WEBVTT - BrainStuff Classics: Do Doctors' Biases Affect Health Care? 0:00:01.800 --> 0:00:04.320 Welcome to brain Stuff, a production of I Heart Radio. 0:00:06.720 --> 0:00:09.680 Hey brain Stuff Lauren Bogle Bam here, and this is 0:00:09.720 --> 0:00:13.160 a classic episode from our archives. This one goes into 0:00:13.240 --> 0:00:17.279 unconscious biases. We all have them, and many of us 0:00:17.280 --> 0:00:20.599 are working on them. But what happens when our doctors 0:00:20.800 --> 0:00:26.479 have them? Hey brain Stuff Lauren Vogelbaum here. Years of 0:00:26.520 --> 0:00:30.680 playing basketball had given Damon Tweetie some bum knees. When 0:00:30.720 --> 0:00:32.800 the swelling didn't go down on his left knee after 0:00:32.840 --> 0:00:35.200 a few days, he went to an urgent care clinic 0:00:35.280 --> 0:00:37.240 for treatment. It was his day off and he was 0:00:37.320 --> 0:00:40.360 dressed in a T shirt and sweatpants. He remembers the 0:00:40.440 --> 0:00:43.199 doctor never looked at me. He just had me stand up, 0:00:43.240 --> 0:00:45.479 looked at my knees, and then said you'll be okay, 0:00:45.520 --> 0:00:47.640 take it easy. He never even asked what kind of 0:00:47.760 --> 0:00:50.879 job I had? What if Tweete's job required a lot 0:00:50.920 --> 0:00:54.520 of moving around in a way it did. Damon Tweetie 0:00:54.560 --> 0:00:56.840 is a doctor himself, and once he made that clear 0:00:56.840 --> 0:00:59.640 to the physician who was treating him, everything changed. The 0:00:59.680 --> 0:01:02.680 doctor made eye contact and started asking him questions. He 0:01:02.720 --> 0:01:05.679 even took Tweetie to get an X ray. Tweety said, 0:01:06.080 --> 0:01:08.839 so it was an example of two different levels of care. 0:01:09.200 --> 0:01:12.440 I was two different people. First time, I was Damon Tweety, 0:01:12.600 --> 0:01:15.600 random black guy not to be taken seriously. In the 0:01:15.640 --> 0:01:17.960 second case, I was Damon tweet E m d. And 0:01:18.080 --> 0:01:21.360 worthy of the same care as anyone else. Tweety told 0:01:21.360 --> 0:01:23.720 his story at the Decatur Book Festival in Georgia and 0:01:23.800 --> 0:01:26.080 has written a book that is part memoir and part 0:01:26.080 --> 0:01:28.800 discussion of bias and medicine, called black Man in a 0:01:28.840 --> 0:01:32.440 White Coat. Not every medical misstep has to do with 0:01:32.480 --> 0:01:36.040 the accidental slip of a scalpel or a medication dosing error. 0:01:36.480 --> 0:01:39.520 The unconscious biases that everyone possesses to one degree or 0:01:39.560 --> 0:01:42.480 another can impact how a doctor cares for a patient. 0:01:43.319 --> 0:01:48.240 Wholly separate from personally accepted prejudices like overt racism or homophobia. 0:01:48.680 --> 0:01:52.440 Unconscious biases are just that, biases that we don't even 0:01:52.480 --> 0:01:55.440 know we have yet can impact how we treat others. 0:01:56.160 --> 0:01:59.080 We also spoke with Renee Salazar, m d. A professor 0:01:59.120 --> 0:02:01.960 of clinical medicine and the Director of Diversity in the 0:02:02.000 --> 0:02:05.280 Department of Medicine at the University of California, San Francisco. 0:02:05.800 --> 0:02:08.280 She put it this way, They're so deep within our 0:02:08.320 --> 0:02:11.960 psyche that we're unaware of their existence, and we spoke 0:02:11.960 --> 0:02:15.160 with Gordon Wallace, m d. Of the Canadian Medical Protective 0:02:15.160 --> 0:02:20.079 Association via email. He explained that cognitive biases, or distortions 0:02:20.080 --> 0:02:23.600 of thinking, are hardwired functions of the human brain, and 0:02:23.639 --> 0:02:26.480 they can occasionally interfere with a doctor's ability to reach 0:02:26.520 --> 0:02:30.360 a correct diagnosis. Racial bias is probably the most commonly 0:02:30.400 --> 0:02:34.239 studied type. However, it's possible to harbor unconscious biases against 0:02:34.320 --> 0:02:37.840 all kinds of people do for example, to their body weight, gender, 0:02:38.040 --> 0:02:42.680 or sexual orientation. Cognitive bias isn't as obvious or easy 0:02:42.720 --> 0:02:45.680 to pinpoint in a clinical setting because it isn't intentional. 0:02:46.200 --> 0:02:48.680 Many studies have been conducted to determine whether or not 0:02:48.800 --> 0:02:52.840 doctors possess unconscious biases, but one published in the Journal 0:02:52.880 --> 0:02:55.320 of Internal Medicine took it a step further to measure 0:02:55.400 --> 0:02:59.600 how these biases would actually affect treatment. In study, physicians 0:02:59.680 --> 0:03:02.760 using an online tool were presented with randomized black and 0:03:02.840 --> 0:03:07.040 white patients showing signs of coronary artery disease. The doctors 0:03:07.040 --> 0:03:09.480 assessed to the patients and recommended a course of treatment 0:03:09.520 --> 0:03:12.640 for each, but the results showed that doctors more often 0:03:12.680 --> 0:03:15.960 suggested thrombolosis, a treatment to break up blood clots to 0:03:16.000 --> 0:03:18.960 the white patients, while the black patients were left with 0:03:19.120 --> 0:03:23.400 less aggressive options. The researchers drew the conclusion that unconscious 0:03:23.440 --> 0:03:27.200 biases can impact the types of treatments prescribed to patients 0:03:27.280 --> 0:03:31.399 even when they present the same symptoms as others. So 0:03:31.800 --> 0:03:34.800 if doctors are completely unaware of their biases, how can 0:03:34.840 --> 0:03:38.480 they possibly change their patient care strategies. Many turned to 0:03:38.520 --> 0:03:42.400 the Implicit Association Test, a respected tool that assesses and 0:03:42.520 --> 0:03:46.760 reports on unconscious bias. Dr Salazar said, what we find 0:03:46.880 --> 0:03:50.200 most often is there's a disconnect between what people explicitly 0:03:50.280 --> 0:03:54.280 feel and what they feel unconsciously. Once the results are available, 0:03:54.440 --> 0:03:57.160 it's easier to be aware of personal cognitive biases and 0:03:57.280 --> 0:04:01.320 take steps to minimize them. Manydical schools and hospitals are 0:04:01.400 --> 0:04:04.360 establishing curricula to better train doctors on how to avoid 0:04:04.360 --> 0:04:08.040 the pitfalls of cognitive bias, offering seminars and encouraging the 0:04:08.120 --> 0:04:11.040 use of the I a T assessment tool. The Canadian 0:04:11.040 --> 0:04:15.040 Medical Protective Association also backs up recommendations by expert Dr 0:04:15.120 --> 0:04:18.640 pat cross Carry, an emergency physician and psychologist at Dalhousie 0:04:18.760 --> 0:04:23.239 University in Halifax, Nova Scotia. Cross Carry suggests group decision 0:04:23.240 --> 0:04:26.800 making and consultation, and the use of mindful reflection and 0:04:26.920 --> 0:04:30.640 slowing down strategies to help the doctor deliberately transition from 0:04:30.680 --> 0:04:34.320 intuitive a k a. Biased thinking to a more analytic mode. 0:04:35.080 --> 0:04:39.479 Following checklists and computerized decision support systems also helped to 0:04:39.520 --> 0:04:43.200 remove the human element, and experts suggest abiding by general 0:04:43.279 --> 0:04:47.239 rules of thumb to avoid bias impact. For example, anyone 0:04:47.279 --> 0:04:51.359 exhibiting specific neurological symptoms should always have their blood sugar tested. 0:04:52.240 --> 0:04:57.200 Self awareness is also key to avoiding medical bias. Salazar explains, 0:04:57.240 --> 0:05:00.000 just by knowing that these biases are there, we can 0:05:00.040 --> 0:05:02.960 really take steps to reduce the impact. Let me stop 0:05:02.960 --> 0:05:04.840 that process right now and make sure that I go 0:05:04.920 --> 0:05:07.400 in with a clean slate and provide care with as 0:05:07.400 --> 0:05:10.880 open a mind as possible. From a patient perspective, It's 0:05:10.880 --> 0:05:12.840 not always going to be easy to figure out if 0:05:12.839 --> 0:05:15.839 a medical provider is unconsciously biased against you or a 0:05:15.880 --> 0:05:19.320 family member. To avoid being swept under the rug, ask 0:05:19.400 --> 0:05:22.320 questions and document the answers, and never be afraid to 0:05:22.320 --> 0:05:26.800 request an additional opinion or consult Doctors aren't the only 0:05:26.839 --> 0:05:30.760 people who experience unconscious bias. You can take an implicit 0:05:30.800 --> 0:05:35.320 association test online at implicit dot Harvard dot edu to 0:05:35.600 --> 0:05:38.320 find out your true opinions on a variety of issues 0:05:38.600 --> 0:05:42.920 including sexual orientation, race, and gender. The results could help 0:05:42.920 --> 0:05:46.800 you identify areas where you might benefit from being more intentional, which, 0:05:47.000 --> 0:05:54.359 let's face it, we've all got a few up. Today's 0:05:54.360 --> 0:05:57.080 episode is based on the article how do doctor's biases 0:05:57.120 --> 0:05:59.359 affect your health Care? On how stuff works dot com, 0:05:59.360 --> 0:06:02.160 written by a Ahoy. Brain Stuff is production by Heart 0:06:02.240 --> 0:06:04.320 Radio in partnership with how stuffworks dot com, and it's 0:06:04.360 --> 0:06:07.640 produced by Tyler Playing. For more podcasts from my heart Radio, 0:06:07.880 --> 0:06:10.520 visit the i heart Radio app, Apple Podcasts, or wherever 0:06:10.560 --> 0:06:11.920 you listen to your favorite shows.