Most Patients Say Implicit Bias in Medicine a Problem for Patient Trust

A total of 59 percent of adult patients think implicit bias in medicine and discrimination is a problem in the US healthcare industry, and another 49 percent of their doctors agree, according to surveying from NORC at the University of Chicago on behalf of the ABIM Foundation.

This perception could effectively erode patient trust, a key ingredient to a good patient-provider relationship and meaningful patient engagement, the researchers added.

The data, which leverages responses from one 2,000-patient survey and one 600-physician survey, showed that implicit bias in medicine is a striking trend. Patients perceive discrimination on the part of the medical industry, and at least half of providers agree it is a problem that gets in the way of a quality medical encounter.

Overall, 12 percent of patients reported they’d been discriminated against in a medical setting, with Black patients twice as likely as White patients to report as much. And that’s resulted in lower levels of patient trust, the data showed. Patients who reported an incident of medical discrimination were also more likely to report no or limited trust in healthcare.

“Just like the deep impact of systemic racism being felt in all aspects of society, any form of discrimination fuels mistrust between patients and the health care system patients rely on to treat them,” Richard J. Baron, MD, president and chief executive officer of the American Board of Internal Medicine (ABIM) Foundation, said in a press release.

“Health care stakeholders must collaborate to identify and address contributors to bias, which worsen health outcomes, especially for people of color.”

Particularly, 12 percent of patients said they experienced discrimination at the hands of their own doctors. Twenty-one percent of Black patients reported implicit bias or discrimination from their physicians, compared to 11 percent of Hispanic and 8 percent of Asian respondents.

And as Baron noted, these experiences of discrimination are a major hit to patient trust. The survey showed that patients generally trust their providers and believe what they say, but there are racial disparities here.

Eighty-six percent of White respondents said they trust their providers, compared to 76 percent of Black adults and 77 percent of Hispanic adults. Seventy-seven percent of White respondents said their providers care about them, while only about two-thirds (67 percent) of Hispanic respondents and 71 percent of Black respondents said the same.

Additionally, White patients perceive their clinicians as spending the right amount of time on patient-provider interactions. Eighty percent of White respondents agreed as much, while 68 percent of Hispanic patients and 73 percent of Black patients said the same.

“Achieving greater equity and less discrimination in health care requires more understanding about what it takes to build truly trusting relationships,” said Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation. “Patients, clinicians and system leaders all want more equitable care and better outcomes, and part of the solution lies with increasing trust.”    

But there might be some disconnect here, the survey showed. Although about half (49 percent) of physicians acknowledged that discrimination happens at least sometimes during healthcare encounters, they don’t perceive as much of a problem as patients do.

For example, 81 percent of physicians would give their employer an either A or B grade on employer health equity efforts, with most (62 percent) saying their organization could move the needle on health equity within the next five years.

Fifty-six percent of physician respondents think their organization can achieve workforce equity within the next five years, something most experts say is important for improving health equity and boosting patient trust. After all, many patients perceive better care encounters when their clinicians look like them.

Only 49 percent of physician respondents said their health systems will diversify leadership within the next five years.

These findings come as ABIM works to address low patient trust levels and incidents of implicit or explicit bias in medicine, the group said. Through its Building Trust initiative, ABIM is working across the care continuum and with patients and their advocates to dismantle implicit biases in healthcare, and ideally reduce the occurrence of discrimination in medicine.