Janice A. Sabin

Physicians' Implicit and Explicit Attitudes About Race by MD Race, Ethnicity, and Gender

Recent reports suggest that providers’ implicit attitudes about race contribute to racial and ethnic health care disparities. However, little is known about physicians’ implicit racial attitudes. This study measured implicit and explicit attitudes about race using the Race Attitude Implicit Association Test (IAT) for a large sample of test takers (N=404,277), including a sub-sample of medical doctors (MDs) (n=2,535). Medical doctors, like the entire sample, showed an implicit preference for White Americans relative to Black Americans. We examined these effects among White, African American, Hispanic, and Asian MDs and by physician gender. Strength of implicit bias exceeded self-report among all test takers except African American MDs. African American MDs, on average, did not show an implicit preference for either Blacks or Whites, and women showed less implicit bias than men. Future research should explore whether, and under what conditions, MDs’ implicit attitudes about race affect the quality of medical care.

Physician implicit attitudes and stereotypes about race and quality of medical care.

Background:Recent reports speculate that provider implicit attitudes about race may contribute to racial/ethnic health care disparities. Objectives:We hypothesized that implicit racial bias exists among pediatricians, implicit and explicit measures would differ and implicit measures may be related to quality of care. Research Design:A single-session, Web survey of academic pediatricians in an urban university measured implicit racial attitudes and stereotypes using a measure of implicit social cognition, the Implicit Association Test (IAT). Explicit (overt) attitudes were measured by self-report. Case vignettes were used to assess quality of care. Results:We found an implicit preference for European Americans relative to African Americans, which was weaker than implicit measures for others in society (mean IAT score = 0.18; P = 0.01; Cohens d = 0.41). Physicians held an implicit association between European Americans relative to African Americans and the concept of “compliant patient” (mean IAT score = 0.25; P = 0.001; Cohens d = 0.60) and for African Americans relative to European Americans and the concept of “preferred medical care” (mean IAT score =−0.21; P = 0.001; Cohens d = 0.64). Medical care differed by patient race in 1 of 4 case vignettes. No significant relationship was found between implicit and explicit measures, or implicit measures and treatment recommendations. Conclusions:Pediatricians held less implicit race bias compared with other MDs and others in society. Among pediatricians we found evidence of a moderate implicit “perceived patient compliance and race” stereotype. Further research is needed to explore whether physician implicit attitudes and stereotypes about race predict quality of care.

Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender.

Overweight patients report weight discrimination in health care settings and subsequent avoidance of routine preventive health care. The purpose of this study was to examine implicit and explicit attitudes about weight among a large group of medical doctors (MDs) to determine the pervasiveness of negative attitudes about weight among MDs. Test-takers voluntarily accessed a public Web site, known as Project Implicit®, and opted to complete the Weight Implicit Association Test (IAT) (N = 359,261). A sub-sample identified their highest level of education as MD (N = 2,284). Among the MDs, 55% were female, 78% reported their race as white, and 62% had a normal range BMI. This large sample of test-takers showed strong implicit anti-fat bias (Cohen’s d = 1.0). MDs, on average, also showed strong implicit anti-fat bias (Cohen’s d = 0.93). All test-takers and the MD sub-sample reported a strong preference for thin people rather than fat people or a strong explicit anti-fat bias. We conclude that strong implicit and explicit anti-fat bias is as pervasive among MDs as it is among the general public. An important area for future research is to investigate the association between providers’ implicit and explicit attitudes about weight, patient reports of weight discrimination in health care, and quality of care delivered to overweight patients.

Unloader Knee Braces for Osteoarthritis: Do Patients Actually Wear Them?

BackgroundUnloader braces are a nonsurgical approach for predominantly unicompartmental knee arthritis. Although noninvasive, braces are expensive and it is unclear whether clinical factors, if any, will predict regular brace use.Questions/purposesWe asked: (1) Do patients continue to use the unloader brace more than 1 year after it is prescribed? (2) Do any clinical or radiographic factors predict continued use of the unloader brace after the first year? (3) What are the most common subjective reasons that patients give for discontinuing the brace?MethodsWe administered 110 surveys to all patients who were fitted for unloader knee braces for predominantly unicompartmental osteoarthritis 12 to 40 months before administration of the survey. Standardized indications and fitting protocols were used. The following parameters were tested for association with ongoing brace use: alignment, arthritis severity, compartment involved, BMI, weight, age, gender, pain and function, number of refittings, and problems with the brace. The survey response rate was 81% (89 of 110).ResultsOf the 89 responders, 28% reported regular brace use (twice per week, an hour at a time, or more); at 2 years, 25% used the brace regularly. No clinical or radiographic factors considered were associated with ongoing brace use. Patients reported lack of symptomatic relief, brace discomfort, poor fit, and skin irritation as reasons for discontinuing the brace.ConclusionsSurgeons and patients need to balance the benefits and absence of complications of bracing against cost and the low likelihood of ongoing use 1 year or more after the prescription of the brace.Level of EvidenceLevel III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

Providers’ Implicit and Explicit Stereotypes About Mental Illnesses and Clinical Competencies in Recovery

We examined community providers’ stereotypes about mental illnesses and their association with clinical competencies among mental health professionals in Washington State’s community mental health system (N = 584). Mental Health Competence and Recovery Implicit Association Tests were developed. The Competency Assessment Instrument (CAI) measured provider competencies in rehabilitation. Bivariate and multivariate analyses were used to examine the associations between stereotypes and clinical competencies. On average, providers did not differentially associate the concepts of competence or recovery with physical illnesses versus mental illnesses. However, providers that implicitly associated recovery more with physical illnesses had lower clinical competency scores (p = .03). Explicit stereotypes were associated with lower competency scores. Providers’ stereotypes about mental illnesses are predictors of clinical competencies.