Patient perspectives on racial and ethnic implicit bias in clinical encounters: Implications for curriculum development

Objective: Patients describe feelings of bias and prejudice in clinical encounters; however, their perspectives on restoring the encounter once bias is perceived are not known. Implicit bias has emerged as a target for curricular interventions. In order to inform the design of novel patient-centered curricular interventions, this study explores patients’ perceptions of bias, and suggestions for restoring relationships if bias is perceived. Methods: The authors conducted bilingual focus groups with purposive sampling of self-identified Black and Latino community members in the US. Data were analyzed using grounded theory. Results: Ten focus groups (in English (6) and Spanish (4)) with N = 74 participants occurred. Data analysis revealed multiple influences patients’ perception of bias in their physician encounters. The theory emerging from the analysis suggests if bias is perceived, the outcome of the encounter can still be positive. A positive or negative outcome depends on whether the physician acknowledges this perceived bias or not, and his or her subsequent actions. Conclusions: Participant lived experience and physician behaviors influence perceptions of bias, however clinical relationships can be restored following perceived bias. Practice implications: Providers might benefit from skill development in the recognition and acknowledgement of perceived bias in order to restore patient-provider relationships.