Why it’s important for physicians to talk about bias

I’m not racist.

I would never refuse to give a patient pain medication or fail to properly get her on a transplant waiting list just because she was black.

And, yet, to deny that I hold any bias would be foolish, naïve at best.

Ask any American if he or she is racist, and you’re likely to get a resounding no. Look at numbers on interview callbacks or prison sentences, and you get a different story. In 2004, researchers at the University of Chicago and MIT found that people with White-sounding names were 50 percent more likely to get callbacks for job interviews compared to those with African American-sounding names. More recently, a report by the U.S. Sentencing Commission found that convicted Black males received federal prison sentences that were 20 percent longer than those given to White males convicted of similar crimes.

Even medicine, a field presumed to have an intrinsic social accountability that differentiates it from others, isn’t immune to the effects of pervasive racism. In his paper published last March, “Education to Identify and Combat Racial Bias in Pain Treatment,” Brian Drwecki describes how,

… members of minority groups have longer wait times in the ER, are less likely to receive catheterization when identical expressions of chest pain are presented, and are less likely to be recommended for evaluation at a transplant center or be placed on a transplant waiting list when suffering from end-stage renal disease. African Americans receive lower-quality pain treatment, even when covered by the same medical insurance and seeking treatment at the same emergency department as patients of other races.

Do we still have too many racist doctors?

The reality is that even when we are not aware of our biases against certain marginalized groups, we all inevitably hold implicit biases. These biases “can leak out through non-verbal behaviors, such as eye contact, speech errors and other subtle avoidance behaviors that convey dislike or unease in the presence of minority group patients.” Implicit biases, as they tend to escape our consciousness, are more difficult to address and, hence, are all the more dangerous. However, when mounting evidence indicates that individual provider bias is associated with health disparities that affect millions of Americans, remaining by the sidelines is not an option.

Indeed, medical institutions across the country are increasingly recognizing the need to address how provider bias can adversely impact patient health outcomes. Educational interventions that seek to directly confront individual bias through methods such as guided introspection can yield substantial discomfort for participants. One paper details “how individuals might move from absolute denial of and defensiveness about [unconscious bias] to acceptance of [unconscious bias] and the ability to recognize it in oneself and then to mitigate its influence on behavior with patients.” Growing pains are unavoidable. Exposing clinicians and others to the notion of bias and increasing their awareness of their own biases is a crucial first step for “debiasing.”

When issues of bias are not openly discussed, both performance and well being of the clinicians themselves can suffer as well. For instance, perceived gender discrimination has been known to contribute to current trends of low numbers of women in surgical fields. One recent study found that “women in departments of academic surgery were 10 times more likely to perceive gender discrimination than their male colleagues.” Bias is discerned from the very beginning of medical training and persists despite ascending the echelons of academic medicine. In response, lower self-confidence and self-esteem, cynicism, and feelings of isolation can emerge.

A little over a year ago, I published an account of my own experiences with encountering bias in the medical school admissions process. These incidents teemed with microaggressions and other discriminatory behaviors. My post seemed to hit a nerve with many of my peers. I bore witness to much frustration, anxiety, anger, and pain. Yet, unlike what the authors of a recent article in the Atlantic, “The Coddling of the American Mind” assert, too much space to discuss microaggressions was not the culprit of this mental anguish.

Too little space was.

Many students I spoke with yearned for more transparency in admissions and grievances processes. Others lamented the lack of strong mentorship for people of marginalized backgrounds. All felt a dearth of spaces in their classrooms and social groups to openly discuss perceived discrimination without being deemed as “overly sensitive” or “too angry.”

The consequences of not adequately addressing microaggressions are too grave to ignore. The paper, “Racial Microaggressions in Everyday Life: Implications for Clinical Practice” provides readers with much-needed insight on the ramifications of ignoring the influence of microaggressions. In it, the authors declare, “Although microaggressions may be seemingly innocuous and insignificant, their effects can be quite dramatic … this contemporary form of racism is many times over more problematic, damaging, and injurious to persons of color than overt racist acts.” They continue on to discuss implications for reduced mortality and increased morbidity.

We need to talk about bias, so we don’t perpetuate gross social injustices.

These injustices are not inherently the product of malicious racists. Often, they are the result of well-intentioned people who engage in problematic power dynamics. Becoming aware of these dynamics and opening the space for discussion on how to counter such dynamics very early on is key. Otherwise, a dearth of such instruction and support would result in the consolidation of detrimental social and professional norms.

It’s uncomfortable. And it will be messy. But it cannot, must not be silenced.

Tehreem Rehman is a medical student.

Image credit: Shutterstock.com

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