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 kind of implicit bias that subconsciously affects their perception and judgment of others.
Implicit bias in pharmacy practice is a direct threat to patient safety, as we’ll see in this blog post. As a healthcare professional, your decisions directly affect the health of another.
When decisions are clouded by bias, they affect adherence and quality of care, enhance 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 explore the definition, types, and impacts of implicit bias before looking into how pharmacists can overcome it.
What is Implicit Bias?
Implicit bias is an unconscious perception toward a group of people that often affects how they are perceived.
It is an unconscious stereotypical perception developed over the years 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 can attach a particular set of behaviors, thought patterns, or habits to them (often negatively). This preconceived notion can affect how you communicate with them or your expectations of them.
The fact that the person having the bias isn’t aware of it makes it even more dangerous. Its impact on pharmacy practice can directly affect a patient’s quality of care.
Types of Implicit Bias
There are different types of implicit bias, including:
Age Bias.
These are negative feelings toward others based on their age.
Attribution Bias.
This is also known as self-serving bias, where a person attributes their success to internal factors like their skills while attributing their failures to external factors or circumstances beyond their control. Contradictorily, these people attribute the success of others to external factors and the failures 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 conceived to be more competent and innocent, whereas people who don’t fit the beauty standards are considered differently.
Confirmation Bias.
This is a kind of bias in which a person constantly searches for information that
supports their views and opinions while disregarding information that supports
otherwise. 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 preference for one gender over the other. It is reflected in various ways. For example, certain professions are attributed to 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.
The Reality Of Implicit Bias In The Healthcare System
Let storytelling show you the reality of implicit bias in the healthcare system:
There is an episode in the medical drama titled “Grey’s Anatomy” 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.”
Another example is from another medical tv show called “The Good Doctor,” where a woman’s prescription refill request was rejected because she ‘looked’ like she was faking the sickness so she could get free drugs under insurance coverage. The M.D.'s 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 patient health outcomes. The attending M.D. could have prevented a heart attack, and a woman’s life could have been saved.
Dangerous Impacts of Implicit Bias in Pharmacy Practice
Here are some dangerous impacts of implicit bias in pharmacy practice:
Medication Errors.
Implicit bias can lead to pharmacists making mistakes with medications, such as overmedicating, undermedicating, writing the wrong prescription, 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 that the patient is not on drugs that can react with their current medications.
This bias can cause drug-drug or adverse drug reactions, leading to readmissions and an increase in healthcare costs.
Disparities and Discrimination in Patient Care.
Sadly, implicit bias can mean some patients don’t get the same level of care as others. This can show up in how pharmacists communicate with patients, their recommendations, and the time spent with each person.
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 the non-adherence of a patient.
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 Britain, the Equality Act 2010 protects certain groups of people from discrimination, including age, race, sex, religion, etc. In America, the Civil Rights Act of 1964 also prohibits discrimination based on race, color, religion, sex, etc.
Implicit bias can lead 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 can be damaged. A pharmacist’s professional decisions might always be questioned because of their unconscious biases.
Increased Mortality.
Unfortunately, the impact of implicit bias in pharmacy practice can be life-threatening. Medication errors, poor communication, health disparities, and reduced adherence can all contribute to worsening health outcomes of patients and increased mortality rates for specific groups.
How To Overcome Implicit Bias In Pharmacy Practice
After understanding the dangerous impacts of implicit bias in pharmacy practice, what measures can 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 crucial for identifying biases creeping into your practice. Regular self-reflection can help you catch those biases before they impact 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. Some people also think implicit bias education should be included in pharmacy training curricula to expose students before they begin professional practice.
Experiential Learning.
Sometimes, the best way to learn is by doing (experiential learning). Simulations or role-playing exercises can 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.
Conclusion
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 can be implemented to ensure pharmacists can overcome their implicit bias, no matter how little, from using the Implicit Association Test (IAT) to 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.
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