1 00:00:02,040 --> 00:00:06,840 Speaker 1: Welcome to brain Stuff from How Stuff Works, Hey, brain 2 00:00:06,880 --> 00:00:10,840 Speaker 1: Stuff Lauren Vogelbaum here. Years of playing basketball had given 3 00:00:10,960 --> 00:00:14,440 Speaker 1: Damon Tweetie some bum knees. When the swelling didn't go 4 00:00:14,520 --> 00:00:16,599 Speaker 1: down on his left knee after a few days, he 5 00:00:16,640 --> 00:00:19,279 Speaker 1: went to an urgent care clinic for treatment. It was 6 00:00:19,280 --> 00:00:20,680 Speaker 1: his day off, and he was dressed in a T 7 00:00:20,760 --> 00:00:24,479 Speaker 1: shirt and sweatpants. He remembers the doctor never looked at me. 8 00:00:24,840 --> 00:00:26,920 Speaker 1: He just had me stand up, looked at my knees, 9 00:00:26,960 --> 00:00:29,400 Speaker 1: and then said, you'll be okay, take it easy. He 10 00:00:29,480 --> 00:00:32,199 Speaker 1: never even asked what kind of job I had. What 11 00:00:32,280 --> 00:00:35,120 Speaker 1: if Tweete's job required a lot of moving around in 12 00:00:35,159 --> 00:00:38,559 Speaker 1: a way it did. Damon Tweetie is a doctor himself, 13 00:00:38,680 --> 00:00:40,400 Speaker 1: and once he made that clear to the physician who 14 00:00:40,440 --> 00:00:43,760 Speaker 1: was treating him, everything changed. The doctor made eye contact 15 00:00:43,760 --> 00:00:46,440 Speaker 1: and started asking him questions. He even took Tweetie to 16 00:00:46,479 --> 00:00:49,680 Speaker 1: get an X ray. Tweet said, so it was an 17 00:00:49,680 --> 00:00:52,600 Speaker 1: example of two different levels of care. I was two 18 00:00:52,640 --> 00:00:56,120 Speaker 1: different people. First time, I was Damon Tweetie, random black 19 00:00:56,160 --> 00:00:59,080 Speaker 1: guy not to be taken seriously. In the second case, 20 00:00:59,120 --> 00:01:01,520 Speaker 1: I was Damon Tweete, m D and worthy of the 21 00:01:01,560 --> 00:01:04,800 Speaker 1: same care as anyone else, tweeted, told his story at 22 00:01:04,800 --> 00:01:07,319 Speaker 1: the Decatur Book Festival in Georgia and has written a 23 00:01:07,319 --> 00:01:09,920 Speaker 1: book that is part memoir and part discussion of bias 24 00:01:09,920 --> 00:01:13,520 Speaker 1: and medicine called black Man in a White Coat. Not 25 00:01:13,640 --> 00:01:16,360 Speaker 1: every medical mistep has to do with the accidental slip 26 00:01:16,400 --> 00:01:20,199 Speaker 1: of a scalpel or a medication dosing error. The unconscious 27 00:01:20,200 --> 00:01:23,160 Speaker 1: biases that everyone possesses, to one degree or another can 28 00:01:23,240 --> 00:01:27,000 Speaker 1: impact how a doctor cares for a patient. Wholly separate 29 00:01:27,120 --> 00:01:32,240 Speaker 1: from personally accepted prejudices like overt racism or homophobia, unconscious 30 00:01:32,280 --> 00:01:35,440 Speaker 1: biases are just that, biases that we don't even know 31 00:01:35,520 --> 00:01:39,160 Speaker 1: we have yet can impact how we treat others. We 32 00:01:39,240 --> 00:01:42,080 Speaker 1: also spoke with Renee Salazar, m d, a professor of 33 00:01:42,080 --> 00:01:45,360 Speaker 1: clinical medicine and the Director of Diversity in the Department 34 00:01:45,400 --> 00:01:48,760 Speaker 1: of Medicine at the University of California, San Francisco. She 35 00:01:48,840 --> 00:01:51,600 Speaker 1: put it this way, they're so deep within our psyche 36 00:01:51,680 --> 00:01:54,920 Speaker 1: that we're unaware of their existence. And we spoke with 37 00:01:54,960 --> 00:01:58,720 Speaker 1: Gordon Wallace, m d. Of the Canadian Medical Protective Association 38 00:01:58,920 --> 00:02:03,400 Speaker 1: via email. He explained that cognitive biases, or distortions of thinking, 39 00:02:03,720 --> 00:02:06,800 Speaker 1: are hardwired functions of the human brain, and they can 40 00:02:06,840 --> 00:02:10,560 Speaker 1: occasionally interfere with a doctor's ability to reach a correct diagnosis. 41 00:02:11,240 --> 00:02:14,640 Speaker 1: Racial bias is probably the most commonly studied type. However, 42 00:02:14,680 --> 00:02:17,840 Speaker 1: it's possible to harbor unconscious biases against all kinds of 43 00:02:17,840 --> 00:02:21,000 Speaker 1: people do for example, to their body weight, gender, or 44 00:02:21,040 --> 00:02:25,680 Speaker 1: sexual orientation. Cognitive bias isn't as obvious or easy to 45 00:02:25,680 --> 00:02:29,320 Speaker 1: pinpoint in a clinical setting because it isn't intentional. Many 46 00:02:29,360 --> 00:02:32,080 Speaker 1: studies have been conducted to determine whether or not doctors 47 00:02:32,080 --> 00:02:35,840 Speaker 1: possess unconscious biases, but one published in the Journal of 48 00:02:35,880 --> 00:02:38,440 Speaker 1: Internal Medicine took it a step further to measure how 49 00:02:38,480 --> 00:02:42,799 Speaker 1: these biases would actually affect treatment. In study, physicians using 50 00:02:42,800 --> 00:02:46,000 Speaker 1: an online tool were presented with randomized black and white 51 00:02:46,000 --> 00:02:50,320 Speaker 1: patients showing signs of coronary artery disease. The doctors assessed 52 00:02:50,400 --> 00:02:52,800 Speaker 1: the patients and recommended a course of treatment for each, 53 00:02:53,240 --> 00:02:56,919 Speaker 1: but the results showed that doctors more often suggested thrombolosis, 54 00:02:56,919 --> 00:02:59,840 Speaker 1: a treatment to break up blood clots, to the white patients, 55 00:03:00,080 --> 00:03:03,440 Speaker 1: while the black patients were left with less aggressive options. 56 00:03:03,960 --> 00:03:07,720 Speaker 1: The researchers drew the conclusion that unconscious biases can impact 57 00:03:07,760 --> 00:03:10,720 Speaker 1: the types of treatments prescribed to patients even when they 58 00:03:10,760 --> 00:03:15,440 Speaker 1: present the same symptoms as others. So if doctors are 59 00:03:15,480 --> 00:03:18,800 Speaker 1: completely unaware of their biases, how can they possibly change 60 00:03:18,840 --> 00:03:23,200 Speaker 1: their patient care strategies. Many turn to the implicit Association test, 61 00:03:23,560 --> 00:03:27,040 Speaker 1: a respected tool that assesses and reports on unconscious bias. 62 00:03:27,800 --> 00:03:30,880 Speaker 1: Dr Salazar said, what we find most often is there's 63 00:03:30,880 --> 00:03:34,040 Speaker 1: a disconnect between what people explicitly feel and what they 64 00:03:34,080 --> 00:03:38,000 Speaker 1: feel unconsciously. Once the results are available, it's easier to 65 00:03:38,040 --> 00:03:40,920 Speaker 1: be aware of personal cognitive biases and take steps to 66 00:03:40,960 --> 00:03:45,320 Speaker 1: minimize them. Many medical schools and hospitals are establishing curricula 67 00:03:45,360 --> 00:03:47,800 Speaker 1: to better train doctors on how to avoid the pitfalls 68 00:03:47,840 --> 00:03:51,280 Speaker 1: of cognitive bias, offering seminars and encouraging the use of 69 00:03:51,320 --> 00:03:54,640 Speaker 1: the I a T assessment tool. The Canadian Medical Protective 70 00:03:54,640 --> 00:03:59,000 Speaker 1: Association also backs up recommendations by expert Dr Pat Crosscerry, 71 00:03:59,080 --> 00:04:02,880 Speaker 1: an emergency physics and psychologist at Dalhousie University in Halifax, 72 00:04:02,920 --> 00:04:07,480 Speaker 1: Nova Scotia. Cross Carey suggests group decision making and consultation, 73 00:04:07,840 --> 00:04:11,160 Speaker 1: and the use of mindful reflection and slowing down strategies 74 00:04:11,200 --> 00:04:14,280 Speaker 1: to help the doctor deliberately transition from intuitive a k 75 00:04:14,480 --> 00:04:18,960 Speaker 1: A biased thinking to a more analytic mode. Following checklists 76 00:04:19,000 --> 00:04:22,800 Speaker 1: and computerized decision support systems also helped to remove the 77 00:04:22,880 --> 00:04:26,520 Speaker 1: human element, and experts suggest abiding by general rules of 78 00:04:26,560 --> 00:04:31,120 Speaker 1: thumb to avoid bias impact. For example, anyone exhibiting specific 79 00:04:31,120 --> 00:04:35,400 Speaker 1: neurological symptoms should always have their blood sugar tested. Self 80 00:04:35,400 --> 00:04:40,080 Speaker 1: awareness is also key to avoiding medical bias. Salazar explains, 81 00:04:40,120 --> 00:04:42,880 Speaker 1: just by knowing that these biases are there, we can 82 00:04:42,920 --> 00:04:45,839 Speaker 1: really take steps to reduce the impact. Let me stop 83 00:04:45,839 --> 00:04:47,720 Speaker 1: that process right now and make sure that I go 84 00:04:47,800 --> 00:04:50,280 Speaker 1: in with a clean slate and provide care with as 85 00:04:50,320 --> 00:04:53,760 Speaker 1: open a mind as possible. From a patient perspective, it's 86 00:04:53,800 --> 00:04:55,719 Speaker 1: not always going to be easy to figure out if 87 00:04:55,720 --> 00:04:58,719 Speaker 1: a medical provider is unconsciously biased against you or a 88 00:04:58,800 --> 00:05:02,200 Speaker 1: family member. To avoid being swept under the rug, ask 89 00:05:02,320 --> 00:05:05,200 Speaker 1: questions and document the answers, and never be afraid to 90 00:05:05,240 --> 00:05:09,920 Speaker 1: request an additional opinion or consult. Of course, doctors aren't 91 00:05:09,920 --> 00:05:13,039 Speaker 1: the only people who experience unconscious bias. You can take 92 00:05:13,080 --> 00:05:17,159 Speaker 1: an implicit association test online at implicit dot Harvard dot 93 00:05:17,160 --> 00:05:20,080 Speaker 1: a d u slash implicit to find out your true 94 00:05:20,080 --> 00:05:24,120 Speaker 1: opinions on a variety of issues, including sexual orientation, race, 95 00:05:24,240 --> 00:05:27,320 Speaker 1: and gender. The results could help you identify areas where 96 00:05:27,360 --> 00:05:30,840 Speaker 1: you could benefit from being more intentional, which, let's face it, 97 00:05:31,080 --> 00:05:38,719 Speaker 1: we've all got a few of. Today's episode was written 98 00:05:38,720 --> 00:05:41,760 Speaker 1: by Alia Hoyt and produced by Tyler Clang. Brain Stuff 99 00:05:41,800 --> 00:05:44,839 Speaker 1: has merched. Now you can contain your liquids, electronics, and 100 00:05:45,040 --> 00:05:47,800 Speaker 1: or body in brainy style by visiting t public dot 101 00:05:47,839 --> 00:05:51,080 Speaker 1: com slash brain stuff, and, of course, for lots more 102 00:05:51,080 --> 00:05:54,080 Speaker 1: on this and other intentional topics, visit our home planet, 103 00:05:54,360 --> 00:06:07,000 Speaker 1: how stuff works dot com.