Do Physicians' Implicit Views of African Americans Affect Clinical Decision Making?

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. Physicians9 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 P P P P = .10) but agreed that subconscious biases could influence their treatment decisions ( P 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. Clinicians9 biases about the medical cooperativeness of blacks versus whites, however, may have influenced treatment decisions.