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Implicit Bias and Microaggressions
Richa Bhatia, MD
DEI Committee Co-Chair

Implicit bias is ubiquitous among human beings (Martinez-Kaigi 2020). It may be
detected as early as preschool age (Setoh et al 2019). Because it is unconscious,
well-intentioned individuals may not be aware of having these biases. While ex-
plicit biases have substantially decreased in medicine in the last few decades, im-
plicit biases have been shown to persist. Evidence suggests that physicians may
have the same levels of implicit bias as the general population. Implicit bias may
contribute to maintaining and/or perpetuating the significant inequities which ex-
ist in healthcare. These inequities mainly affect racial/ethnic minorities, LGBTQ
individuals, and other minority populations, eg. evidence suggests that African
American patients are less likely to receive certain cardiac interventions and pro-
cedures. Studies show that minority patients have longer wait times in the ER (Park et al, 2009).
Studies show that implicit bias may affect physician judgement and behavior (Chapman et al 2013), and
higher levels of implicit bias may be linked to lower quality of care (Fitzgerald, Hurst 2017). Implicit bi-
as may affect physicians’ communication with patients and patient’s level of trust and engagement
(Zescott et al 2016).
Microaggressions are subtle, often automatic, verbal or non-verbal put downs or slights that are deni-
grating towards marginalized social groups. Sue et al (2007) classified microaggressions into three
main categories- microinsults (eg. assuming inferior intelligence in someone who doesn’t speak Eng-
lish), microassaults (more overt- eg. name calling), microinvalidations (minimizing or nullifying
someone’s experience, eg. ‘don’t be so sensitive’). 54% of medical students surveyed at a US medical
school reported microaggresions (Espillat et al 2019). Repeated microaggressions may take a cumula-
tive toll (Walker et al 2022) and may affect physical health, mental health, performance, and quality of
life (Williams 2020).
Introspection, improving self-awareness, consciously taking the other’s perspective, may be useful
steps individuals can take in recognizing and addressing implicit bias. To help reduce implicit bias in
healthcare, organizations can implement implicit bias testing, cultural humility training, counter-
stereotyping measures, and implicit bias awareness training.

Reflections after the Diversity, Equity and Inclusion Panel: Anti-Asian Vio-
lence and Discrimination
Rona J. Hu, MD

On Saturday, March 19, 2022 I was honored to be part of the Diversity, Equity
and Inclusion Panel at the NCPS Annual Meeting, live and in person after a two-
year pandemic. Our panel included my longtime mentor Dr. Francis Lu and Dr.
Richa Bhatia, both of whom are contributing their thoughts as well for this news-
letter. I’ll therefore focus on topics not otherwise covered so far.
The timing of our panel was apropos: just 3 days before, a Washington Post arti-
cle by Marian Chia-Ming Liu noted “A year after the Atlanta shootings, Asian
women live in fear”. My first, primal, gut reaction to the request for an interview and photograph was
“No!” A year ago, after the shootings and street violence against the elderly, major Silicon Valley com-
panies asked me to speak to their frightened Asian employees, and I did. The talks were very well-
received: Apple put me on their internal website and asked me to speak for them again, and the re-
sponses reached my superiors at Stanford, welcome recognition during an isolating and lonely pandem-
ic. But some of my relatives were aghast, warning me it would attract attention, make me a target, en-
courage the racists. So this time, a year later, I didn’t ignore my gut reaction: I acknowledged it exist-
ed, and why. But I didn’t let it dictate my actions.
The photo was an even more stressful prospect at first: I broke my back in August 2020 so I stopped
my usual fitness routines (I taught Zumba at Stanford for 7 years). I haven’t worn makeup since the
pandemic started. I worked on the acute inpatient unit, seeing patients in person for at least some of
every month of 2021, January to September, until my dad died in October 2021.
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