Whether it’s in medical settings, on the street or in the classroom, unconscious bias exists all around us. And it is largely racial bias.

A recent GeneSight Cares webinar began with a panel of board-certified psychiatrists sharing instances where they experienced both implicit and explicit bias they would define as unconscious; and offered participants the chance to learn strategies to address unconscious bias and stereotypes in healthcare settings. You can watch the full webinar on our YouTube channel.

The panel featured:

Malaika Berkeley, MD, MPH
Co-founder of Global Health Psychiatry LLC in Atlanta, Ga. and co-author of Mind Matters: A Resource Guide to Psychiatry for Black Communities

Crystal Nelson, MD
A national speaker and founder/CEO of Blueprint Psychiatry in Newnan, Ga.

Angela Shannon, MD
Founder/director of Positive Balance Wellness Center, and consulting psychiatrist at Georgia Regional Hospital in Atlanta, Ga.

Johnny Williamson, MD
Owner of Spectrum Behavioral Health in Hinsdale and New Lenox, Ill.

What is Unconscious Bias? Examples of Unconscious Racial Bias in Clinical Settings

Unconscious bias can happen from doctor to patient – and patient to doctor.

Dr. Shannon explained how, during a session, she often hears the patient ask: “When will I see the doctor?” She typically responds: “You’ve been seeing her for the past 40 minutes.”

Unconscious bias from doctor to patient also can have serious consequences. Dr. Nelson experienced this first-hand when she suffered excruciating pain in her leg following an emergency C-section, yet she was told by a nurse, “just relax, you just had a baby – you’re probably anxious.”

However, as a medical professional, Dr. Nelson knew her pain would not just wear off. She feared she was having an embolism. It wasn’t until she explained that she was a doctor that the hospital staff started taking her pain seriously.

“The statistics are very real,” said Dr. Nelson, referring to the higher rates of childbirth deaths experienced by African American women in the U.S.

Panel members suggested that these actions weren’t intended to offend or cause harm yet represented experiences common to many African Americans.

What’s the Difference Between Implicit Bias and Unconscious Bias?

 Dr. Berkeley argued that too often the terms “unconscious” or “implicit” bias are used as cover for behavior when explicit racism has not been ruled out.

“Racism is the conscious belief that one’s race is superior to others,” said Dr. Berkeley. “Implicit bias is basically the automatic reaction that you have to something or someone.”

She explained that most adults are aware and have had experiences with issues of race; as a result, many racially insensitive actions are likely explicit biases rather than implicit biases.

Directly confronting examples of unconscious bias can result in improved awareness, recognition and ultimately better treatment outcomes for Black patients, explained Dr. Shannon. As a practitioner in the justice system, she discovered a pattern of overmedicating Black male patients in comparison to white patients exhibiting the same symptoms. Dr. Shannon said that the physician who had ordered the high doses was not aware of his different treatment and took corrective action when information about the discrepancy was presented.

According to Dr. Williamson when people typically describe unconscious biases, they describe what that bias relates to (e.g., sexism, homophobia, etc.). However, in the context of implicit or unconscious bias regarding race, the word “racial” is often left out. Such a pattern, he argues, shows how society softens and neutralizes racial issues.

He adds that the social determinants of health for African Americans go beyond what happens during an appointment. For example, he remarked that African Americans will experience longer wait times before receiving treatment and aren’t granted special requests, like visits outside of office hours, as often as white patients. The Washington Post recently wrote about these exact biases.

Explaining Microaggressions as a Way to Start a Dialogue about Race

Examples of Microaggression in Healthcare

Dr. Berkeley defined microaggressions as any situation where someone acts as if they, or their time, is more important than another’s. Dr. Berkeley added that microaggressions intrude on others without seeing the other person.

A board-certified psychiatrist with more than 20 years of experience, Dr. Williamson has experienced actions from patients that he says act along an underlying form of bias, like when patients are surprised at how well he knows his subject, or his ability to articulate a treatment plan.

Within psychiatry, Dr. Berkeley and Dr. Shannon agreed that race has played a role in medical and public attitudes toward issues like substance abuse and addiction. They argue that it wasn’t until the opioid crisis reached a larger number of families (including those white and suburban families), that the public recognized substance abuse as a chronic medical condition. Until that time, many held beliefs that addiction was a personal failure.

Dr. Williamson believes if less empathy is shown toward Black patients, it affects both patient compliance and the treatment relationship, which can lead to less positive patient outcomes.

How to Address Microaggressions

When Dr. Williamson sees a bias is present and can determine that it is not explicit, he often weighs the pros and cons of addressing it directly with the patient. He admits that mentioning race in some instances could make his patients and their families uncomfortable, which may undermine their care. Accordingly, he considers the therapeutic value of bringing up cultural differences on a case-by-case basis.

Dr. Nelson pointed out that it is important for patients to find the right fit when choosing their healthcare provider.

“I’m the expert on psychiatry but you’re the expert on you,” said Dr. Nelson. “In mental health particularly, it’s so often that people are not feeling heard and they’re feeling dismissed with what they are trying to communicate.”

How to Overcome Unconscious Bias

One of the hardest things about psychiatry is “knowing your own stuff,” Dr. Nelson said.

To provide the best care, she believes that clinicians should recognize their own biases. Often, biases and beliefs are formed in early life, in part by that individual’s culture, but by regularly attending therapy, clinicians can be more open when giving treatment to people of a different culture.

If a medical practice is serious about making Black patients feel safe and welcome, then their marketing materials should reflect that. Dr. Nelson includes photos of herself and her staff to show their practice has diverse representation.

Individuals and health systems should work to create safe spaces for Black patients, according to Dr. Williamson. The most visible improvement would be for health systems to hire more Black clinicians and staff, while conducting implicit and unconscious bias training for new employees. Further, he recommended investing in research into the mental health issues faced by minorities and marginalized communities – and turning those findings into changes in policy and practice.

Diversity education efforts could do better at reaching the audiences that need to hear them, Dr. Shannon shared. For example, those attending speeches and panels about bias are often not the ones reinforcing stereotypes or perpetrating the acts.

“Treat[ing] everyone with respect and dignity goes a long way,” Dr. Berkeley concluded.

Visit our blog to learn more about racism, discrimination and mental health and how minority cultures talk about depression.