Abstract: Female College Students’ Perceptions of Physicians’ Implicit Bias

◆ Rachael Hernandez, University of Missouri

Minoritized groups in the United States are more likely to experience low-quality health care (Meyer, Yoon, & Kaufmann, 2013; Nelson, 2002; Singh et al., 2017), and health care disparities persist regardless of patients’ financial status (Nelson, 2002). One factor exacerbating these disparities is physicians’ implicit biases, or the unconscious assumptions based on stereotypes about social groups (FitzGerald & Hurst, 2017; Nelson, 2002). There is growing evidence that implicit bias has the potential to negatively affect physician cognition and decision-making with patients from certain social groups (Blair et al., 2014; Blair, Steiner, & Havranek, 2011; Burgess et al., 2008; Fitzgerald, 2014; Green et al., 2007; Pletcher, Kertesz, Kohn, & Gonzales, 2008; Pletcher et al., 2008; Sabin & Greenwald, 2012). Much of the implicit bias research seeks to capture the hidden and potentially insidious effects of implicit bias, however, there is little information about whether patients are aware of implicit bias and how it impacts their perspectives on physician-patient communication.
Given its’ sensitive nature, physician-patient communication about sexual behavior is a critical context for examining physician bias. Physicians have an opportunity to provide accurate and timely information about safe sexual behavior to individuals in their care. However, many young people, and in particularly college women, are reticent to talk to their physicians about sexual behavior. This reticence may be related to perceptions of physicians’ communication. Because of their particular sexual health risk factors, this study employs interviews with female college students to explore their perceptions of physician implicit bias and to what extent this perception shapes their interactions with physicians. Qualitative analysis of open-ended interviews was used to explain the way female college students perceive issues concerning physician implicit bias. Due to the private nature of information about sexual behavior, the results of the study were interpreted through the lens of the theory of Communication Privacy Management (Petronio, 2002). Overall, participants described either avoiding or limiting communication with a physician as a result of implicit bias, illustrating how broader social forces shape interpersonal communication in a dynamic process of privacy management. Themes revealed participants’ layered experiences of physician bias, particularly how intersectional identity exacerbates experiences of implicit bias and how physician bias is seen as a trigger for the physician delegitimizing the patients’ disclosures. Participants also described interpreting physicians’ cognitions and emotions in the context of implicit bias. This study provides new findings in the area of implicit bias in doctor-patient communication, introducing a new group of patients who perceive physician biases because of their young age, and suggesting a potential new consequence of perceived implicit bias- a closed privacy boundary. The results of this study show how biases can influence the processes of private disclosures, demonstrating another way that disempowered groups are further disempowered through communication. These findings have the potential to improve communication interventions both for female college students and healthcare professionals.