In healthcare, as in many areas of society, people take in mountains of information every day and often make decisions subconsciously without asking the conscious brain to weigh in.

Many times, those decisions are sound and lead to good outcomes. But subconscious decision-making, by its nature, opens the door to implicit bias. Even though implicit bias occurs outside of a person’s awareness, it still drives decisions and affects outcomes. In the healthcare arena, that equates to health disparities.

OU Tulsa physician and educator Jabraan Pasha, M.D., leads workshops on implicit bias locally and around the world, to groups both inside and outside of healthcare. The key to dealing with implicit bias is understanding that no one is immune to it, he said.

“Simply acknowledging that implicit bias is a reality for most of us is the first step,” Pasha said. “Implicit bias doesn’t have anything to do with our intentions, but the outcomes are the same no matter what the intentions are. There’s no way to protect against it if we don’t know it’s there.”

In healthcare, implicit bias can be found in several well-documented ways. Women receive fewer necessary cardiac interventions than men do, Pasha said, because healthcare providers often don’t think their symptoms are associated with heart disease. African-American patients do not get their pain treated as aggressively as non-African-American patients. People who are overweight and obese don’t receive routine screenings as often as those who are not overweight or obese. Minority women, especially African-American and Hispanic women, are much more likely to die during or after childbirth than women who are not minorities.

“Even when socioeconomic status and insurance payer status are equal, we know that these gaps still exist,” Pasha said. “So we know that a lot of it has to do with implicit bias.”

During his presentations, Pasha talks about disparities not only in healthcare but in other high-stakes areas like criminal justice, employment and education. Participants share their experiences, both of being biased or experiencing bias. They also brainstorm and talk about methods of reducing implicit bias at both an individual and institutional level.

Once the workshop is over, Pasha encourages participants to take online implicit bias association tests developed at Harvard. Multiple tests are offered in the areas of age, sexual orientation, race, religion, skin tone, disability and others. He also introduces the concept of how the tests work by having participants take an implicit association test about flowers and insects. The results are never surprising – most people have positive associations with flowers and negative for insects. Though simplified, the example sets the stage for people to take the tests on their own.

“Taking those tests can tell you that you have a propensity for bias toward certain groups,” he said. “It doesn’t necessarily mean that you have had discriminatory practices toward someone, but it tells you that you’re more likely to. That’s a good thing because it puts us on notice so that we can be more conscious about our thoughts and the decisions we make. It allows us to step back and say, ‘Am I making this decision based on enough information, or am I filling in the blanks and making this decision based on some biases that I have?’”