Under the radar: How unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities

American Journal of Public Health

Volumn 102, Issue 5, 2012, Pages 945-952

  Dovidio, John F ^a   Fiske, Susan T ^b  

^a YALE UNIVERSITY   (United States)

^b PRINCETON UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ATTITUDE TO HEALTH; DECISION MAKING; DOCTOR PATIENT RELATION; ETHNOLOGY; HEALTH CARE DISPARITY; HEALTH DISPARITY; HEALTH PERSONNEL ATTITUDE; HUMAN; SOCIAL PSYCHOLOGY;

ATTITUDE OF HEALTH PERSONNEL; ATTITUDE TO HEALTH; DECISION MAKING; HEALTH STATUS DISPARITIES; HEALTHCARE DISPARITIES; HUMANS; PHYSICIAN-PATIENT RELATIONS; PREJUDICE; STEREOTYPING;

EID: 84861950584     PISSN: 00900036     EISSN: 15410048     Source Type: Journal    
DOI: 10.2105/AJPH.2011.300601     Document Type: Article

References (112)

1. National Center for Health Statistics. Healthy People 2010. Hyattsville, MD: Government Printing Office; 2011.
2. Mead H, Cartwright-Smith L, Jones K, Ramos C, Woods C, Siegel B. Racial and Ethnic Disparities in U.S. Healthcare: A Chartbook. Winston-Salem, NC: Wake Forest University School of Medicine.
3. Orisi JM, Margellos-Anast H, Whitman S. Black-White health disparities in the United States and Chicago: a 15-year progress analysis. Am J Public Health. 2010;100(2):349-356.
4. Penner LA, Albrecht TL, Orom H, Coleman DK, Underwood W III. Health and health care disparities. In: Dovidio JF, Hewstone M, Glick P, Esses VM, eds. Handbook of Prejudice, Stereotyping, and Discrimination. London, UK: Sage; 2010:472-490.
5. Smedley B, Stith A, Nelson A, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
6. Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478-486.
7. Rhoads KF, Cullen J, Ngo JV, Wren SM. Racial and ethnic differences in lymph node examination after colon cancer resection do not completely explain disparities in mortality. Cancer. 2012; 118(2):469-477.
8. Dovidio JF, Gaertner SL. Intergroup bias. In: Fiske ST, Gilbert D, Lindzey G, eds. Handbook of Social Psychology. New York, NY: Wiley; 2010:1084-1121.
9. Dovidio JF, Hewstone M, Glick P, Esses VM. Prejudice, stereotyping, and discrimination: theoretical and empirical overview. In: Dovidio JF, Hewstone M, Glick P, Esses VM, eds. Handbook of Prejudice, Stereotyping, and Discrimination. London, UK: Sage; 2010:3-28.
10. Fiske ST. Stereotyping, prejudice, and discrimination. In: Gilbert DT, Fiske ST, Lindzey G, eds. Handbook of Social Psychology. Vol 2, 4th ed. New York, NY: McGraw-Hill; 1998:357-411.
11. Weng Y, Korte JE. Racial disparities in being recommended for oral and oropharyngeal cancer in the United States. Community Dent Oral Epidemiol. 2012; 40(1):80-88.
12. Livaudais JC, Hershman DL, Habel L, et al. Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. Breast Cancer Res Treat. 2012;131(2):607-617.
13. Institute of Medicine. To Err Is Human: Building a Safer Health Care System. Washington, DC: National Academies Press; 1999.
14. Lee CN, Ko CY. Beyond outcomes- the appropriateness of surgical care. JAMA. 2009;302(14):1580-1581.
15. Smith ER, Mackie DM. Affective processes. In: Dovidio JF, Hewstone M, Glick P, Esses VM, eds. Handbook of Prejudice, Stereotyping, and Discrimination. London, UK: Sage; 2010:131-145.
16. Abele AE, Cuddy AJC, Judd CM, Yzerbyt VY. Fundamental dimensions of social judgment. Eur J Soc Psychol. 2008; 38(7):1063-1065.
17. Abele AE, Wojciszke B. Agency and communion from the perspective of self versus others. J Pers Soc Psychol. 2007;93 (5):751-763.
18. Judd CM, James-Hawkins L, Yzerbyt VY, Kashima Y. Fundamental dimensions of social judgment: understanding the relations between judgments of competence and warmth. J Pers Soc Psychol. 2005;89(6):899-913. (Pubitemid 43083775)
19. Wojciszke B. Morality and competence in person- and self-perception. Eur Rev Soc Psychol. 2005(1);16:155-188.
20. Cuddy AJC, Fiske ST, Glick P. Competence and warmth as universal trait dimensions of interpersonal and intergroup perception: the Stereotype Content Model and the BIAS map. Adv Exp Soc Psychol. 2008;40:61-149.
21. Fiske ST. Envy Up, Scorn Down: How Status Divides Us. New York, NY: Russell Sage Foundation; 2011.
22. Fiske ST, Cuddy AJC, Glick P. Universal dimensions of social perception: warmth and competence. Trends Cogn Sci. 2007;11(2):77-83. (Pubitemid 46188417)
23. Kervyn N, Yzerbyt VY, Demoulin S, Judd CM. Competence and warmth in context: the compensatory nature of stereotypic views of national groups. Eur J Soc Psychol. 2008;38(7):1175-1183.
24. Kervyn N, Yzerbyt VY, Judd CM, Nunes A. A question of compensation: the social life of the fundamental dimensions of social perception. J Pers Soc Psychol. 2009;96(4):828-842.
25. Fiske ST, Cuddy AJC, Glick P, Xu J. A model of (often mixed) stereotype content: competence and warmth respectively follow fromperceived status and competition. J Pers Soc Psychol. 2002;82(6):878-902.
26. Cuddy AJC, Fiske ST, Glick P. The BIAS map: behaviors from intergroup affect and stereotypes. J Pers Soc Psychol. 2007;92(4):631-648.
27. Clausell E, Fiske ST. When do subgroup parts add up to the stereotypic whole? Mixed stereotype content for gay male subgroups explains overall ratings. Soc Cogn. 2005;23(2):161-181. (Pubitemid 40816400)
28. Harris LT, Fiske ST. Dehumanizing the lowest of the low: neuroimaging responses to extreme out-groups. Psychol Sci. 2006;17(10):847-853. (Pubitemid 44715254)
29. Russell AMT, Fiske ST. It's all relative: competition and status drive interpersonal perception. Eur J Soc Psychol. 2008;38(7):1193-1201.
30. Maddox KB. Perspectives on racial phenotypicality bias. Pers Soc Psychol Rev. 2004;8(4):383-401. (Pubitemid 39665856)
31. Gluszek A, Dovidio JF. The way they speak: a social psychological perspective on the stigma of nonnative accents in communication. Pers Soc Psychol Rev. 2010;14(2):214-237.
32. Steele CM. A threat in the air: how stereotypes shape intellectual identity and performance. Am Psychol. 1997;52(6): 613-629. (Pubitemid 127458590)
33. Talaska CA, Fiske ST, Chaiken S. Legitimating racial discrimination: emotions, not beliefs, best predict discrimination in a meta-analysis. Soc Justice Res. 2008;21(3):263-296.
34. Asbrock F. Stereotypes of social groups in Germany in terms of warmth and competence. Soc Psychol. 2010;41 (2):76-81.
35. Guan Y, Deng H, Bond MH. Examining stereotype content model in a Chinese context: inter-group structural relations and Mainland Chinese's stereotypes towards Hong Kong Chinese. Int J Intercult Relat. 2010;34(4):393-399.
36. Bliss TK, Blum CM, Bulanda J, Cella AM. Racial perceptions of homelessness: a Chicago-based study investigating racial bias. Praxis. 2004;4:36-44.
37. Hogg MA. Self-categorization theory. In: Levine JM, Hogg MA, eds. Encyclopedia of Group Processes and Intergroup Relations. Vol 2. Thousand Oaks, CA: Sage; 2010:728-731.
38. Harris LT, Fiske ST. Social neuroscience evidence for dehumanized perception. Eur Rev Soc Psychol. 2009; 20(1):192-231.
39. Weiner B. The development of an attribution-based theory of motivation: a history of ideas. Educ Psychol. 2010;45 (1):28-36.
40. Green A. Attacks on homeless rise, with youths mostly to blame. New York Times. February 15, 2008:A12. Available at: http://www.nytimes.com/2008/02/15/ us/15homeless.html. Accessed November 2, 2011.
41. Lyon J. Update: House panel rejects bill to deny services to illegal immigrants. Arkansas News. February 23, 2011. Available at: http://arkansasnews. com/ 2011/02/23/house-panel-rejects-bill-todeny-services-to-illegal-immigrants. Accessed November 2, 2011.
42. Burgess DJ, Dovidio JF, Phelan S, van Ryn M. The effect of medical authoritarianism on physicians' treatment decisions and attitudes regarding chronic pain. J Appl Soc Psychol. 2011;41(6):1399-1420.
43. Langer EJ, Rodin J. The effects of choice and enhanced personal responsibility for the aged: a field experiment in an institutional setting. J Pers Soc Psychol. 1976;34(2):191-198.
44. Leach CW, Spears R, Branscombe NR, Doosje B. Malicious pleasure: schadenfreude at the suffering of another group. J Pers Soc Psychol. 2003;84(5): 932-943. (Pubitemid 37189387)
45. Cikara M, Botvinick MM, Fiske ST. Us versus them: social identity shapes neural responses to intergroup competition and harm. Psychol Sci. 2011;22(3): 306-313.
46. Cikara M, Fiske ST. Stereotypes and Schadenfreude: Affective and physiological markers of pleasure at outgroup misfortunes. Soc Psychol Pers Sci. 2012; 3(1):63-71.
47. Yzerbyt V, Demoulin S. Intergroup relations. In: Fiske ST, Gilbert D, Lindzey G, eds. Handbook of Social Psychology. New York, NY: Wiley; 2010:1024-1083.
48. Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Rep. 2004;119(4):418-426. (Pubitemid 40353148)
49. Fazio RH, Olson MA. Implicit measures in social cognition research: their meaning and uses. Annu Rev Psychol. 2003;54:297-327. (Pubitemid 37417496)
50. Dovidio JF, Kawakami K, Beach KR. Implicit and explicit attitudes: examination of the relationship between measures of intergroup bias. In: Brown R, Gaertner SL, eds. Blackwell Handbook of Social Psychology. Vol 4. Oxford, UK: Blackwell; 2001:175-197.
51. Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. J Pers Soc Psychol. 2009;97(1):17-41.
52. Carlsson R, Björklund F. Implicit stereotype content: mixed stereotypes can be measured with the implicit association test. Soc Psychol. 2010;41(4): 213-222.
53. Rudman LA, Glick P. Prescriptive gender stereotypes and backlash toward agentic women. J Soc Issues. 2001; 57(4):743-762. (Pubitemid 33122396)
54. Blair IV. Implicit stereotypes and prejudice. In: Moskowitz GB, ed. Cognitive Social Psychology: The Princeton Symposium on the Legacy and Future of Social Cognition. Mahwah, NJ: Erlbaum; 2001: 359-374.
55. van Ryn M, Burgess DJ, Malat J, Griffin J. Physicians' perceptions of patients' social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease. Am J Public Health. 2006; 96(2):351-357. (Pubitemid 43167136)
56. Bobo L. Racial attitudes and relations at the close of the twentieth century. In: Smelser NJ, Wilson WJ, Mitchell F, eds. Racial Trends and Their Consequences. Vol 1.Washington, DC: National Academies Press; 2001:264-301.
57. Epstein RA. Disparities and discrimination in health care coverage: a critique of the Institute of Medicine study. Perspect Biol Med. 2005;48(1 Suppl): S26-S41.
58. Kaiser Family Foundation. National survey of physicians part I: doctors on disparities in medical care. Available at: http://www.kff.org/minorityhealth/ 20020321a-index.cfm. Accessed February 25, 2011.
59. Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678-685.
60. Nosek BA, Smyth FL, Hansen JJ, et alet al. Pervasiveness and correlates of implicit attitudes and stereotypes. Eur Rev Soc Psychol. 2007;18(1):36-88.
61. Karpinski A, Hilton JL. Attitudes and the Implicit Association Test. J Pers Soc Psychol. 2001;81(5):774-788. (Pubitemid 33597817)
62. Rudman LA. Sources of implicit attitudes. Curr Dir Psychol Sci. 2004;13 (2):79-82. (Pubitemid 38554343)
63. Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107:101-126.
64. Dovidio JF, Kawakami K, Smoak N, Gaertner SL. The roles of implicit and explicit processes in contemporary prejudice. In: Petty RE, Fazio RH, Brinol P, eds. Attitudes: Insights From the New Implicit Measures. New York, NY: Psychology Press; 2009:165-192.
65. Dovidio JF, Gaertner SL. Aversive racism. Adv Exp Soc Psychol. 2004;36:1-52. (Pubitemid 39753654)
66. Burgess DJ, van Ryn M, Crowley- Matoka M, Malat J. Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from dual process models of stereotyping. Pain Med. 2006;7(2):119-134.
67. Geiger HJ. Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes. In: Smedley B, Stith A, Nelson A, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003:417-454.
68. Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62-68.
69. Richeson JA, Shelton JN. Prejudice in intergroup dyadic interactions. In: Dovidio JF, Hewstone M, Glick P, Esses VM, eds. Handbook of Prejudice, Stereotyping, and Discrimination. London, UK: Sage; 2010:276-293.
70. Sabin JA, Nosek BA, Greenwald AG, Rivara FP. Physicians' implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009;20(3):896-913.
71. Hirsh AT, Jensen MP, Robinson ME. Evaluation of nurses' self-insight into their pain assessment and treatment decisions. J Pain. 2010;11(5):454-461.
72. Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for Black and White patients. J Gen Intern Med. 2007;22(9):1231-1238. (Pubitemid 47247298)
73. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19(2): 101-110. (Pubitemid 38368458)
74. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003; 139(11):907-915.
75. Penner LA, Dovidio JF, West TV, et al. Aversive racism and medical interactions with Black patients: a field study. J Exp Soc Psychol. 2010;46(2): 436-440.
76. Cooper LA. Patient-client and perceived discrimination in health care. Paper presented at: Science of Research on Discrimination and Health Conference; February 3, 2011; National Cancer Institute; Bethesda, MD.
77. Brondolo E, Hausmann LR, Jhalani J, et al. Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators. Ann Behav Med. 2011;42(1): 14-28.
78. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32: 381-398.
79. Gee GC. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health. 2008;98(9 Suppl):S48-S56.
80. Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and health status in a racially diverse sample. Med Care. 2008;46(9): 905-914.
81. Otiniano AD, Gee GC. Self-reported discrimination and health-related quality of life amongWhites, Blacks,Mexicans and Central Americans. J Immigr Minor Health. 2012; Epub ahead of print.
82. Penner LA, Dovidio JF, Edmondson D, et alet al. The experience of discrimination in Black-White health disparities in medical care. J Black Psychol. 2009;35 (2):180-203.
83. Gordon HS, Street RL Jr, Sharf BF, Kelly PA, Souchek J. Racial differences in trust and lung cancer patients' perceptions of physician communication. J Clin Oncol. 2006;24(6):904-909. (Pubitemid 46638843)
84. Malat J, Hamilton MA. Preference for same-race health care providers and perceptions of interpersonal discrimination in health care. J Health Soc Behav. 2006; 47(2):173-187. (Pubitemid 44014948)
85. Halbert CH, Armstrong K, Gandy OH Jr, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896-901.
86. Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007; 14(2):56-60.
87. Benkert R, Peters RM, Clark R, Keves-Foster K. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. J Natl Med Assoc. 2006;98(9):1532-1540. (Pubitemid 44413923)
88. Guadagnolo BA, Cina K, Helbig P, et al. Medical mistrust and less satisfaction with health care among Native Americans presenting for cancer treatment. J Health Care Poor Underserved. 2009;20(1):210-226.
89. Hausmann LR, Hannon MJ, Kresevic DM, Hanusa BH, Kwoh CK, Ibrahim SA. Impact of perceived discrimination in healthcare on patient-provider communication. Med Care. 2011;49(7):626-633.
90. Nguyen DD, Ho KH, Williams JH. Social determinants of health service use among racial and ethnic minorities: findings from a community sample. Soc Work Health Care. 2011;50(5):390-405.
91. Musa D, Schilz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older Black and White adults. Am J Public Health. 2009; 99(7):1293-1299.
92. Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53(9):721-730. (Pubitemid 39223149)
93. Casagrande SS, Gary TL, LaVeist TA, Gaskin DJ, Cooper LA. Perceived discrimination and adherence to medical care in a racially integrated community. J Gen Intern Med. 2007;22(3): 389-395. (Pubitemid 46941228)
94. Crawley LM, Ahn DK, Winkleby MA. Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults. Cancer Epidemiol Biomarkers Prev. 2008;17(8):1937-1944.
95. Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and use of preventive health services. J Gen Intern Med. 2008;23 (10):1679-1684.
96. Mouton CP, Carter-Nolan PL, Makambi KH, et al. Impact of perceived racial discrimination on health screening in Black women. J Health Care Poor Underserved. 2010;21(1):287-300.
97. Kim AE, Kumanyika S, Shive D, Igweatu U, Kim S-H. Coverage and framing of racial and ethnic disparities in US newspapers, 1996-2005. Am J Public Health. 2010;100(Suppl 1):S224-S231.
98. Coombs AA, King RK. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005; 97(4):467-477. (Pubitemid 40463576)
99. Nunez-Smith M, Pilgrim N, Wynia M, et al. Health care workplace discrimination and physician turnover. J Natl Med Assoc. 2009;101(12):1274-1282.
100. Dasgupta N, Rivera LM. From automatic antigay prejudice to behavior: the moderating role of conscious beliefs about gender and behavioral control. J Pers Soc Psychol. 2006;91(2):268-280. (Pubitemid 44232651)
101. Haider AH, Sexton J, Sriram N, et al. Association of unconscious race and social class bias with vignette-based clinical assessments by medical students. JAMA. 2011;306(9):942-951.
102. Smith WR, Betancourt JR, Wynia MK, et al. Recommendations for teaching about racial and ethnic disparities in health and health care. Ann Intern Med. 2007;147(9):654-665.
103. Satcher D, Higginbotham EJ. The public health approach to eliminating disparities in health. Am J Public Health. 2008;98(3):400-403. (Pubitemid 351354505)
104. Commission to End Health Care Disparities. Quality health care for minorities: understanding physicians' experiences. Available at: http://www.amaassn.org/ama/pub/physician-resources/public-health/ eliminating-health-disparities/commission-end-health-care-disparities/ quality-health-care-minorities-understandingphysicians.shtml. Accessed February 25, 2011.
105. Crosby F, Clayton S, Alksnis O, Hemker K. Cognitive biases in the perception of discrimination: the importance of format. Sex Roles. 1986;14(11-12): 637-646.
106. van Ryn M, Burgess DJ, Dovidio JF, et al. The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois Rev. 2011;8(1):199-218.
107. Betancourt JR, Green AR. Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Acad Med. 2010;85(4):583-585.
108. Gaertner SL, Dovidio JF. Reducing Intergroup Bias: The Common Ingroup Identity Model. Philadelphia, PA: Psychology Press; 2000.
109. Wheeler ME, Fiske ST. Controlling racial prejudice and stereotyping: socialcognitive goals affect amygdala and stereotype activation. Psychol Sci. 2005; 16(1):56-63. (Pubitemid 40176528)
110. Penner LA, Dailey R, Markova T, Porcerelli J, Dovidio JF, Gaertner SL. Using the Common Group Identity Model to increase trust and commonality in racially discordant medical interactions. Paper presented at: Annual Meeting of Society of Personality and Social Psychology; February 6, 2009; Tampa, FL.
111. Moskowitz GB. On the control of stereotype activation and inhibition. Soc Pers Psychol Compass. 2010;4(2):140-158.
112. Monteith MJ, Arthur SA, Flynn SM. Self-regulation and bias. In: Dovidio JF, Hewstone M, Glick P, Esses VM, eds. Handbook of Prejudice, Stereotyping, and Discrimination. London, UK: Sage; 2010:93-507.