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The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma

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  • Sabin, J.A.
  • Greenwald, A.G.

Abstract

Objectives. We examined the association between pediatricians' attitudes about race and treatment recommendations by patients' race. Methods. We conducted an online survey of academic pediatricians (n = 86). We used 3 Implicit Association Tests to measure implicit attitudes and stereotypes about race. Dependent variables were recommendations for pain management, urinary tract infections, attention deficit hyperactivity disorder, and asthma, measured by case vignettes. We used correlational analysis to assess associations among measures and hierarchical multiple regression to measure the interactive effect of the attitude measures and patients' race on treatment recommendations. Results. Pediatricians' implicit (unconscious) attitudes and stereotypes were associated with treatment recommendations. The association between unconscious bias and patient's race was statistically significant for prescribing a narcotic medication for pain following surgery. As pediatricians' implicit pro- White bias increased, prescribing narcotic medication decreased for African American patients but not for the White patients. Self-reported attitudes about race were associated with some treatment recommendations. Conclusions. Pediatricians' implicit attitudes about race affect pain management. There is a need to better understand the influence of physicians' unconscious beliefs about race on pain and other areas of care.

Suggested Citation

  • Sabin, J.A. & Greenwald, A.G., 2012. "The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma," American Journal of Public Health, American Public Health Association, vol. 102(5), pages 988-995.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2011.300621_4
    DOI: 10.2105/AJPH.2011.300621
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    1. Ursula Meidert & Godela Dönnges & Thomas Bucher & Frank Wieber & Andreas Gerber-Grote, 2023. "Unconscious Bias among Health Professionals: A Scoping Review," IJERPH, MDPI, vol. 20(16), pages 1-28, August.
    2. Manning, Mark & Byrd, DeAnnah & Lucas, Todd & Zahodne, Laura B., 2023. "Complex effects of racism and discrimination on African Americans' health and well-being: Navigating the status quo," Social Science & Medicine, Elsevier, vol. 316(C).
    3. Penner, Louis A. & Harper, Felicity W.K. & Dovidio, John F. & Albrecht, Terrance L. & Hamel, Lauren M. & Senft, Nicole & Eggly, Susan, 2017. "The impact of Black cancer patients' race-related beliefs and attitudes on racially-discordant oncology interactions: A field study," Social Science & Medicine, Elsevier, vol. 191(C), pages 99-108.
    4. Rachel West & John P. Bartkowski, 2019. "Negotiating Patient-Provider Power Dynamics in Distinct Childbirth Settings: Insights from Black American Mothers," Societies, MDPI, vol. 9(2), pages 1-21, June.
    5. Drewniak, Daniel & Krones, Tanja & Sauer, Carsten & Wild, Verina, 2016. "The influence of patients’ immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland," Social Science & Medicine, Elsevier, vol. 161(C), pages 64-73.
    6. Warren Kealy-Bateman & Georgina M. Gorman & Adam P. Carroll, 2021. "Patient/Consumer Codesign and Coproduction of Medical Curricula: A Possible Path Toward Improved Cultural Competence and Reduced Health Disparity," SAGE Open, , vol. 11(2), pages 21582440211, June.
    7. Dominique H. Como & Lucía I. Floríndez & Christine F. Tran & Sharon A. Cermak & Leah I. Stein Duker, 2020. "Examining unconscious bias embedded in provider language regarding children with autism," Nursing & Health Sciences, John Wiley & Sons, vol. 22(2), pages 197-204, June.
    8. Maina, Ivy W. & Belton, Tanisha D. & Ginzberg, Sara & Singh, Ajit & Johnson, Tiffani J., 2018. "A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test," Social Science & Medicine, Elsevier, vol. 199(C), pages 219-229.
    9. Freda F. Liu & Jessica Coifman & Erin McRee & Jeff Stone & Amy Law & Larissa Gaias & Rosemary Reyes & Calvin K. Lai & Irene V. Blair & Chia-li Yu & Heather Cook & Aaron R. Lyon, 2022. "A Brief Online Implicit Bias Intervention for School Mental Health Clinicians," IJERPH, MDPI, vol. 19(2), pages 1-19, January.
    10. Feagin, Joe & Bennefield, Zinobia, 2014. "Systemic racism and U.S. health care," Social Science & Medicine, Elsevier, vol. 103(C), pages 7-14.

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