ORIGINAL RESEARCH 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. Physi-cians ’ 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 im-plicit 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 as-sociated “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 blac