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

Treating all patients with compassion


Physician bias is one driver of poor health outcomes among Black patients. A commitment to compassion and active listening can combat this trend. 

I lay on a hard bed in a cold, nearly empty exam room in my local emergency room, my mother sitting in the corner worried as I held my belly tight, squirming from pain. We waited for the results of my CT scan. The doctor walked in and without niceties asked, “How many pregnancies have you had?” 


Despite the physical pain of even speaking, I said “Zero.” 


Irritated, he rephrased his question. “I don’t think you understand me. I’m not asking how many children you have, I’m asking how many pregnancies you’ve had.  


Returning his irritation with my own, I replied, “I understood your question. The answer is still zero.” 


“You’re 26? Hmm. That’s surprising. Typically, Black women like you have had pregnancies by now.” 


I gave my mom the look that said, “Please let this go, don’t confront this doctor.” I just wanted to go home. 


Steps to improve Black patients’ health 

I’ll never forgot how I felt at that moment. My physician believed that I, as a Black, middle-class woman should have been pregnant many times by now. The doctor relied on his biases against women and Black people to discriminate against me and deny me much needed care.  


I know that physician bias like this is one factor in Black people’s generally worse health. I also know that other Black people have the same story as mine. From this experience, and similar experiences shared by other people from minority groups, I often focus on three basic ideas that clinicians can use to give better care to Black and minority patients:  


1. Go beyond awareness of biases and be proactive in preventing and countering discrimination.

Clinicians must acknowledge their biases, including all the ways that their different biases work together, learn about how biases turn into discrimination, and rely on checks and balances within their care team to catch, prevent, or correct potentially discriminatory care. 


2. Don’t blame Black patients for their poor health.

Black people’s generally poor health is not because of some biological flaw or a lack of concern for their own health. A lack of resources and racism’s influence in institutions like housing and education, which can affect health, are a better explanation for the state of Black people’s health. 


3. Listen. 

It’s a simple action but listening can do so much for establishing trust between Black patients and clinicians who represent an institution that has often dispensed violence against Black people. 


It will take effort and action from individual clinicians and the institutions that employ them to improve Black patients’ health. In sum, it will take a commitment to treating Black people like all patients: human beings worthy of compassion.  








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.