient reports, we risk improperly treating patients with real pain. Keep in mind that in the past, physicians were notorious for under-treating pain” (Dougherty, 2012).
Beckman, H. (2003). Complex patients: Behavioral medicine in primary care. New York, McGraw-Hill Medical.
Dougherty, P. (2012). Is it possible to gain pain relief in the drug-seeking patient? Journal of Emergency Nursing, 38(3), 262-263.
Green, A., et al. (2007). Implicit bias among physicians and its perdition of thrombolysis decisions for black and white patients. Journal of General Internal Medicine, 22(9), 1231-1238.
Hall, W. et al. (2015). Implicit racia
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