Do I have implicit biases? The short answer is, “Yes, - many.” We are all susceptible to these automatic cognitive processes, whether we want to admit it or not. Implicit bias develops based on the natural functioning of our brains as we observe patterns and formulate generalizations. Jerry Kang (2022), Vice Chancellor at the University of California Los Angeles, describes our brains as constantly processing millions of stimuli every second. We catalog this information by developing mental schemas or “shortcuts” that sort knowledge into broader categories. In most instances, these schemas are beneficial as they help us navigate our complex world. Yet, they tend to create biases, swaying us away from a neutral position. Explicit biases are ones we are consciously aware of, we know we have them. However, implicit biases are attitudes and stereotypes that exist in our unconscious – we are not aware of them – but they influence our decisions and actions. These biases are formed through our direct experiences or through the types of media we consume such as television, books, and social media.
 
Implicit biases can be positive, but they can also have negative consequences, causing discrimination when we classify individuals based solely on social categories such as age, sex, race, role, or profession. Kang explains that when we identify someone as belonging to a particular group, our brain automatically processes information that we associate with that group. This information influences our attitudes and how we perceive and interact with that individual. As health care professionals, we are subject to these implicit biases every day. We unconsciously make false assumptions about our patients based on appearance or socioeconomic status. It may affect the tone in which we speak to patients or the types of tests or referrals that are ordered. These interactions can damage the patient-provider relationship and result in distrust, non-compliance, or poor health outcomes.

Strategies to Reduce Implicit Bias

Combatting negative implicit bias begins with awareness and education. Edgoose, Quiogue & Sidhar (2019) describe eight evidence-based strategies in the form of a mnemonic IMPLICIT.

• Introspection: Spend time thinking and identifying your own implicit biases; there are free implicit association tests (IATs) online that can help with this process.
• Mindfulness: Practice methods to reduce stress and increase mindfulness, such as meditation, yoga, or focused breathing.
• Perspective-taking: Think about experiences from the perspective of the person being stereotyped. Seek out media depicting those experiences such as books or videos, or strive to interact with people from that group.
• Learn to slow down: Stop and reflect on your potential biases before interacting with people of certain groups to decrease automatic reactions.
• Individuation: Assess people based on their personal characteristics rather than those affiliated with their group. Attempt to connect over shared interests or backgrounds.
• Check your messaging: Adopt evidence-based statements that decrease implicit bias. Strive to be welcoming and embrace multiculturalism.
• Institutionalize fairness: Promote organizational change that supports a socially accountable health care system with an end goal of health equity.
• Take two: Practice humility to reduce the power imbalance between the clinician and patient.

 
Attempt to “debias” your thoughts through exposure to counter-stereotypes (i.e., individuals that possess characteristics or roles that are different from established stereotypes). Broaden your social circles with diverse and inclusive communities. Spend more time with people that are different from yourself. Thoughtful, consistent work will help each of us make progress in reducing discrimination and improving health care for all.

References
Edgoose, J., Quiogue, M., & Sidhar, K. (2019). How to Identify, Understand, and Unlearn Implicit Bias in Patient Care. Family practice management, 26(4), 29–33.
 
Kang, J. (2022). Implicit Bias Video Series. BruinX, UCLA Office of Equity, Diversity, and Inclusion. https://equity.ucla.edu/know/implicit-bias/