Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Danger of Reinforcing Negative Biases


The way clinicians talk about patients publicly reinforces biases about race, gender, class, etc.

There have been several recent incidents of healthcare professionals mocking patients on social media. Many of these posts center on the idea of patients faking or exaggerating symptoms and, consequently, wasting the provider’s time. Those who defend these posts refer to them simply as “gallows humor,” the kind of humor that is intended to alleviate the stress that comes with working in intense clinical environments. They argue that while some of these jokes may seem insensitive to outsiders, making these jokes or laughing along with them does not affect patient care.


How humor can reinforce bias

To be sure, the clinical environment is a high-pressure one, with life or death hanging in balance every day. Yet, some patient populations are particularly vulnerable to the kind of attitude that underlies this humor. There is strong evidence that patients who are nonwhite, women, and/or chronically ill are less likely to have their symptoms taken seriously. Humor that revolves around the idea that some patients fake or exaggerate their symptoms may unintentionally normalize this perception among healthcare providers in ways that disproportionately harm those patients who are already more vulnerable to not being taken seriously. In other words, sometimes these attempts at humor can reinforce bias.


The consequences of bias

Delayed diagnosis and treatment, and poorer overall outcomes that contribute to health disparities, are some of the potential consequences. Additionally, patients who believe that their clinicians do not take them seriously may be reluctant to disclose important information, like additional symptoms or medication side effects. Other patients who do not feel that medical professionals take them seriously may feel it is even more important to advocate for themselves, to insist on being heard. Yet, being perceived as “too pushy” can also backfire, souring the encounter.


Furthermore, which patients are more likely to be perceived as “too pushy” or exaggerating is often mediated by broader sociocultural beliefs. For example, women’s symptom complaints are more likely to be dismissed as “in the head,” a tendency that Sasha Ottey, founder of the National Polycystic Ovary Syndrome Association, refers to as “healthcare gaslighting,” in her article in “The Atlantic.”


Healthcare professionals do not seem to exhibit any more bias than the general population. However to the extent that patients who are nonwhite, women, and/or chronically ill bear the disproportionate brunt of negative bias, clinicians must be mindful of the potentially life-threatening consequences of these biases.