title: Do physicians' implicit views of African Americans affect clinical decision making?
abstract: BACKGROUND
  Total knee replacement (TKR) is a cost-effective treatment option for severe osteoarthritis (OA). While prevalence of OA is higher among blacks than whites, TKR rates are lower among blacks. Physicians' implicit preferences might explain racial differences in TKR recommendation. The objective of this study was to evaluate whether the magnitude of implicit racial bias predicts physician recommendation of TKR for black and white patients with OA and to assess the effectiveness of a web-based instrument as an intervention to decrease the effect of implicit racial bias on physician recommendation of TKR.
  
  
  METHODS
  In this web-based study, 543 family and internal medicine physicians were given a scenario describing either a black or white patient with severe OA refractory to medical treatment. Questionnaires evaluating the likelihood of recommending TKR, perceived medical cooperativeness, and measures of implicit racial bias were administered. The main outcome measures included TKR recommendation, implicit racial preference, and medical cooperativeness stereotypes measured with implicit association tests.
  
  
  RESULTS
  Subjects displayed a strong implicit preference for whites over blacks (P < .0001) and associated "medically cooperative" with whites over blacks (P < .0001). Physicians reported significantly greater liking for whites over blacks (P < .0001) and reported believing whites were more medically cooperative than blacks (P < .0001). Participants reported providing similar care for white and black patients (P = .10) but agreed that subconscious biases could influence their treatment decisions (P < .0001). There was no significant difference in the rate of recommendation for TKR when the patient was black (47%) versus white (38%) (P = .439), and neither implicit nor explicit racial biases predicted differential treatment recommendations by race (all P > .06). Although participants were more likely to recommend TKR when completing the implicit association test before the decision, patient race was not significant in the association (P = .960).
  
  
  CONCLUSIONS
  Physicians possessed explicit and implicit racial biases, but those biases did not predict treatment recommendations. Clinicians' biases about the medical cooperativeness of blacks versus whites, however, may have influenced treatment decisions.
authors.affiliation: the Department of Family Medicine and the Department of Psychology, University of Virginia, Charlottesville; and the Virginia Commonwealth University, Richmond.
authors.forename: M Norman
authors.initials: MN
authors.lastname: Oliver
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Wells
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Joy-Gaba
authors.forename: Carlee Beth
authors.initials: CB
authors.lastname: Hawkins
authors.forename: Brian A
authors.initials: BA
authors.lastname: Nosek
mesh_terms: D000328:Adult; D001741:Black or African American; D019645:Arthroplasty, Replacement, Knee; D001291:Attitude of Health Personnel; D003657:Decision Making; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000208:ethnology / Q000601:surgery*; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D063505:Racism / Q000523:psychology*; D057566:Self Report; D011795:Surveys and Questionnaires; D014481:United States
keywords: African Americans; Health Care Disparities; Minority Health; Race; Racial Bias