Check out the Today’s Wound Clinic guest editorial written by my friend and colleague, Monique Abner, MD about implicit bias, Wrestling With Implicit Bias to Deliver Better Care for Our Patients.
I have been thinking a lot about bias since I started going to doctor’s appointments with friends and family. A few weeks ago, I visited the father of a lifelong friend who was hospitalized after a fall. The patient, despite his 90-something age, was alert and articulate. He was also a well known academic and if I said more about who he is, it would be a HIPAA violation. His daughter, who had been in his hospital room with him since his admission, is the CEO of a major medical system. Despite their combined “credibility,” the attending physician’s attitude changed from condescending to collaborative when I casually mentioned that I was a physician. When the attending physician left the room, my girlfriend said, “Well, thank you for that. She has not listened to what I was trying to tell her until now.” I have seen that happen many times and so, likely have you.
My Mom suffers from “age bias.” She is in her late nineties but is on no medications, still drives, shops and lives independently. I am aware that she is at the far right of the “bell curve of function” for her age. But, a year ago when she was genuinely sick with an abdominal abscess, the only reason the very kind surgeon hospitalized her is because I went with her to seen him and said, “I know she is sick and if you get a CT scan, you will see an abscess.” He listened, she had an abscess, he handled it, and afterwards said, “You were right – I didn’t think she was sick.” In his defense, she had none of the findings that are typical with an abscess – she hadn’t even managed to raise a white count or a fever. However, she looked and felt “sick.” To quote my mother, “When you are in your nineties and tell the doctor you are tired, lack energy, and believe that something is seriously wrong, they roll their eyes.”
As humans we all have preconceived ideas about the way that the world works. Some of those preconceptions contribute to useful survival skills. As doctors, some of those preconceptions can be useful in guiding our interactions (as a simple example, I never call a patient by their first name unless they ask me to, particularly among patients who are older than I am since many of our parent’s generation consider it disrespectful – and that I supposed is a form of bias). But preconceptions can also cause us not to ask the right questions or not to listen open-mindedly to the answers.
I don’t have a solution other than to maintain as much humility as we can. One of my many favorite quotes is, “It’s what you learn after you know it all that counts,” variously attributed to President Harry Truman, Coach John Wooden and baseball manager Earl Weaver. Whoever said it first, it’s a good rule for physicians. If we could keep our interactions with patients focused on what it is that they can teach us today, we could overcome a lot of bias, implicit and otherwise. We’d be better doctors, and probably be better people. Sometimes what we “know” is the PROBLEM.