Implicit Bias among Physicians and Its Prediction of Thrombolysis Decisions for Black and White Patients

Studies documenting racial/ethnic disparities in health care frequently implicate physicians' unconscious biases. This study measured physicians' unconscious racial bias and tested whether it predicted physicians' thrombolysis recommendations for black and white patients with acute coronary syndromes. Resident physicians viewed a clinical vignette of a black or a white patient presenting to the emergency department with an acute coronary syndrome and completed measures of implicit (unconscious) and explicit (conscious) racial bias. Physicians reported no explicit bias against blacks but showed significant levels of implicit racial bias. As physicians? pro-white implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis. This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity in medical decision making.