Implicit Bias – Is it Real?

Premier Pulse     September 2019

Belcastro_350x350By Marc Belcastro, DO, chief medical officer, Premier Health Southern Region

Implicit, or unconscious, bias is an unconsciously held set of associations about a social group. The word “unconscious” implies that we are not aware of these patterns. A more academic description is often noted as implicit social cognition. These attitudes or stereotypes affect our actions and decisions in an unconscious manner. Thus, implicit biases are not accessible through introspection. These associations develop over the course of a lifetime, beginning at a very early age, through exposure to direct and indirect messages. These unconscious beliefs can exist for race, religion, gender, weight, generations, socioeconomic status, and a variety of other groups. While less common, it is even possible to have an implicit bias toward a group to which one belongs.

My exposure to this area of cognitive research came while studying infant mortality and birth outcomes improvement. Shockingly, black infants have approximately twice the rate of preterm birth and infant mortality compared with non-black infants – the current theory being that the chronic stress of maternal exposure to societal and health care workers’ implicit biases can predispose the maternal physiology to preterm labor. 

A greater awareness of this topic can improve communication and your relationships with your patients and ultimately a compassion they will more likely experience. The following is a personal story that helped me explore my own attitudes and deeply held associations: The NICU team was preparing for the discharge of a preterm infant to a socially and economically challenged family, when a nurse stated that the mother had not visited her baby in the past two weeks. Parental participation is critical for the safe discharge of a preterm infant. As the care team discussed the mother’s lack of involvement, imagine the variety of stories verbalized by the rounding team. Fortunately, our astute social worker said, “She is a single mother, working two jobs, with two children in school, and her car recently broke down. She has not been able to visit due to lack of transportation and time.”

This moment was pivotal for me. My beliefs and conversations with families shifted to assuming the best, even when the information or situation appeared to indicate otherwise. My connections with families became stronger and my compassion was deepened. While much of this research has been challenged, and the implicit bias tests viewed with skepticism by some, I would encourage you to remain open to exploring this topic.

If you have any interest in testing and self-improvement work, two popular links are and

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