Medical student and provider biases may contribute to health disparities in vulnerable populations by negatively impacting communication with patients and decisions about patient care. With less time and limited information processing capacity, provider’s decisions are increasingly governed by stereotypes and implicit biases. Health care provider’s implicit biases towards vulnerable patient groups may persist despite an absence of negative explicit attitudes, resulting in preconceived notions about patient adherence, poor doctor-patient communication, and micro-aggressions, all of which can interfere with optimal care. Importantly, implicit bias measures are more strongly associated with real-world behaviors than explicit bias measures and are linked to intergroup discrimination. Explicit biases held by health professionals towards racial/ethnic minorities, women, and older adults are known to affect clinical assessments, medical treatment, and quality of care. Health care provider biases are correlated with poorer access to services, quality of care, and health outcomes. Implicit bias can be assessed with the Implicit Association Test (IAT), which measures the strength of association between concepts. In contrast, the term implicit bias refers to attitudes and beliefs that are unconscious (i.e., outside of conscious awareness) and automatic. Research in social-cognitive psychology on intergroup processes defines explicit biases as attitudes and beliefs that are consciously-accessible and controlled they are typically assessed via self-report measures and are limited by an individual’s awareness of their attitudes, motivation to reveal these attitudes, and ability to accurately report these attitudes. A large study of heterosexual, first-year medical students demonstrated that about half of students reported having negative attitudes towards lesbian and gay people (i.e., explicit bias) and over 80% exhibited more negative evaluations of lesbian and gay people compared to heterosexual people that were outside of their conscious awareness (i.e., implicit bias). These biases, also known as negative stereotypes, may be either explicit or implicit. īiases among health care professions students and providers toward LGBTQ patients are common despite commitments to patient care equality. Disparities in health care access and outcomes experienced by LGBTQ patients are compounded by vulnerabilities linked to racial identity and geographic location. Perceived discrimination from health care providers and denial of health care altogether are common experiences among LGBTQ patients and have been identified as contributing factors to health disparities. These disparities are due, in part, to lower health care utilization by LGBTQ individuals. Sexual minority women report fewer lifetime Pap tests, transgender youth have less access to health care, and LGBTQ individuals are more likely to delay or avoid necessary medical care compared to heterosexual individuals. Compared to their heterosexual counterparts, LGBTQ patients have higher rates of anal cancer, asthma, cardiovascular disease, obesity, substance abuse, cigarette smoking, and suicide. LGBTQ individuals face significant disparities in physical and mental health outcomes. There is an urgent need to ensure that health care providers are prepared to identify and address their own implicit biases to ensure they do not contribute to the health care disparities experienced by LGBTQ and other vulnerable populations. Even when institutions and providers make commitments to equitable care explicit, implicit biases operating outside of conscious awareness may undermine that commitment. Implicit physician biases may result in LGBTQ patients receiving a lower standard of care or restricted access to services as compared to the general population. This rapid growth brings with it risk for stigmatization. Lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals represent a rapidly growing segment of the U.S.
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