Diversity and Inclusion in Surgery: The Role of Implicit Bias on Patient Care

Abstract

Implicit bias is a fundamental contributor to widespread healthcare inequalities. This review aims to shed light on known healthcare disparities in the surgical field, to discuss the role of implicit bias in both patient care and the development of a diverse surgical workforce, and to generate discussion on how surgeons can mitigate implicit biases in order to improve patient outcomes and the future of academic surgery. National reports consistently demonstrate that patients in minority groups have worse care as judged by multiple quality measures when compared to non-minority peers. Provider bias is significantly associated with differences in treatment decisions, treatment adherence, and patient health outcomes. Overall, healthcare providers demonstrate more negative implicit biases toward Black/African American, Hispanic, and Native American patients compared with white patients. Controlled experiments reveal that treatment recommendations for minority patients differ significantly from those made for non-minority patients presenting with the same symptoms, and that providers implicitly associate minority patients with poor compliance and poor cooperation. Providers who belong to the same minority group as their patients are reported to have improved patient satisfaction and better quality of care by several measures. Although embracing efforts to enhance diversity in the workforce, the surgical field is still dominated by white males. The training, hiring, and promotions processes all suffer from the negative consequences of implicit bias. A more diverse surgical workforce would allow for improvements in patient care by decreasing the impact of implicit bias on patient interactions. Recognizing and proactively addressing provider-derived biases presents an opportunity to lessen the well-documented disparities in surgical care and to broadly improve outcomes. Building a more diverse surgical workforce will strengthen this effort, ultimately contributing to the advancement of surgical care for all patients.