Healthcare News & Insights

Doctors reveal their biases in new survey

Whether they’re positive or negative, most people have biases in some areas. You don’t want to think your hospital’s physicians allow any biases to adversely affect patient care, but according to new research, they may have a bigger impact than doctors think. 

79085824A new survey from Medscape evaluated the effects of bias and burnout on over 15,800 physicians in a variety of specialties, from critical care to family medicine.

Not surprisingly, the most burned-out doctors work in the emergency department (ED). But they’re also the group that’s most likely to have biases toward certain types of patients.

While 40% of all doctors who responded to the survey admitted they had biases toward certain patients, 62% of ED physicians said they held specific biases.

The top patient characteristics that triggered bias in physicians included:

  • emotional problems
  • weight
  • intelligence
  • language differences, and
  • insurance coverage.

The areas that immediately spring to mind when thinking of biased behavior actually ranked the lowest on physicians’ lists: age, income level, race, level of attractiveness and gender.

Impact on treatment

Although most physicians indicated that bias didn’t affect the way they administered treatment to patients, a handful admitted that they did, including 14% of the ED physicians surveyed.

And while some physicians (29%) thought their biases affected treatment in a negative way, 25% thought they had a positive effect on treatment. A similar number (24%) acknowledged that bias had both positive and negative impacts on treatment.

Many physicians reported that since they were aware of their biases, they went out of their way to treat patients better as a way of overcompensating, particularly regarding biases due to emotional problems, weight and intelligence. Per the study, doctors aged 45 or younger were more likely to engage in this behavior than older providers.

Effect of unintentional bias

One aspect of bias the survey couldn’t measure is implicit bias. This describes the actions people take without being consciously aware of them. A person may claim not to be biased toward a certain person, but can do something inadvertently that creates a disparity impacting patient care.

A recent study shows how such bias can affect care delivery for hospitalized patients. According to an article in U.S. News and World Report, doctors were asked to give news to critically ill patients, who were actually portrayed by both black and white actors. While most doctors said the same words to each “patient,” their body language differed depending on the patient’s race.

In fact, when evaluating their nonverbal interactions, their scores on that portion of the encounter were 7% lower when interacting with black patients than they were with white ones. Doctors were less likely to touch and stand close to black patients while talking about their plan of care. These differences may be attributed to implicit biases the doctors had.

Experiences like these leave minorities distrustful of their providers and the care they’re receiving. It makes them less engaged in the recovery process and less receptive to following suggestions from clinical staff.

That’s why it’s critical for your physicians to take a close look at the way they communicate with patients, both verbally and nonverbally. It could be key to improving outcomes for patients of all backgrounds.

You should also encourage your providers to confront and address any biases they have, such as those toward people with mental disorders or with less education.

This is especially important since stressful situations (like working in the ED) can magnify these biases and affect the quality of care patients receive. Study respondents who felt burned out were more likely to say they were biased toward certain patients.

How hospitals can help

In many cases, counteracting bias is as simple as reminding providers to take a patient-centered approach to care and to leave their personal feelings toward certain types of people at the door.

Providing doctors with a more supportive environment that gives them access to resources for managing stress and burnout can also go a long way toward keeping biases from negatively affecting treatment.

  • Shiva Sharma

    Ms. White does an excellent job bringing up the Medscape survey on the effects of bias and burnout in physicians. Physicians are often the most overworked and overstressed members of the workforce, which increases or creates biases of people they work with. While some physicians may feel their biases are justified, other physicians may not be aware of the biases they hold and consequently present to the patients. Ms. White also wanted to highlight the top characteristics that triggered bias in physicians, in order to show how different the triggers are from each other—the point being that there is no relationship between the triggering factors. The triggers that most commonly stimulate physician bias include the following: emotional problems, weight, intelligence, language differences, and insurance coverage. The survey further demonstrated that based on non-verbal communication, physicians scored 7% lower on interacting with black patients compared to white patients. Some physicians also reported to have noticed their biases, and consequently overcompensated upon realizing their beliefs. These biases go against the ethical principle of beneficence. A physician’s duty should be to act in the best interest of his or her patients. When physicians hold biases or other irrational beliefs that affect their patients, they violate this principle. By not acting in the patient’s best interest, a physician is introducing medical risk, emotional disconnection, and a lack of professionalism in their interactions. From the physician’s point of view, it is understandable to know how biases develop and how they may predominate interactions. A physician must deal with several patients a day, and he or she may notice patterns pertaining to their ailments. Take diabetes for an example. A patient may check in to the emergency department with high blood sugar. The physician may ask the patient whether he or she took the insulin as required, and the patient may state that they forgot to take it. If this happens infrequently, it can be reasonable to conclude that a physician may not develop any biases because it’s an out-of-the-ordinary case. If a case like this presents often, then the physician may start developing biases against patient weight and intelligence. The physician may make rude comments or seem irritated at having to deal with people like these, and may take their frustrations out on someone undeservedly. Going back to beneficence, it is a physician’s duty to put his or her existing thoughts aside, and to put the patients’ needs upon theirs. Bias and burnout may be unavoidable in this field, but the physician must learn to not let their preconceived notions affect their interactions with their patients. I do not believe that biases can be eliminated, as there is some significance to them as in stereotypes—they allow our mind to make shortcuts and associations to save time and to allow our resources to be directed elsewhere. The physician must realize this and work around it to ensure proper and fair treatment of the patients, and to put the patient’s needs first.

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