implicit bias can result in favorable or unfavorable attitudes, it operates in the subconscious, outside of intentional control. These biases can impact healthcare, informing the degree to which patients and doctors trust each other, the way team members collaborate, or even how disease processes are approached. Thus, inclusion of implicit bias awareness and training is crucial to beginning the work of diversity, equity and inclusion.


Those familiar with discussions of implicit bias in medicine may think of widely reported statistics regarding the disproportionate Black maternal death rates,6


When patients are treated by someone who looks like them, speaks like them and understands the realities of their experiences, it will create deeper levels of trust—which will result in better patient care.


or studies such as a 2015


paper in the American Journal of Public Health showcasing how racial bias can lead to unfavorable treatment decisions and outcomes.7


But cases of implicit


bias happen on large and small scales every day in every department of every health system across the nation.


During the peak of COVID-19 infections, a colleague in internal medicine told me how the department had begun changing the workflow and standards of the ICU. Before COVID, the ICU was largely full of white patients, and any individual exhibiting pulmonary issues would receive CT scans and routine imaging. Once COVID-19 struck, however, this practice changed. It was determined that presumed positive patients would not receive default imaging, due to concerns of spreading infection throughout staff and other patients. The change in process was rooted in a well-intentioned desire to protect other individuals and keep up with the onslaught of cases.


However, this change came with an unintended implication: As a large number of COVID-positive patients were Black, this meant that our most vulnerable populations were not receiving the same degree of full diagnostic care that previous patients would have.


The need for dedication and leadership The second step in addressing healthcare disparities is education. In


16 IRQ | FALL 2020


order to create a curriculum to enact change, the individuals most impacted by disparities must have leadership opportunities and a role in the decision- making process–with the weight, support and resources they deserve.


Many institutions have begun creating task forces, committees and diversity efforts staffed by individuals dedicated to intentional change. These take many forms: providing grants to education, writing papers and conducting research, supporting new leaders, elevating voices at all tiers of the system, and fostering a safe and welcoming environment. But these efforts often fall on the shoulders of underrepresented minorities (URMs) and, as a result, creates the “minority tax”—the additional labor and responsibility that comes with equity work.8


Individuals doing this work have


tremendous passion for the subject, but because it must be done in conjunction with clinical demands and daily life, diversity and inclusion efforts may often receive a lower priority.


If this education is prioritized by systems and the work shared by non- URMs, it allows more time, freedom and resources to be dedicated to equity efforts. This approach has a trickle-down effect—URMs within systems will feel better represented and better able to speak more confidently and safely on how to enact change. It will open up avenues for a more diverse workforce at all levels of healthcare, which will resonate with vulnerable populations. When


patients are treated by someone who looks like them, speaks like them and understands the realities of their experiences, it will create deeper levels of trust—which will result in better patient care.


SIR believes that success draws strength not just from the clinical expertise of physicians but from the diversity of their backgrounds and experiences as individuals. Learn more about SIR’s commitment to diversity and inclusion (D&I) and view the SA-CME-accredited D&I module at sirweb.org/member-central/ diversityinclusiveness.


References


1. Centers for Disease Control and Prevention. CDC COVID Data Tracker. cdc.gov/covid-data- tracker/index.html#demographics. Accessed Aug. 19, 2020.


2. Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups. cdc.gov/ coronavirus/2019-ncov/community/ health-equity/race-ethnicity.html?CDC_ AA_refVal=https%3A%2F%2Fwww.cdc. gov%2Fcoronavirus%2F2019-ncov%2Fneed- extra-precautions%2Fracial-ethnic-minorities. html. Published 2020.


3. Bui DP, McCaffrey K, Friedrichs M, et al. Racial and ethnic disparities among COVID-19 cases in workplace outbreaks by industry Sector — Utah, March 6–June 5, 2020. MMWR Morb Mortal Wkly Rep. ePub: dx.doi.org/10.15585/ mmwr.mm6933e3.


4. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics associated with hospitalization among patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. 2020;69:790–794. dx.doi. org/10.15585/mmwr.mm6925e1external icon


5. COVID-19 Health Equity Response Team. https://covid19.colorado.gov/covid-19-in- colorado/health-equity-response-team. Accessed Aug. 19, 2020


6. Villarosa L. Why America’s Black mothers and babies are in a life-or-death crisis. The New York Times. nytimes.com/2018/04/11/magazine/ black-mothers-babies-death-maternal-mortality. html. Published April 11, 2018.


7. Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among healthcare professionals and its influence on healthcare outcomes: A systematic review. Am J Public Health. 2015;105(12):e60-e76. doi:10.2105/ AJPH.2015.302903


8. Rodríguez, J.E., Campbell, K.M. & Pololi, L.H. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ 15, 6 (2015). doi.org/10.1186/s12909-015-0290-9.


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