Although the discussion ended with this comment, it seems useful to begin the summary with a link provided by @patdevine
pat_devine one thing about unconscious bias is that many people don't realize it exists. intriguing to take the test: https://t.co/3YCdArWL
Created by Harvard researchers, The Implicit Association Test or IAT is part of Project Implicit. Here is a direct quote and explanation of what the researchers have been trying to learn...
Psychologists understand that people may not say what's on their minds either because they are unwilling or because they are unable to do so. For example, if asked "How much do you smoke?" a smoker who smokes 4 packs a day may purposely report smoking only 2 packs a day because they are embarrassed to admit the correct number. Or, the smoker may simply not answer the question, regarding it as a private matter. (These are examples of being unwilling to report a known answer.) But it is also possible that a smoker who smokes 4 packs a day may report smoking only 2 packs because they honestly believe they only smoke about 2 packs a day. (Unknowingly giving an incorrect answer is sometimes called self-deception; this illustrates being unable to give the desired answer).
The unwilling-unable distinction is like the difference between purposely hiding something from others and unconsciously hiding something from yourself. The Implicit Association Test makes it possible to penetrate both of these types of hiding. The IAT measures implicit attitudes and beliefs that people are either unwilling or unable to report.There are a number of demonstration AIT tests:
- Native-American
- Gender-Career
- Skin-Tone
- Age
- Arab-Muslim
- Sexuality
- Weight
- Presidents
- Asian-American
- Race
- Disability
- Religions
- Gender-Science
- Weapon
Q1 @EquityPA Before we begin & for clarity, can you describe the Physician Assistant's role in the medical team?
EquityPA: We are licensed to practice medicine, diagnose, prescribe, in partnership with physicians and others
pat_devine: physician assistants practice medicine. they are one of the groups I work with to increase access to medical information.
pat_devine http://t.co/Sh25YoIf Read about PAs on MedlinePlus from the Nat'l library of medicine
EquityPA another good source is http://t.co/KZ1m0Qpi, rich with info about PAs
Q2: @equitypa Why are you and the American Academy of PAs working in the area of inequality in the provision of healthcare?
EquityPA Q2: Because we think it is the right thing to do, and because we have a long trad of working with underserved.
HealthJusticeCT So happy to hear PAs are focusing on health equity issues. We need others involved, too!
EquityPA Q2: I chair AAPA Health Disparities Work Group, we have partic focus on implicit bias of providers
pat_devine Q2: I think many provider organization are now interested in disparities in health care, in order to improve patient outcomes
rv_rikard MT @EquityPA: partic focus on implicit bias of providers <-- can you elaborate on what you mean a bit more, please?
EquityPA Q2: Our org AAPA is very supportive of work on these issues. We approach it with sense of urgency.
EquityPA Implicit or unconscious bias is a field of study a decade or so old, from behav psych world.
EquityPA a wonderful resource about implicit bias is IAT http://t.co/9vDITao5, anyone seen that?
yayayarndiva Implicit or unconscious bias sounds a bit sanitized...some work around issues of structural racism and individual bias as well
pat_devine Project Implicit from Harvard: https://t.co/VH95MKmG
EquityPA @kdhoffman2 re resistance, very much so, but it is changing! I lectured today to PA school, and they totally embraced it
Q3 @equitypa we'd like to know more about implicit bias and unconscious stereotyping, what is the history of this field of study? #hchlitss -8:24 PM Jan 26th, 2012
EquityPA Q3: came out of Harvard, decade ago, from behav psych folks. Pretty much accepted as valid, some still resist.
EquityPA Q3: I see it as a missing link in understanding why disparities are worsening. Not THE answer, but a piece of it.
pat_devine just looked in http://t.co/JxNneCPL. "social perception" and "stereotyping" searched as MeSH terms yeld interesting results
EquityPA There are reliable techniques [to address implicit bias and unconscious stereotyping] to use in exam rooms.
EquityPA @schwartzbrown re: techniques: 1. Perspective Taking. Empathy exercise, strongly shown to decrease impact of bias. RE clinician role: two fold. First what can I do in iexam room, 2nd what can I do outside (policy, etc)
EquityPA another technique: data shows that just talking about implicit bias decreases it's impact. Like we are doing now.
pat_devine here's an article about empathy reducing the effects of bias: http://t.co/XrnJlsPI
EquityPA here is perspective taking piece, i think it is strong http://t.co/fMs8HP9C
Q4 @equitypa how has the understanding of health disparities by the medical community evolved or changed in the last few years? #hchlitss -8:32 PM Jan 26th, 2012
EquityPA Q4: just a few years ago, manycolleagues would dismiss this, "I'm not racist!" Not the point, and people are coming around
EquityPA We talk and write about Citzen PA Concept. It's a PAs job to improve health, even if that means engaging in policy.
schwartzbrown Yes, the question should be why more disciplines don't have orgs devoted to this issue
Q5 @equitypa what particular challenges are there in addressing unconscious bias on the part of providers such as PAs, MDs, & NPs? #hchlitss -8:42 PM Jan 26th, 2012
EquityPA q5: biggest challenge is getting people to move past "I would never do that!"
EquityPA @kdhoffman2 we feel fortunate to be in an association that takes this issue seriously, and it not afraid to probe.
Q6 @equitypa where do you see efforts to address health disparities going in the next decade? #hchlitss -8:53 PM Jan 26th, 2012\
EquityPAQ6: it will move with great speed in social determinants, income inequality, and provider attitudes. #hchlitss -8:54 PM Jan 26th, 2012One important aspect of the discussion was reasons for health disparities:
@EquityPA Q5: biggest challenge is getting people to move past "I would never do that!" <=A huge barrier to change! #hchlitss -8:51 PM Jan 26th, 2012
EquityPA @kdhoffman2 re challenge, not as big as I once thought. I see it decreasing, Very pleased to see that! There is hope! #hchlitss -8:52 PM Jan 26th, 2012
EquityPA the cause are so complex. I've tried to find a niche for our group, and support others in their efforts as well. #hchlitss -8:42 PM Jan 26th, 2012
HealthJusticeCT @EquityPA Glad to hear that! Some still think the playing field is equal and that good health is an individual choice. #Hchlitss -8:26 PM Jan 26th, 2012
schwartzbrown When we talk about access to health care in this country, we don't account for poor care due to bias/disparities
- the missing link===money, recession, cutback of programs
- Where I live, programs are consciously being moved out of lower income areas to generate more income, at great cost to many pts
- The persistence of White Privilege and Institutional Racism in US policy http://t.co/wTLqjE9t
- Special Report on Racial healing http://t.co/Qk9nVl4T
- schwartzbrown Stress is a factor hypothesized to account for disparities in outcomes for Blacks of high socio-economic status with good h/c acc
- Encountering bias daily, conscious and unconscious is toxic
- re: stress, there is concept called allopathic load, this book is wonderful description!http://bit.ly/yW7j01
A point was made that many org[anization]s address[the] issue theoretically, but in practice, it is difficult to address and very prevalent. However, the discussion yielded a list of organizations that have long standing work around health disparities, racism and discrimination:
- social factors such as where you live<-Yes, the social env shapes hlth outcomes & hlth status
- National Medical Association- group of predom African American physicians has worked tirelessly in the area of health disparities
- American Public Health Association
- Professional groups of AAPI, Latino, Native American and LGBTQ
- Robert Wood Johnson Foundation
- Kellog Foundation
- several academic centers in the US
The Health Disparities Work Group of the American Academy of Physician Assistants RE work with many other groups, and sees inter-org[anizational] and inter-prof[fressional] engagment as key.
