Bias and Discrimination

Question 1

Define stereotype

Answer 1

o Cognitive expectancies and associations about an outgroup

Question 2

Define prejudice

Answer 2

o Emotional reaction to someone on basis of group membership

Question 3

Define discrimination

Answer 3

o Acting on the basis of stereotypes and prejudices; denial of equality of treatment

Question 4

Why is early identification and treatment of ill-health important?

Answer 4

to prevent/treat negative health consequences of non-treatment

Question 5

Why might trust in the medical profession have decreased over the last 50 yrs

Answer 5

• heightened awareness of medical errors
• more questioning based approach to treatment
• experience of bias

Question 6

What is the greatest concern affecting people with disabilities?

Answer 6

Social isolation

Question 7

What is the NHS constitution regarding patient rights

Answer 7

Equitable treatment, regardless of race, ethnicity, etc. is a patient right

Question 8

Give an example of institutional bias, where equitable treatment may not be delivered

Answer 8

• Denial of healthcare
• Requirement for people with obesity to lose weight (5%) before receiving surgery
o But if this isn’t met, then they’re not offered the help to loose weight (!)
• NICE recommendation to offer surgery more widely (at lower BMI values)

Question 9

Why are older adults often disproportionately disadvantaged

Answer 9

• Less likely to be referred to specialist services
• Less likely to get the medications and tests they need
• More likely to experience poorer clinical interactions
o See Bowling (2007); Callahan et a. (2000); Hajjij et al. (2010)

Question 10

In what way does bias affect workers within the NHS?

Answer 10

• Minority healthcare professionals (HCPs) concentrated in lower paid jobs and over-represented in cases of misconduct
• HCPs also suffer racial abuse by patients
• 40% of doctors in NHS are black and ethnic minority populations
• CONCLUSION: institutional bias exists in healthcare and affects both patients’ access to the system and treatment within it

Question 11

Define personally-mediated bias

Answer 11

Personally-mediated bias reflects individually-based differential treatment based on group membership

Question 12

Define institutional bias

Answer 12

Institutional bias refers to accessibility of healthcare; opportunities

Question 13

What did the institute of medicine (2003) report reveal regarding BAME populations and treatments

Answer 13

o Black patients and minority population receive fewer procedures and poorer-quality medical care
o Effect remains even when accounting for variations in e.g., insurance, disease severity, income, education etc. (factors known to affect access to healthcare)

Question 14

The GMC principles state doctors should not refuse or delay treatment due to a patient’s actions and shouldn’t discriminate.
Therefore if they are biased, how could this be evident?

Answer 14

At an unconscious level

Question 15

What is an implicit attitude

Answer 15

operate at unconscious level, involuntarily formed, largely unknown to the individual

Question 16

What is an explicit attitude

Answer 16

operate at conscious level, deliberately formed and expressed

Question 17

Give one way you may assess implicit bias

Answer 17

with the Implicit Associations Test (IAT)

Question 18

What and how does the IAT measure bias

Answer 18

strength of association between social categories (e.g., black, obese) and evaluations (good, bad) or stereotypes
• Bias is determined through speed of responding to paired associations
• Indicated by slower processing of pairs that are inconsistent with expectations

Question 19

Outline 1 study which gives evidence of the presence of bias in HCPs

Answer 19

• Schwartz (2003): evidence of implicit obesity bias which was uncorrelated with explicit bias
• Sabin (2008): replicated effects for racial bias
• White-Means (2009): biases present throughout medical training- perhaps not training them well to avoid bias?

Question 20

Outline 1 study which gives evidence of the presence of bias in treatment

Answer 20

• Green (2007): vignette study of patient presenting with chest pain
o No evidence of explicit bias, but evidence of implicit bias
o Bias associated with likelihood of giving patient thrombolysis (to break down blood clots)
o More likely to administered to white patients
• Sabin (2012): Black patients implicitly associated with non-adherence
o Implications for assumptions made in consultation settings?

Question 21

Outline 1 study which gives evidence that patients may be affected by bias

Answer 21

• Todd (2000): white and black patients deemed to have similar pain levels but white patients more likely to receive pain medication
o Similar effects in other groups (Hispanics)
• Relatives of Black patients evaluate end-of-life care for family members as lower compared to Whites (Welch et al., 2005)
• Non-white patients report less satisfaction with doctor interactions than do whites (Barr, 2004) – i.e., bias translates to consultations with patients
• Doesn’t necessarily indicate bias, but..
• Implicit bias in doctors is associated with lower patient satisfaction (Cooper et al., 2012)
• Indicates that doctor bias is affecting treatment (or at least communication in treatment settings)
• Biased doctors tend to be evaluated by patients as less friendly and warm (Penner et al., 2010)

Question 22

Why does bias occur?

Answer 22

• Attentional resources are important
• Fiske & Taylor (1984) “cognitive miser”
o Human propensity to do just enough mental work to function
o Reliance on stereotypes: mentally easier than forming individuated impressions
o Stereotype-based impressions are over-simplifications – loss of individuating information
• Assumes superiority of individually-based impression formation (over-simplification of what stereotyping is- assumes its always wrong)

Question 23

Describe the activation of stereotypes

Answer 23

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

Question 24

Describe the application of stereotypes

Answer 24

treating someone in terms of their category membership (e.g., expressing bias; discrimination)

Question 25

What concept could inhibit stereotype activation?

Answer 25

cognitive loading