A one-liner works in comedy but leads to biases in medicine. Listening, getting to know, and learning from each patient will allow you to serve them best.
Lifelong Learning in Clinical Excellence | November 9, 2021 | 3 min read
Below is a reflection an article from the “Gaurdian,” entitled, “The bias that blinds: why some people get dangerously different medical care,” by Jessica Nordell.
Recently, I cared for a patient whose one-liner was, “a middle-aged man with history of chronic pain presenting with musculoskeletal chest pain.” As myself, a Black woman, and my attending, an Indian woman, began to discuss discharge plans, the patient’s demeanor changed. He became upset and wanted us to know that “he worked hard and that white people struggle too.” In our discharge plan, we hadn’t considered that he couldn’t afford the medications. He was a single parent who was already spending a great deal on his medical care and adding the cost of medication on top of that wasn’t feasible. This brief encounter revealed that there were many assumptions we had about him, and that he had about us.
A bias is a prejudice in favor of or against one thing. In medicine we’re constantly weighing choices, differentials, and possibilities: it’s a field littered with bias. As clinicians, recognizing our biases and understanding the biases set up by the systems we work in is key. One thing that’s perpetuated many biases in medicine is the “one-liner.” This one sentence seeks to simplify a whole person, a whole life, a whole system. It condenses information to build illness scripts that can be used to recognize patterns while also spotting zebras.
This system excludes social and economic factors, cultural and religious influences, baseline health literacy, and historical contexts that shape patient-doctor relationships. As a result, healthcare professionals aren’t equipped to care for a diverse array of patients because the lens of medicine has always been one of the majority perspectives.
Additionally, there’s little education in medical training on how bias impacts care. Some of us had a lecture or a module on social and environmental determinants of heath, which the EMR is now working to integrate. But again, as we reduce the complexities of a person’s life and experiences into one data point, we lose the nuances of all that encapsulate a life and illness. We must take measures to know our patient’s whole story, including the injustices they’ve experienced that can impact their health.
As we come to the end of our internal medicine residency training, we sat together, as three Black female physicians, to think of tips for clinicians in all specialties to improve their care of patients. Here’s a few that we hope you keep in mind:
1. Be aware of your privilege, perspective, and bias.
Beyond just the implicit bias assessments, what are your blind spots? Find books, articles, and podcasts that highlight biases in medicine and try to incorporate the learning pearls into your practice.
2. When reading articles in medical journals, consider who was included in the research studies.
Know that many disparities exist in recruitment efforts for clinical trials.
3. Be humble.
Listen to your patients and believe their experience. Brainstorm with your patient about how their experience affects their health and consider that in your patient-centered treatment plan.
4. Remember that access is key!
At the end of each patient encounter try to build points of access, like PCP, community health worker, and/or social worker, to minimize gaps in care.
5. Health disparities come from systems, not people.
People can only work within the systems they exist in, so be patient. Take the time to understand a patient’s struggle and empathize. This will help build rapport.
6. Take time to know your patient’s whole story.
Realize that this will take more than one visit.
7. Work to diversify medical staff.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.