Posted On: October 12, 2023

10 Examples of Unconscious Bias in Healthcare

Research shows that all kinds of factors influence how a patient is treated, from someone’s style of dress to their insurance status to the kind of neighborhood and various aspects of their identity. In fact, controlled experiments show that medical advice can be based on who the patient is as much as by their symptoms and medical data.

Understanding and addressing unconscious bias can help patients receive fair and unbiased treatment. Let's explore the impact of unconscious bias in healthcare and discuss strategies to mitigate its effects.

What is Unconscious Bias?

Your brain makes decisions up to 10 seconds before you know it. It's one of the marvels and pitfalls of the human mind. There's so much information to process, we often make unconscious shortcuts by relying on previously learned categorizations, stereotypes, and preferences. In other words, we pigeonhole people without realizing we're doing it.

That's the root of unconscious bias.

You're more likely to lean on unconscious categories when you're stressed, busy, multi-tasking, and moving quickly. Unfortunately, that describes every day in a healthcare environment. It can be difficult to see the cumulative impact of these decisions until you step back and look at them in the aggregate, which is why research on examples of unconscious bias in the workplace is so valuable – particularly when that workplace is healthcare.

What Impact Does Unconscious Bias Have on Healthcare?

Below, you'll find all sorts of specific examples of bias directly impacting healthcare providers' decisions and, therefore, the outcome. But that's not the only way that unconscious bias impacts our patients and our healthcare system.

Patients can tell when their providers have negative attitudes towards them, and this has a ripple effect on their own behavior and health outcomes. They may become less compliant when advice is given from a doctor they don’t feel has their best interests at heart. They may delay or avoid healthcare settings altogether.

This distrust can be reflected by future healthcare providers, which creates a vicious cycle and blocks people from the care they need.

Here are 10 examples of the effects bias has in the healthcare industry and the research that backs it up.

Example #1: Concerns of Obese Patients Are Ignored

A lot of research has been conducted on the stigma of obesity and the associated healthcare bias. Physicians are less likely to build rapport with obese patients, in part due to a socially acceptable explicit bias. In addition to more general negative opinions like the belief that they're lazy and weak-willed, there are healthcare-specific beliefs like obese people are less likely to comply with medications or treatment.

As a result of these attitudes, research has shown that healthcare providers spend less time with obese patients and consider it a waste of time.

At least one study has suggested that physicians are more likely to attribute an obese patient's symptoms to their weight without further investigation. This leads to a delay in diagnosing treatable conditions.

Between negative attitudes and lack of medical intervention, it's no wonder that obese people avoid or delay healthcare.

Example #2: Women’s Pain Is Not Taken Seriously

Research indicates that female patients are perceived as more emotional or anxious, which impacts how seriously their medical team takes their symptoms.

A 2008 study found that assessment for heart disease is delayed in women because family physicians are more likely to consider their symptoms to be psychogenic – typically attributing them to an anxiety disorder. Another 201 study found a gender bias in the diagnosis of COPD, partly because there's a belief that anxiety often manifests as respiratory symptoms in women.

On the flip side, multiple studies have shown that men are recommended for knee replacement more quickly because it's assumed they're stoic in their presentation of pain.

A 2018 review of literature on chronic pain treatment revealed similar assumptions that men must be desperate before they seek help, while women are exaggerating, hysterical, or overly sensitive.

Example #3: Low-Income Patients Are Seen As Irresponsible

A 2017 study found that physicians rated people of lower socioeconomic status (SES) as less likely to be intelligent, responsible, rational, and likely to comply with medical advice or return for follow-up treatments.

These perceptions have been shown to affect physicians' decision-making. They're more likely to delay testing and avoid specialty referrals for patients with low SES. Sometimes this is even done with the best intentions, as the physicians believed that tailoring care to their patients' SES would improve compliance and health outcomes, but by doing so, they deny their patients the autonomy to decide.

Example #4: People of Color Receive Less Pain Medication

We know that patients of color are less likely to be prescribed pain medication – narcotic and non-narcotic – than non-Hispanic white patients, even when their symptoms are the same. Many studies have confirmed this unconscious bias example.

A 2011 study found that "racial/ethnic minorities" consistently received less adequate treatment for acute and chronic pain compared to white patients, even after controlling for age, gender, and pain intensity. The authors attributed this in part to underreporting of pain intensity and in part to the unconscious bias of physicians.

A 1993 study focused specifically on the likelihood of emergency analgesic administration for long-bone fractures. They found that Hispanic patients were twice as likely as white patients to receive no pain medication in the emergency department. A similar study found that Black patients were 66% more likely to receive no analgesic than White patients for long-bone fractures.

Example #5: Black Patients Are Less Listened To

A 2012 study found that primary care physicians tended to dominate conversations with Black patients during routine visits, while white patients tended to receive more patient-centered care. As a result, Black patients rated their care more poorly than white patients.

Example #6: Black Patients Are Assumed to be Uncooperative

Studies have found that Black patients are seen as uncooperative, non-compliant, and not well-educated, which affects clinical decision-making and health outcomes.

A 2016 study attributed the difference in bypass surgery between Black and White patients to physicians' belief that their Black patients are uneducated and, therefore, wouldn't take part in the necessary exercise after surgery.

Interestingly, a study on thrombolysis decisions found that physicians' self-reported stereotypes about cooperativeness had no statistical relationship with their decision to give thrombolysis, but there was a relationship between the degree of implicit bias and decision-making.

In other words, the impact of these stereotypes on outcomes may be complicated and not a straightforward cause and effect.

Example #7: Inadequate Care for Older People

According to a 2015 report, 20% of patients over 50 say they've experienced discrimination resulting in improper or inadequate healthcare.

Healthcare workers are more likely to discount an older patient’s opinion or leave pain and discomfort untreated because they're considered normal for the age group.

This doesn't just go for the physical. Physicians are less likely to treat suicidal thoughts in patients over 85, despite their heightened risk – the elderly have the highest rate of suicide in any group.

Example #8: Barriers to Care for Trans People

While barriers to gender-affirming care for trans patients have been prominent in the news lately, trans individuals have a harder time accessing all kinds of healthcare.

Unfortunately, there isn't nearly enough research on the specific barriers and biases, but reported causes include those related to SES, outright discrimination, lack of cultural competence or sufficient knowledge by providers, and systemic barriers like recordkeeping.

Example #9: Bias Against Gay and Lesbian Patients

There is both implicit and explicit bias toward patients based on sexual orientation.

This bias may contribute to a higher prevalence among gay and lesbian patients of multiple negative health outcomes, including higher rates of anal cancer, asthma, cardiovascular disease, obesity, substance abuse, and suicide. This can be through explicit refusal of care, microaggressions, poor communication, or the delay/avoidance of health care.

Example #10: Bias Against People with Disabilities

A 2020 study found that 86% of healthcare providers have an implicit preference for people without disabilities. They found little explicit prejudice, but prominent bias in attitudes and interactions, including providers making clinical decisions that help them avoid treating people with disabilities.