Advancing health equity: Identifying existing biases

In a discussion with Medical Economics at the ACP Internal Medicine Meeting 2025 in New Orleans, Earl Stewart Jr., MD, FACP, shares real-world examples of how unconscious bias can influence clinical interactions — often without clinicians realizing it.

“I would say just the assumption that, you know, based on where a patient lives, or based on the patient’s specific ethnicity, that they’re automatically going to be noncompliant,” Stewart said. “We’ve gotten away in the profession of medicine really from incorporating that in some way by labeling patients based on their race.”

He reflected on how medical training has evolved, noting how the way patients are presented during clinical rounds — often emphasizing race in descriptors — can unintentionally perpetuate bias. "We’ve now understood that that’s not as important,” he said, acknowledging the shift in academic medicine. “Sometimes just that specific mechanism of how we learn and how we train can sometimes automatically trigger in a care team’s mind that, ‘Oh, this person may be this way.’”

Stewart also highlighted language choices in clinical documentation. Referencing the work of Fatima Cody Stanford, MD, MPH, MPA, at Harvard University, he emphasized respectful phrasing around weight-related conditions. “Changing our terminology from saying a patient is obese to saying a patient has obesity … those biases matter.”

He urged practices to ensure inclusivity for LGBTQ+ patients as well. "We’re grappling with this even in our own health system — how to effectively make them feel more included and make them feel like they belong,” Stewart said. That includes asking about pronouns and tailoring care respectfully: “It is their time, and so we have to make sure we afford them all of the rights, the privileges, and the respect that comes from delivering culturally competent, cost-conscious, evidence-based clinical care.”