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Paper from The Fenway Institute offers strategies to mitigate clinician implicit bias against sexual and gender minority patients

A Perspective essay published in Psychosomatics: The Journal of Consultation-Liaison Psychiatry uses case scenarios to illustrate how implicit bias among psychiatrists and other clinicians can affect patient-clinician communication and diminish the quality of health care provided to sexual and gender minority people. The Perspective was authored by researchers at The Fenway Institute and Massachusetts General Hospital and adds to a growing body of literature on the effect of implicit bias in clinicians on health care outcomes.

“Clinicians, like member of the general population, may hold negative implicit biases regarding lesbian, gay, bisexual, transgender, queer, and intersex people, even if they do not hold explicit biases against sexual and gender minorities,” said perspective senior author Alex Keuroghlian, MD, MPH, Director of Education and Training Programs at The Fenway Institute. “Clinician implicit bias has been shown to adversely affect patient-clinician interaction, so it is important to address bias in the context of patient care, particularly in mental health care where a strong therapeutic alliance is the cornerstone of successful treatment.”

Common ways in which implicit bias can influence interactions with patients include assuming that all patients are heterosexual and cisgender. Instead, the authors suggest asking a patient for whom sexual history is relevant to the visit about whether they are sexually active, with whom they are sexually active, and the genders of their sexual partners. In this way, recommendations can be based on sexual history and behavior, rather than identity, which can help avoid making clinical decisions based on stereotypes.

The authors recommend four interventions for clinicians and health care systems to address clinician implicit bias against sexual and gender minorities:

  • Becoming more aware of one’s own preferences, behaviors, and biases. This can be accomplished by noticing times when an assumption or prejudicial belief arises, asking colleagues to point out instances of bias, and taking the Implicit Attitudes Test (IAT). The IAT is a validated computer tool that measures reaction time when sorting positive versus negative attributes into groups such as race and gender.
  • Engaging in mindfulness and practice exercises. Higher awareness paired with practice exercises such as replacing negative stereotypes with positive ones and focusing on a person’s individual characteristics rather than their group membership. Practicing meditation may also reduce implicit bias by promoting emotional control, increasing self-compassion and compassion toward patients.
  • Engaging in continuing education and research. To increase knowledge, clinicians can participate in conferences, meetings, and online continues medical education programs.
  • Addressing structural bias. Healthcare inequities must be addressed at neighborhood, institutional, and policy levels, as well as the individual clinician level. Healthcare institutions can make intentional change by having all-gender restrooms, adding sexual orientation, gender identity, and gender expression to patient and staff non-discrimination policies, and collecting data on sexual orientation and gender identity to identify and address health disparities.

“Clinician implicit bias and its effects on health care are understudied areas. The potential for implicit bias to intensify health disparities among sexual and gender minority people that are associated with societal stigma and discrimination cannot be ignored,” added Keuroghlian. “Chronic exposure to discrimination, including unintentional acts rooted in implicit bias, can produce adverse responses to stress and worsen health outcomes.

The Perspective, titled “Strategies to Mitigate Clinician Implicit Bias Against Sexual and Gender Minority Patients,” was published in Psychosomatics: The Journal of Consultation-Liaison Psychiatry.

Since 1971, Fenway Health has been working to make life healthier for the people in our neighborhoods, the LGBTQ community, people living with HIV/AIDS and the broader population. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues.

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