Implicit Bias: open your eyes

I look like a doctor

In a previous post, I talked about how I manage bias in the professional setting as a physician who is both a woman and a Muslim in hijab.  But the issue of bias has many more far-reaching implications than that.

There are two aspects of bias that we need to consider.  Firstly, implicit bias, which refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.  Implicit bias is activated involuntarily, without our awareness or intentional control.  

By contrast, explicit bias refers to the attitudes and beliefs we have about a person or group on a conscious level.  Expressions of explicit of bias (e.g. discrimination, hate speech) occur as the result of deliberate thought and can be consciously regulated.

Both biases are harmful in many ways, but the latter is the one more likely to lead to death and destruction.  I deal with both, often at the same time, on a regular basis. 

In this post, I would like to examine implicit bias, its effects, and how to change it.  I discuss explicit bias in a separate piece. 

A story of implicit bias:

A fellow female physician parked in the designated parking spot for her speciality in the hospital lot.  When she returned to her car, she found a parking ticket.  She went to the parking office to inquire and the attendant told her: “I didn’t know you were a doctor.  You don’t look like a doctor.”

This leads to the obvious question: what does a doctor look like?  And the inherent answer: male.

The women physicians she shared the story with had varying responses. Many shared similar stories and expressed frustration.  Some said, take it as a compliment, you are a young and beautiful woman.  However, if we don’t address implicit bias, people will not become aware of it and not be able to change it. Implicit biases can be changed if people realize them in their own minds.  If they come to recognize that they have a bias about people of a certain skin color, gender, or religion, they can work to correct that.  But if they are in denial about it, it will never change and continue to lead to negative consequences to the people on the receiving end of the their bias-directed actions. 

Implicit bias can be addressed in many ways, politely, creatively, even with wit. It probably won’t be effective to attack someone with angry words.  For example, before performing surgery on a patient, he said to me, I can’t believe you’re the surgeon, you look like you’re 16 years old.  I shrugged, smirked, and responded firmly:  well i’ve been doing this for 16 years so there’s something wrong with the math.  I went on to perform a successful surgery, and the patient was thrilled with the outcome.  During the ensuing post-operative visits, he continued to refer back to his remark and say things like:  “I didn’t mean anything offensive by it, I was just surprised by how young you look.  Clearly you are very good at what you do. You are a professional. You did a great job.”  Although I never brought it up to him again, he recognized his own implicit bias and felt the need to redress it.  

I probably have a similar story for almost every day I’ve worked as a doctor.  That was a simple example of a more complex issue.  So you may be thinking, implicit bias seems harmless.  Well actually, no it is not.  In fact, it is detrimental. 

Let’s start with just two examples:

  • A 2012 study gave pediatricians identical case vignettes to examine how their implicit racial attitudes affect treatment recommendations for four common pediatric conditions.  Results indicated that as pediatricians’ pro-white implicit biases increased, they were more likely to prescribe painkillers for simulated patients who were white as opposed to black.  This is just one example of how implicit bias leads to differential health care treatment, even for children.
  • Academic scientists who evaluated identical resumes belonging either to a fake “John” or “Jennifer” perceived Jennifer as less competent. They were less likely to offer to mentor Jennifer and were more likely to say they would hire John to be a lab manager. Furthermore, scientists proposed a starting salary that was $4,000 (13 percent) higher for John than for Jennifer, based on identical resumes.  One can easily infer how implicit bias leads to significant gender disparities in the workplace that increase exponentially over time.

Research shows that most Americans have positive attitudes associated with white people and negative attitudes with African Americans, leading to myriad unfavorable and harmful outcomes for black Americans.  Extensive research has documented the pernicious effects of implicit racial biases in various settings, like classrooms, courtrooms, and hospitals.

In medicine specifically, implicit biases about gender have led, amongst other things, to a pay gap, where female physicians make 80 cents on the dollar compared with males.  Over a 30-year career, that translates to women being paid millions of dollars less than men for the same work. 

The silver lining is that implicit bias can be modified.  Studies suggest that we can reduce bias in our minds and in our workplaces by becoming aware of it, discussing it, and implementing anti-bias education.  As GI Joe always said:  knowing is half the battle.  Awareness of the unconscious associations and connections we hold is the first step toward correcting our biases.

Many have taken to social media to break down these biases with campaigns like:  #ILookLikeADoctor (to combat the myth of what a doctor looks like), #BeEthical (to end gender disparity), and #HeForShe (men advocating for gender equity).

When you see implicit bias, don’t stay silent.  Look for it in your own thoughts and fight it.  Find polite and appropriate ways to address it with others.  By definition, people are completely unaware of their own implicit bias.  

I work hard in my life to combat bias and stereotypes; and honestly, it can be exhausting.  There are days when I want to give up.  But what kind of world would I leave behind for my offspring if I did that!

Would love to hear your thoughts and experiences on this very important topic.

Check out my article on explicit bias.

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