Cooper and other researchers examined audio recordings of office visits among 40 primary care physicians and 269 patients in Baltimore-area medical practices. The recordings were from earlier studies examining care regimens for patients with chronic diseases such as hypertension and depression. The patients were mostly middle-aged women, and 80% were African-Americans. Of the physicians, 48% were white, 30% were Asian, and 22% were African-American. Two-thirds of the physicians were women.
The researchers used the standard Implicit Association Test to assess the physicians' unconscious racial attitudes. The physician took two versions of the IAT—one related to race bias and one that assessed whether the physicians thought patients of different races were compliant with medical advice.
"I don't know if these physicians were aware that they were acting this way because of the unconscious stereotype," Cooper says. "I don't think we were quite prepared for the finding that when physicians would have that unconscious stereotype, it almost seem like they were trying to compensate by talking more slowly and lecturing the patients. That was surprising."
Cooper says there is a lack of awareness in the general public as well as among physicians about this unconscious bias. "A lot of people feel on a conscious level they have very positive attitudes about people of different racial and ethnic backgrounds. So they don't feel on a conscious level that there is a problem," she says. "But we are socialized in such a way that these unconscious biases are there from an early point in our lives. We don't realize that we are behaving in a certain way."