7 Dangerous Impacts of Implicit Bias in Pharmacy Practice
- SARMLife
- Nov 23, 2024
- 7 min read
Updated: Jul 19
Summary: The impacts of implicit bias in pharmacy extend beyond perception, affecting medication safety, patient trust, and care outcomes. This article breaks down how unconscious bias affects pharmacist decisions, ranging from skipped prescriptions to overlooked warning signs. Through real-world examples and actionable steps, pharmacists learn how to identify bias, remain mindful, and use tools that support fair and evidence-based care. Tackling the impacts of implicit bias is key to closing care gaps and advancing health equity.
The Hidden Impacts of Implicit Bias in Pharmacy Practice
One of the factors that makes the impact of implicit bias so profound is that it is unconscious, and the person with the bias is completely oblivious.
This unconscious preconception against a person or group of people is so dangerous that it shouldn’t be anywhere in healthcare. Unfortunately, reality doesn’t agree.
Studies suggest that everyone has some implicit bias that subconsciously affects their perception and judgment of others.¹ ² Often, this is reflected in hiring practices, which result in the underrepresentation of ethnic and cultural groups in the workplace.
Implicit bias in pharmacy practice poses a direct threat to patient safety, as illustrated in this blog post. As a healthcare professional, your decisions have a direct impact on the health of others.
When decisions are clouded by bias, they affect adherence and quality of care, exacerbate disparities, and can even lead to increased mortality.
Pharmacists must work together to eliminate implicit bias from practice and ensure the safety of their patients.
This blog post will examine the definition, types, and effects of implicit bias before exploring how pharmacists overcome it.
Defining Implicit Bias in Healthcare and Pharmacy
Implicit bias refers to an unconscious perception of a group of people that often influences how they are perceived.
It is an unconscious, stereotypical perception developed over time, based on personal experiences, other people’s opinions, and the environment.
For example, someone who grew up around people constantly badmouthing a specific minority group might end up developing an implicit bias toward that group even if they did not actively take part in the conversation.
When you have an implicit bias toward a person or a group, you associate a particular set of behaviors, thought patterns, or habits with them (often in a negative way). This preconceived notion affects how you communicate with them or your expectations of them.
The fact that the person with the bias lacks awareness of it makes it even more dangerous. Its impact on pharmacy practice directly affects a patient’s quality of care.
Types of Implicit Bias That Undermine Pharmacy Practice
There are different types of implicit bias, including:
Age Bias.
These are negative feelings toward others based on their age.
Attribution Bias.
This phenomenon is also known as self-serving bias, where a person attributes their success to internal factors, such as their skills, while attributing their failures to external factors or circumstances beyond their control. Conversely, these individuals tend to attribute the success of others to external factors and the shortcomings of others to internal factors.
Beauty Bias.
This is an implicit bias where a person’s competence level is attached to their appearance. Beautiful people are perceived to be more competent and innocent, whereas people who don’t fit the beauty standards are considered differently.
Confirmation Bias.
This is a type of bias in which a person consistently seeks out information that supports their views and opinions, while disregarding information that contradicts them. This bias is dangerous, as it can often lead to ignoring the truth even when it is crucial.
Gender Bias.
This is a bias based on a preference for one gender over the other. It is reflected in various ways. For example, certain professions are often associated with a particular gender.
Recency Bias.
This bias happens when a person places more importance on recent events or information than on older ones. In pharmacy practice, where medication history and reconciliation are crucial, this can be a very dangerous bias for a pharmacist to have.
Real-World Examples: Implicit Bias in Healthcare Systems
Let's use a televised example to illustrate the harm associated with implicit bias in the healthcare system:
There is an episode in the medical drama, Grey’s Anatomy, titled "Don't Dream It's Over", episode 11 of season 14, where a female medical doctor (M.D.) was disregarded by other M.D.s when she said she was going to have a heart attack because she didn’t ‘look’ like someone who had one. This female M.D. kept asking for the proper treatment she would give someone in her condition, but the other M.D.s felt she was being dramatic. She ended up having a full-blown heart attack.
The attending M.D.'s excuse was, “She wasn’t having the symptoms of a typical heart attack patient.” The attending M.D. could have prevented a heart attack, and a woman’s life could have been saved.
Another example is from another medical TV show called The Good Doctor, in episode 9 of season 4, titled "Irresponsible Salad Bar Practices," a woman’s prescription refill request was rejected because she ‘looked’ like she was faking the sickness so she could get free drugs with insurance coverage. The M.D. wasted time trying to look for information to support their theory, and unfortunately, the woman died of sepsis.
Sadly, even though these are from TV shows, they accurately portray the reality of implicit bias and its direct impact on people's lives and patient health outcomes.
Dangerous Impacts of Implicit Bias in Pharmacy Practice
Here are some dangerous impacts of implicit bias in pharmacy practice:
Medication Errors.
Implicit bias may lead to pharmacists making mistakes with medications, such as overmedicating, undermedicating, writing down the incorrect prescription drug, or refusing to refill a legitimate prescription because of an unfounded suspicion of the patient.
For example, a pharmacist with recency bias might prioritize current medication information given to them by the patient without taking a look at their entire medication history to ascertain if the patient is at risk for drug-drug interactions based on their current medication list.
This bias may also lead to drug-drug or adverse drug reactions, resulting in increased hospital admissions and healthcare costs.
Disparities and Discrimination in Patient Care.
Sadly, implicit bias means some patients are denied the same level of care as others. This may be reflected in how pharmacists communicate with patients, their recommendations, and the time spent with each individual.
We’ve seen some examples in movies where a pharmacist might be reluctant to fill a medication request for a person because of the preconceived notion that they may have an addiction. This notion can be based on appearance or color.
Reduced Adherence.
If patients feel judged or not taken seriously because of their race, gender, age, or other factors, they might not trust the pharmacist’s advice. This can lead them not to take their medications as prescribed, impacting the outcome of their health.
No pharmacist should be the reason for a patient's non-adherence.
Reduced Patient Trust.
Trust is essential in healthcare. When patients feel their pharmacist is biased against them, that trust is broken.
This impacts the patient-pharmacist relationship. Patients may be less likely to share important information about their medications or ask questions to clarify their medication regimen, which can lead to medication errors, non-adherence, and reduced health outcomes.
Legal & Ethical Implications.
Pharmacists have a legal and ethical duty to provide unbiased care to their patients.
In the United Kingdom, the Equality Act 2010 protects certain groups of people from discrimination, including those based on age, race, sex, religion, and other protected characteristics. In the United States, the Civil Rights Act of 1964 also prohibits discrimination based on race, color, religion, sex, and other protected characteristics.
Implicit bias leads to actions that violate these standards, potentially resulting in legal issues or disciplinary action.
Loss of Professional Credibility.
If pharmacists gain a reputation for being biased, their credibility and relationships with patients and other healthcare providers will be damaged. A pharmacist’s professional decisions may always be questioned due to unconscious biases.
Increased Mortality.
Unfortunately, the impact of implicit bias in pharmacy practice is life-threatening. Medication errors, poor communication, health disparities, and non-adherence all contribute to worsening health outcomes of patients and increased mortality rates for specific groups.
Strategies That Address Implicit Bias in Pharmacy Practice
After understanding the dangerous impacts of implicit bias in pharmacy practice, what measures should pharmacists implement to eliminate this bias?
Here are some ways to overcome implicit bias in pharmacy practice:
Accessing Implicit Bias.
The Implicit Association Test (IAT) helps you uncover those hidden biases you might not even realize you have. It is considered the most effective method of assessing a person’s implicit bias.
Self-Reflection Training.
Reflecting on your thoughts, feelings, and actions is essential for identifying biases that may be creeping into your practice. Regular self-reflection helps you identify and address biases before they affect your patients’ care.
Implicit Bias Education.
It is essential for all healthcare professionals, including pharmacists, to learn about implicit bias, its impacts, and strategies to overcome it. A few schools have also incorporated implicit bias education into their pharmacy training curricula to reduce its occurrence in professional practice.
Experiential Learning.
Sometimes, the best way to learn is through hands-on experience (experiential learning). Simulations or role-playing exercises help pharmacists experience how implicit bias can manifest in real-life situations and practice strategies to counteract it. This can be more effective when done in group settings.
Practicing Mindfulness.
Being present and aware of your thoughts and feelings can help you identify and challenge biased thoughts as they arise.
When dealing with patients, pharmacists must stay present in the moment and mindful of their recommendations. There is no harm in a pharmacist reviewing their medical advice and confirming that they are making a nonjudgmental and unbiased decision.
Leveraging Pharmacogenomics.
Pharmacogenomics examines how a person’s genes affect their response to medications. Using this information, pharmacists can make more personalized medication recommendations to their patients, reducing the potential for bias to influence their decisions.
Eliminating Implicit Bias to Close Pharmacy Care Gaps
Implicit bias impacts the quality of care a patient receives, thereby contributing to increased health inequity.
A pharmacist with unaddressed implicit bias can withhold a patient’s prescription or be unwilling to advocate for medication coverage. These actions can affect the patient’s overall health outcome and promote non-adherence.
Measures are constantly being taken to reduce this impact, but pharmacists must make it a responsibility to eliminate any form of implicit bias from their minds when dealing with patients.
Several measures are implemented to help pharmacists overcome their implicit bias, no matter how slight, including the use of the Implicit Association Test (IAT) and practicing mindfulness and experiential learning.
Achieving health equity starts with taking one step at a time, and for now, that step is eliminating implicit bias.
References
Espinosa, Adriana. "How Explicit and Implicit Biases Can Hurt Workplace Diversity and What Public Managers Can Do about It." The City College of New York, 2019, www.ccny.cuny.edu/psm/blog/how-explicit-and-implicit-biases-can-hurt-workplace-diversity-and-what-public-managers-can-do.
Knight, Rebecca. "7 Practical Ways to Reduce Bias in Your Hiring Process." Harvard Business Review, 12 June 2017, hbr.org/2017/06/7-practical-ways-to-reduce-bias-in-your-hiring-process.
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