WEBVTT - Do Doctors' Biases Affect Health Care?

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<v Speaker 1>Welcome to brain Stuff from How Stuff Works, Hey, brain

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<v Speaker 1>Stuff Lauren Vogelbaum here. Years of playing basketball had given

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<v Speaker 1>Damon Tweetie some bum knees. When the swelling didn't go

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<v Speaker 1>down on his left knee after a few days, he

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<v Speaker 1>went to an urgent care clinic for treatment. It was

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<v Speaker 1>his day off, and he was dressed in a T

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<v Speaker 1>shirt and sweatpants. He remembers the doctor never looked at me.

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<v Speaker 1>He just had me stand up, looked at my knees,

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<v Speaker 1>and then said, you'll be okay, take it easy. He

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<v Speaker 1>never even asked what kind of job I had. What

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<v Speaker 1>if Tweete's job required a lot of moving around in

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<v Speaker 1>a way it did. Damon Tweetie is a doctor himself,

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<v Speaker 1>and once he made that clear to the physician who

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<v Speaker 1>was treating him, everything changed. The doctor made eye contact

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<v Speaker 1>and started asking him questions. He even took Tweetie to

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<v Speaker 1>get an X ray. Tweet said, so it was an

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<v Speaker 1>example of two different levels of care. I was two

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<v Speaker 1>different people. First time, I was Damon Tweetie, random black

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<v Speaker 1>guy not to be taken seriously. In the second case,

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<v Speaker 1>I was Damon Tweete, m D and worthy of the

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<v Speaker 1>same care as anyone else, tweeted, told his story at

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<v Speaker 1>the Decatur Book Festival in Georgia and has written a

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<v Speaker 1>book that is part memoir and part discussion of bias

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<v Speaker 1>and medicine called black Man in a White Coat. Not

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<v Speaker 1>every medical mistep has to do with the accidental slip

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<v Speaker 1>of a scalpel or a medication dosing error. The unconscious

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<v Speaker 1>biases that everyone possesses, to one degree or another can

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<v Speaker 1>impact how a doctor cares for a patient. Wholly separate

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<v Speaker 1>from personally accepted prejudices like overt racism or homophobia, unconscious

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<v Speaker 1>biases are just that, biases that we don't even know

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<v Speaker 1>we have yet can impact how we treat others. We

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<v Speaker 1>also spoke with Renee Salazar, m d, a professor of

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<v Speaker 1>clinical medicine and the Director of Diversity in the Department

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<v Speaker 1>of Medicine at the University of California, San Francisco. She

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<v Speaker 1>put it this way, they're so deep within our psyche

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<v Speaker 1>that we're unaware of their existence. And we spoke with

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<v Speaker 1>Gordon Wallace, m d. Of the Canadian Medical Protective Association

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<v Speaker 1>via email. He explained that cognitive biases, or distortions of thinking,

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<v Speaker 1>are hardwired functions of the human brain, and they can

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<v Speaker 1>occasionally interfere with a doctor's ability to reach a correct diagnosis.

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<v Speaker 1>Racial bias is probably the most commonly studied type. However,

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<v Speaker 1>it's possible to harbor unconscious biases against all kinds of

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<v Speaker 1>people do for example, to their body weight, gender, or

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<v Speaker 1>sexual orientation. Cognitive bias isn't as obvious or easy to

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<v Speaker 1>pinpoint in a clinical setting because it isn't intentional. Many

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<v Speaker 1>studies have been conducted to determine whether or not doctors

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<v Speaker 1>possess unconscious biases, but one published in the Journal of

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<v Speaker 1>Internal Medicine took it a step further to measure how

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<v Speaker 1>these biases would actually affect treatment. In study, physicians using

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<v Speaker 1>an online tool were presented with randomized black and white

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<v Speaker 1>patients showing signs of coronary artery disease. The doctors assessed

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<v Speaker 1>the patients and recommended a course of treatment for each,

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<v Speaker 1>but the results showed that doctors more often suggested thrombolosis,

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<v Speaker 1>a treatment to break up blood clots, to the white patients,

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<v Speaker 1>while the black patients were left with less aggressive options.

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<v Speaker 1>The researchers drew the conclusion that unconscious biases can impact

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<v Speaker 1>the types of treatments prescribed to patients even when they

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<v Speaker 1>present the same symptoms as others. So if doctors are

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<v Speaker 1>completely unaware of their biases, how can they possibly change

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<v Speaker 1>their patient care strategies. Many turn to the implicit Association test,

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<v Speaker 1>a respected tool that assesses and reports on unconscious bias.

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<v Speaker 1>Dr Salazar said, what we find most often is there's

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<v Speaker 1>a disconnect between what people explicitly feel and what they

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<v Speaker 1>feel unconsciously. Once the results are available, it's easier to

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<v Speaker 1>be aware of personal cognitive biases and take steps to

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<v Speaker 1>minimize them. Many medical schools and hospitals are establishing curricula

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<v Speaker 1>to better train doctors on how to avoid the pitfalls

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<v Speaker 1>of cognitive bias, offering seminars and encouraging the use of

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<v Speaker 1>the I a T assessment tool. The Canadian Medical Protective

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<v Speaker 1>Association also backs up recommendations by expert Dr Pat Crosscerry,

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<v Speaker 1>an emergency physics and psychologist at Dalhousie University in Halifax,

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<v Speaker 1>Nova Scotia. Cross Carey suggests group decision making and consultation,

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<v Speaker 1>and the use of mindful reflection and slowing down strategies

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<v Speaker 1>to help the doctor deliberately transition from intuitive a k

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<v Speaker 1>A biased thinking to a more analytic mode. Following checklists

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<v Speaker 1>and computerized decision support systems also helped to remove the

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<v Speaker 1>human element, and experts suggest abiding by general rules of

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<v Speaker 1>thumb to avoid bias impact. For example, anyone exhibiting specific

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<v Speaker 1>neurological symptoms should always have their blood sugar tested. Self

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<v Speaker 1>awareness is also key to avoiding medical bias. Salazar explains,

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<v Speaker 1>just by knowing that these biases are there, we can

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<v Speaker 1>really take steps to reduce the impact. Let me stop

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<v Speaker 1>that process right now and make sure that I go

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<v Speaker 1>in with a clean slate and provide care with as

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<v Speaker 1>open a mind as possible. From a patient perspective, it's

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<v Speaker 1>not always going to be easy to figure out if

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<v Speaker 1>a medical provider is unconsciously biased against you or a

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<v Speaker 1>family member. To avoid being swept under the rug, ask

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<v Speaker 1>questions and document the answers, and never be afraid to

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<v Speaker 1>request an additional opinion or consult. Of course, doctors aren't

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<v Speaker 1>the only people who experience unconscious bias. You can take

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<v Speaker 1>an implicit association test online at implicit dot Harvard dot

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<v Speaker 1>a d u slash implicit to find out your true

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<v Speaker 1>opinions on a variety of issues, including sexual orientation, race,

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<v Speaker 1>and gender. The results could help you identify areas where

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<v Speaker 1>you could benefit from being more intentional, which, let's face it,

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<v Speaker 1>we've all got a few of. Today's episode was written

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<v Speaker 1>by Alia Hoyt and produced by Tyler Clang. Brain Stuff

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<v Speaker 1>has merched. Now you can contain your liquids, electronics, and

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<v Speaker 1>or body in brainy style by visiting t public dot

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<v Speaker 1>com slash brain stuff, and, of course, for lots more

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<v Speaker 1>on this and other intentional topics, visit our home planet,

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<v Speaker 1>how stuff works dot com.