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The Intergroup Time Bias effect and Its psychological mechanisms in the medical context
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The Intergroup Time Bias (ITB) effect is a discriminatory behavior characterized by individuals’ motivation to invest more time in members of their own social group as compared to those from different social groups. This phenomenon can profoundly impact various facets of social life, especially within the context of healthcare provision. In the healthcare domain, time is a crucial factor that notably influences both medical decision-making and the ultimate satisfaction of patients with their care outcomes. However, what if the allocation of time in this context is not distributed equally among patients from different social groups, revealing an unobtrusive and often overlooked form of intergroup discrimination? What are the implications of the ITB effect on healthcare outcomes for patients? In the medical context, is the ITB effect associated with well-known racial attitudes, such as aversive racism? This dissertation presents a comprehensive research program that provides evidence that the ITB represents one of the primary insidious discriminatory behaviors exhibited by aversive racists, which ultimately impacts the quality of medical care provided to patients. Our research program was conducted within the clinical assessment and medical decision-making processes to investigate whether White medical trainees exhibit a bias in their investment of time that favors White (vs. Black) patients. Additionally, we investigated whether the ITB effect contributes to healthcare disparities, impacting patient care quality. Critically, the research examines the relationship between ITB and aversive racism in two distinct ways. First, we propose that the ITB is most prevalent among individuals who claim to uphold egalitarian beliefs, consider themselves non-racist, but hold nonconscious negative attitudes and beliefs about Black individuals (i.e., aversive racists). Second, we suggest that avoidance behavior, specifically physical examination avoidance of patients, may serve as an underlying mechanism through which patients’ skin color influences the time invested, particularly among individuals exhibiting an aversive racist profile. In addition to discussing the significance of time in psychological literature and discrimination in healthcare provision within asymmetric intergroup relationships (Chapter 1), this research program includes eight studies and eight pre-tests of paradigms and materials organized in three empirical chapters. These chapters examine whether White medical trainees invest more time in White than Black patients across various healthcare aspects. Specifically, Chapter 2 reveals that White trainees display ITB in forming first impressions, indicating diagnostic hypotheses, assessing pain, and prescribing opioids, with the effect being stronger in those with an aversive racist profile. Chapter 3 replicates the ITB effect in the diagnostic and clinical action recommendation realms and demonstrates that this time bias mediates the effect of patients’ skin color on diagnostic accuracy and recommendation quality. Chapter 4 extends the ITB investigation to the communication domain, exploring whether physical examination avoidance underlies the ITB effect in medical context among individuals who express an aversive racist profile. The synthesis of this research program provides the first experimental evidence that bias in time investment, favoring White over Black patients, is associated with aversive racism and impacts healthcare outcomes. These findings contribute to understanding the socio-psychological implications of time investment in healthcare, offering a new theoretical explanation for an understudied, insidious form of discrimination underlying racial healthcare disparities.
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relações intergrupais enviesamento do tempo nas relações intergrupais racismo aversivo afeto aversivo contexto médico disparidades nos cuidados de saúde intergroup relations intergroup time bias aversive racism aversive affect medical context healthcare disparities