Do physicians' implicit views of African Americans affect clinical decision making?

Area of Science:

• Orthopedic Surgery
• Health Disparities
• Medical Ethics

Background:

• Osteoarthritis (OA) disproportionately affects Black individuals, yet they receive fewer total knee replacements (TKR) compared to White individuals.
• Physician implicit bias may contribute to racial disparities in TKR recommendations.
• This study investigated the link between implicit racial bias and TKR recommendations.

Purpose of the Study:

• To determine if implicit racial bias predicts TKR recommendation differences for Black and White patients with severe OA.
• To assess if a web-based intervention can mitigate the impact of implicit racial bias on TKR recommendations.

Main Methods:

• A web-based study involving 543 physicians assessing TKR likelihood for hypothetical Black and White OA patients.
• Utilized implicit association tests to measure implicit racial bias and perceived patient medical cooperativeness.
• Collected data on explicit bias, patient race, and TKR recommendation rates.

Main Results:

• Physicians exhibited significant implicit and explicit racial biases, favoring White patients.
• No significant difference was found in TKR recommendation rates between Black (47%) and White (38%) patients.
• Neither implicit nor explicit racial biases predicted differential treatment recommendations by race.

Conclusions:

• Despite possessing racial biases, physicians' implicit and explicit biases did not directly predict TKR recommendations.
• Stereotypes regarding medical cooperativeness may subtly influence treatment decisions, contributing to disparities.
• Further research is needed to understand the complex interplay of bias and clinical judgment in orthopedic care.