Date of Award

6-2010

Document Type

Open Access Thesis

Degree Name

Master of Arts (MA)

Department

Clinical Psychology

First Advisor

Ester Shapiro

Second Advisor

David Lisak

Third Advisor

Mary-Jo DelVecchio Good

Abstract

Disparities in healthcare stem from historical, social, institutional, and interpersonal factors--all of which can manifest at the level of the clinical encounter. A growing body of research has addressed implicit bias and, more specifically, the implicit bias involved in aversive racism as a mediator of disparate care. While recent studies have suggested links between disparate treatment and implicit bias, little direct evidence exists for how implicit bias may effect disparate care. Qualitative research on physician understanding of processes by which implicit bias translates into disparate care can help fill this gap and identify areas for further research. This study conducted secondary analysis of physician narratives discussing health disparities using thematic analysis to focus on narratives addressing bias and striving for reflexivity. Thematic analysis yielded three distinct themes for bias: paternalism, involving assumptions about patient lack of capacity and agency to engage in discussions around treatment and treatment itself; preferential connection, involving preferential attitudes toward members of one's identified group that come at a cost to others who are not treated so preferentially when physician time and focused attention are in effect rationed commodities; and social prototypes, involving the creation of medical prototypes contaminated by information from devaluing social stereotypes. Physician narratives of reflexivity revealed struggles to identify bias, and strategies for self-awareness and accountability to minimize distortion of patient care. Themes for reflexivity described processes that physicians identified to: encounter and counter bias by becoming aware, via attentiveness to one's own subjectivity, of the ways in which bias can operate and also the ways in which one can search for evidence within one's own experience to counter bias; and connect to and with difference by seeking better understanding of a patient's unique subjectivity, equalizing knowledge and power in the medical encounter, and seeking opportunities to serve diverse and marginalized patients as a positive source of knowledge and professional identity. This study substantiates both the presence of and the need to address physician bias, and suggests links to emerging research on social cognitive strategies for countering physician bias.

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