When issues related to the unequal treatment of specific populations are examined, clinician bias is increasingly implicated for its probable role in impacting patient care. Past columns have examined the role of clinician bias and stereotyping, a relatively young area of research and data gathering.
Several researchers have emerged as leaders in the development of the theory and measurement of clinician bias and stereotyping. One is Diana Burgess, PhD, of the Department of Medicine at the University of Minnesota. Her most recent work, from the journal Medical Decision Making, was released online in advance of its scheduled publication. In “Are Providers More Likely to Contribute to Healthcare Disparities Under High Levels of Cognitive Load? How Features of the Healthcare Setting May Lead to Biases in Medical Decision Making,” Burgess proposes that stressful clinical settings with intense “cognitive load” for providers may increase the occurrence of racial disparities in care via two distinct mechanisms. She describes these mechanisms:
“First, providers who experience higher levels of cognitive load are hypothesized to make poorer medical decisions and provide poorer care for all patients, due to lower levels of controlled processing. Second, under greater levels of cognitive load, it is hypothesized that healthcare providers' medical decisions and interpersonal behaviors will be more likely to be influenced by racial stereotypes, leading to poorer processes and outcomes of care for racial minority patients. It is further hypothesized that certain healthcare settings will result in higher levels of cognitive load experienced by providers. Finally, it is hypothesized that minority patients will be disproportionately likely to be treated in healthcare settings in which providers experience greater levels of cognitive load, which will result in racial disparities due to lower levels of controlled processing by providers and the influence of racial stereotypes.”
Burgess' contributions in the area of understanding the potential role of clinician bias continues to focus on developing a framework for better assessing how clinician bias may occur, under which circumstances it may be exacerbated, and in developing methods and metrics for measuring it.
Next month: Measuring the impact of unequal treatment of gay, lesbian, bisexual, and transgender patients
Jim Anderson is the PA-NP Supervisor, Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington. He is a former chair of the AAPA's Committee on Diversity and a member of the JAAPA editorial board.