How to eliminate bias in the exam

Excerpted from page 24 of the May/June 2022 edition of AOA Focus.

Unintentional, implicit bias can show itself in all corners of society, even in the examination rooms of optometric practices. The consequence of that bias—preconceived associations of patients based on race/ethnicity, sexual orientation, age, economic status or disability, for instance—is among many factors that can impact the delivery of patient care, says Greg Waldorf, O.D., M.P.H., associate dean of clinical programs in the Eye and Vision Center at the Massachusetts College of Pharmacy and Health Services. Dr. Waldorf is leading a course on the subject at Optometry’s Meeting® 2022 on June 17.

“It’s part of being human,” Dr. Waldorf says. “Implicit bias can manifest itself in our body language toward a patient or in the way we communicate with a patient.”

In a review of 15 studies published in 2015 by the American Journal of Public Health, researchers defined implicit attitudes as “thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.”

Low to moderate levels of implicit racial/ethnic bias were found among health care providers in all but one study, they wrote in the article “Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systemic Review.”

AOA Focus asked Dr. Waldorf about what subjects he might touch on during his presentation and what can be done about implicit bias in a practice.

1. Identify your own bias.

“Be mindful of it,” Dr. Waldorf says. Tests that can help people identify their bias toward others are available on the internet, and he cites a particularly popular one, the Harvard Implicit Association Test.

That self-test is made available under Project Implicit, whose mission is “to educate the public about bias and to provide a ‘virtual laboratory’ for collecting data” preferences. Researchers use the data from the test to shed light on individuals’ bias and disparities, in comparison to the collective information.

“Being mindful of the results of an implicit bias associations test is one way of decreasing its presence in one’s practice,” Dr. Waldorf adds.

2. Heal thyself.

Once self-aware, what do you do? Dr. Waldorf speaks about training oneself to “individuate.” That’s the process of learning how to look at the individual rather than stereotyping or generalizing by group.

“Think about the patient experience in a doctor’s office,” he says. “Walk in their shoes. One way of thinking about it is if this were your mother, how would you like them to be treated? Make a conscious effort to focus on your clinical information rather than just looking at patient groups.”

3. Engage patients, differently.

Patient One, warm and confident, arrives for a visit with the doctor. Later, Patient Two, less warm and confident, arrives for a visit with the doctor. Both have similar medical conditions. Will the patients be treated differently by the doctor and staff? Will Patient One’s shiny disposition affect how well they communicate and the level of care received?

Unintentional bias might come into play, Dr. Waldorf says, potentially resulting in disparities in care. And that can matter when it comes to patient outcomes. “Studies have shown that engaged patients have better health outcomes and better health care experiences, and likely use fewer health care services and spend less,” Dr. Waldorf says.

The authors of the 2015 articles review said: “Dominant communication styles, fewer demonstrated positive emotions, infrequent requests for input about treatment decisions, and less patient-centered care seem to characterize patient–provider interactions involving people of color.”

4. Empower patients through health literacy.

Dr. Waldorf notes the benefits of patient education to bolster their confidence through knowledge.

“I think doctors of optometry do a really good job with health literacy,” he says. “But let’s say your patient doesn’t understand the health care system or maybe doesn’t understand the purpose of the medication you’re prescribing. Sometimes it might be easy to think this person isn’t going to understand either of those, so I might just brush over it when talking with them. One of the objectives of the course is to make doctors aware of potential blind spots.”

Know Before You Go

What: Can Implicit Bias Affect the Optometric Exam?
Where: Optometry’s Meeting in Chicago
When: 7-8 a.m., Friday, June 17
Credit Hours: 1

Register to attend the meeting.