Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients.
Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients.
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DOI：
10.1007/s11606-007-0258-5
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发表时间：
2007-09
影响因子：
5.7
通讯作者：
Banaji, Mahzarin R.
中科院分区：
文献类型：
--
作者：
Green, Alexander R.;Carney, Dana R.;Pallin, Daniel J.;Ngo, Long H.;Raymond, Kristal L.;Iezzoni, Lisa I.;Banaji, Mahzarin R.
记录医疗保健中种族/民族差异的研究经常涉及医生的无意识偏见。到目前为止，还没有研究测量医生无意识的种族偏见，以测试这是否预测医生的临床决策。检验医生是否表现出隐性种族偏见，以及这种偏见的程度是否预示着急性冠脉综合征黑人和白色患者的溶栓建议。一种基于互联网的工具，包括急性冠脉综合征患者到急诊室就诊的临床小插曲，随后是问卷调查和三项内隐关联测试（IAT）。研究邀请通过电子邮件发送给亚特兰大和波士顿四个学术医疗中心的所有内科和急诊科住院医师; 287人完成了研究，符合纳入标准，并随机分配到黑人或白色患者中。IAT分数（正常连续变量）测量医生的内隐种族偏好和合作的看法。医生对随机分配种族的小插曲患者的冠状动脉疾病症状归因及其溶栓治疗决定通过问卷调查评估医生的外显种族偏见。医生报告没有明确的偏好白色与黑人患者或差异感知合作。相反，IAT显示内隐偏好有利于白色美国人（平均IAT得分= 0.36，P <0.001，单样本t检验）和内隐刻板印象的黑人美国人与医疗程序合作较少（平均IAT得分0.22，P <0.001），一般合作较少（平均IAT得分0.30，P <0.001）。随着医生的亲白色隐性偏见增加，他们治疗白色患者而不治疗黑人患者溶栓的可能性也增加（P = 0.009）。这项研究代表了第一个证据无意识（内隐）种族偏见的医生，它的解离有意识（外显）的偏见，其预测的有效性。结果表明，医生的无意识的偏见可能会导致种族/民族的差异，在使用医疗程序，如心肌梗死溶栓。
Studies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions. To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes. An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient. IAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire. Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009). This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.
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