Medicine is very much like driving. As an emergency physician, when you see a patient, you ask the same questions, “What brought you in today? What’s bothering you?” and go through the normal flow of the history and physical. You order the same labs and imaging reflexively. When you’re driving to a location that you’ve been to many times before, when you get into your car again and turn the ignition on, it seems like seconds later you are at your destination. And you don’t even realize this happened until after the fact.
Is this unconsciousness in medicine a good thing? When time is of the essence, sometimes yes. You allow your knowledge and reflexes to take over in emergency cases while pressing the brakes slowly if you need to recalibrate and seek assistance.
Surgeons would tell you this too. I was on a helicopter to retrieve a heart one time, and when we came back to the hospital, the cardiothoracic surgeon had his arms crossed, took a hard look at the heart, and slowly cradled it to the operating table. 10+ hours later, with minimal complications, the patient had a new heart.
Though, let’s think of unconsciousness as implicit biases. As medical students, we’re taught that African Americans run a higher risk of elevated blood pressure. The elderly have several comorbidities and are frail. Patients who are obese because they don’t eat right or exercise regularly. The implicit biases are endless, and some are outright dangerous.
Fact: Black cardiac arrest victims receive fewer bystander CPR than white cardiac arrest victims.
Fact: Patients of color are frequently blamed for not taking an active part in their health care.
Fact: The homeless are often assumed to be medication-seeking and come to the ER feigning illness for food and shelter.
Regardless of medical training, we all have implicit biases. In situations where we must act right away, we often fall back on our implicit biases for answers. For guidance as to how to proceed next. Do I give this medication or not? Do I need to consult this service or not? Do I trust what this patient is telling me or not?
It’s far too easy to make assumptions because it’s the path of least resistance in our way of thinking. To truly see the patient in front of you and hear the words they say takes time and consideration, which is often lost in different places like the ER because of the demanding and high-stress environment. Trust in medicine is lost too, leading to patients who are discriminated against to them rarely trusting the medical profession again.
How do we then address implicit biases? It starts in medical school and what’s taught by professors, mentors, residents, and attendings. Not only what is taught, but the verbal and nonverbal actions students see from their teachers. Students model what they see, and if they see discrimination against minorities not being addressed, some students may see this as acceptable behavior. And from that point forward, the implicit biases of their teachers become theirs. Medical schools also need to have courses that teach about implicit biases, racism in medicine, and real-life examples of both.
Outside of education, self-reflection is a big part of reducing implicit bias. Reflecting on a past patient and how things could have gone differently. Actively changing your worldview to take out the stereotypes of others you may hold true. Most of all, every future interaction with a patient is a conversation with a person. A person who has a story to tell based on a life lived so far.
So yes, medicine is very much like driving. But, instead of being a passive driver and allowing the streets to pass you by, be conscious and take time to make decisions. The more time you take and the more thought you give, there is no more unconsciousness in medicine.
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