7 - bias and discrimination in healthcare

Question 1

stereotype

Answer 1

over-simplified cognitive expectation and association about a group

Question 2

prejudice

Answer 2

emotional reaction

preconceived opinion that is not based on reason or actual experience

Question 3

discrimination

Answer 3

acting upon prejudices in an unjust way

Question 4

discrimination in healthcare

Answer 4

denying equality of treatment depending on their social health category
e.g. denying someone surgery due to their weight

Question 5

why has trust in the medical profession declined rapidly over the last 50 years

Answer 5

heightened awareness of medical errors (through media)
more question based approach to treatment due to increased information about our health
experience of biases

Question 6

examples of groups experiencing bias

Answer 6

obese
disabled
ethnic minorities
different sexualities

Question 7

NHS guiding principle contradicting institutional bias

Answer 7

“equitable treatment, regardless or race, ethnicity etc. is a patient right”

Question 8

institutional bias

Answer 8

advantages given to certain groups over others due to stigmas built into the institution

Question 9

example of institutional bias against patients

Answer 9

requirement for people with obesity to lose 5% of their weight before receiving surgery

NICE recommends offering surgery more widely at lower BMIs

older adults disadvantaged
- less likely to receieve specialist referrals

Question 10

institutional bias against health care professionals

Answer 10

HCPs of minority ethnic backgrounds concentrated in lower paid jobs

also often blamed for cases of misconduct

suffer racial abuse from patients

Question 11

personally-mediated bias

Answer 11

reflects individually-based differential treatment based on group membership

Question 12

evidence from institute of medicine 2003 report

Answer 12

black patients receive fewer health procedures and poorer-quality medical care

Question 13

its a social norm to express prejudices

Answer 13

crandall et al 2002

says prejudice is correlated with norms/social acceptability

obesity bias seen as the most socially acceptable

Question 14

general medical councils view on bias

Answer 14

“doctors must not unfairly discriminate against patients”

“doctos must not refuse or delay treatment because they believe that a patients actions have contributed to their condition”

Question 15

why is it likely that bias operates at an unconscious level

Answer 15

doctors enter the medical profession to help others

not deliberately biased

Question 16

implicit bias

Answer 16

unconscious
involuntary
largely unknown to individual

Question 17

explicit bias

Answer 17

conscious

deliberately formed and expressed

Question 18

chapman et al 2013

Answer 18

study assessing bias in healthcare

3 major focuses:

• whether bias is present in HCPs
• whether bias impacts the treatment they give
• whether patients are affected by the bias expressed

Question 19

activation of stereotype

Answer 19

perceiving someone in terms of their category membership rather than individual attributes

Question 20

application of stereotypes

Answer 20

treating someone in terms of their category membership
discrimination

often automated once stereotype is activated

Question 21

method to activate stereotypes

Answer 21

cognitive loading though word-completion task

Question 22

where is it easy to apply stereotypes but important not to

Answer 22

emergency departments

the doctors know little about the patient and are responsible for many patients at the same time
under time pressure

Question 23

where must stereotypes be applied in medicine

Answer 23

prioritising patients for treatment in accident and emergency

Question 24

methods to reduce bias in HCPs

Answer 24

make them aware that bias is a ‘natural habit of mind’

de-categorisation approach - brewer and miller 1984

stereotype suppression (1998)

re-categorisation approach

perspective taking approach 2000

Question 25

evidence to suggest that making doctors aware of bias can help reduce it

Answer 25

green et al 2007

raising awareness of bias can encourage doctors to over-ride it

Question 26

de-categorisation approach - brewer and miller 1984

Answer 26

method to reduce bias

focusses on adopting an interpersonal focus during patient interaction
helps to perceive others as individual rather than in their social grouping

Question 27

stereotype suppression (1998)

Answer 27

method to reduce bias

teaches doctors to actively suppress negative stereotypes

however:
- requires activation of stereotype in the first place

Question 28

re-categorisation approach

Answer 28

method to reduce bias

intended to alter the salient basis for categorisation
understands importance of social categories

• either give patient more than one identity
• or give the patient a shared identity with you

Question 29

perspective taking approach 2000

Answer 29

promoting empathy in health care

“walk in the shoes of others”