The standard of care in medicine requires equal treatment of patients regardless of their skin color, weight, or other characteristics. However, implicit biases against stigmatized groups threaten this standard of care. These biases are automatic, unconscious, and uncontrollable associations between a category attribute and a negative evaluation or another category attribute. They can influence a physician’s decision-making and action, resulting in health care disparities.
Despite limited evidence of effectiveness, implicit bias training is widely offered in the English-speaking world. Medical specialty and experience may also moderate implicit obesity and mental illness prejudice among physicians, and this study aims to explore their interaction.
The study examines how specializing in psychiatry/general medicine and years of experience affect implicit bias, intended behavior through clinical vignettes, the malleability of implicit bias, and its correlation with explicit prejudice. Implicit obesity and mental illness prejudice were chosen because they are present in physicians and the general population and are tied to patient characteristics relevant to medical reasons.
A recent study published in BMC Medical Ethics has found that physicians display bias against mentally ill and obese patients, but this bias is not uniform across specialties. The study found that physicians specializing in psychiatry were less biased against the mentally ill than their counterparts in general medicine. The study also found that while experience did not correlate with implicit bias, it was associated with warmer explicit feelings towards the mentally ill and more significant concern for the mentally ill, but not the obese patient, on a clinical vignette.
The findings also indicated that specialty correlates with implicit and explicit mental illness prejudice but not obesity prejudice. University of Massachusetts Medical School researchers used the Implicit Association Test (IAT) to measure physicians’ implicit bias against mentally ill and obese patients. The IAT is a widely used tool for measuring implicit bias, the unconscious bias people hold without realizing it.
The study found that physicians overall displayed a moderate implicit bias against the obese but that this bias was slightly weaker than the solid negative bias found among physicians and the general public in a previous study. The study also found that the lack of mental illness prejudice on the vignette could be due to physicians’ greater awareness of a risk of bias against the mentally ill than against the obese due to the broader prevalence of campaigns against mental illness stigma.
The study examined the correlation between specialty and bias toward mentally ill and obese patients in physicians. The researchers used a variety of Implicit Association Tests (IATs) and explicit measures to measure bias in 200 practicing physicians. The IAT is a commonly used measure of implicit bias that assesses the speed at which participants associate positive and negative words with different categories (in this case, mental illness, obesity, physical illness, and a neutral category).
The findings showed that specialty correlated with an implicit and explicit bias towards the mentally ill but not with obesity prejudice. The physicians overall displayed a moderate implicit bias against the obese, which was weaker than the solid negative bias found among physicians and the general public in a previous study. The Mental Illness IAT results showed a slight positive bias for psychiatrists and a slight negative bias for internists, indicating that internists may have similar levels to the general population, whereas psychiatrists display less.
Interestingly, the study found no association between experience and implicit bias. However, more experienced physicians displayed warmer explicit feelings towards the mentally ill and a higher level of concern for the fictional patient in the vignette. This could indicate that experience in the field improves patient care by making physicians more sympathetic to patients, in addition to other ways. When the fictional patient was described as obese, the experience did not correlate with increased concern.
One limitation of the study is that it may include a higher percentage of physicians interested in improving patient care than average, making results vulnerable to a self-selection effect. Another area for improvement is the slight difference in the experienced and less experienced categories. However, the study still highlights important implications for healthcare practice.
Medical education and training should specifically target the levels and varieties of implicit bias in specialties. For instance, medical trainees and experienced physicians may require different forms of explicit and implicit bias training. The study also suggests that specializing in psychiatry correlates with lower implicit and explicit mental illness prejudice than specializing in general medicine. Further research is needed to tease out potentially interacting factors and thus help the medical profession tailor implicit and explicit bias interventions to specific groups.
