This post was written by Dr. Bernie Lopez, Associate Provost for Diversity and Inclusion at Thomas Jefferson University, and Executive Vice Chair of the Department of Emergency Medicine at Thomas Jefferson University Hospital.
On January 26th, the honorable Reverend Dr. Bernice King will speak at Jefferson. Her presence will remind us of her family’s legacy, of the great Martin Luther King, Jr. and the importance of his work in promoting eliminating disparities for all. Her visit to Jefferson is fitting in that health care is an area in which equity is vitally important. It is unfortunate that in the year 2018, health disparities are the rule rather than the exception.
We know the data, the numbers that point to differences in treatment without indicating a cause which shows us that black patients with acute heart attack are less likely to receive life-saving interventions than white patients. Black patients also wait longer in the emergency department to receive care for chest pain. Transgender patients are asked questions that have no bearing on their clinical condition or treatment. Women have a higher rate of missed heart attack. Generally, these disparities are not intentional – healthcare providers are committed to giving the best care possible to help people get and stay better. Somehow, they continue to happen. While the causes for these disparities are multi-factorial and systems-related, unconscious bias plays a major role.
Unconscious bias comprises the attitudes or stereotypes that are outside of our awareness and affect our understanding, interactions, and decisions. They exist as learned responses that allow us to make fast decisions in high-pressure situations, but they can also prompt us to jump to unwarranted and inaccurate conclusions. In the medical environment, these biases can have life-altering effects and are thought to play a major role in healthcare disparities. Unconscious bias affects how we interpret clues or evidence and how we provide care. It also affects our co-workers and sets the stage for the patient care environment. Patients and their families harbor their own unconscious biases as well, further complicating the provider-patient interaction.
As medical practitioners, we recognize that the work of becoming aware of our own biases should be an ongoing journey, a process of frequent re-examination. Because unconscious bias is just that – it’s something we’re not aware of, but which can impact how we interact with others. It takes work, it takes study. And it is a study that is no less vital to our patients’ well-being than our study of the medical fields we specialize in.
At Jefferson, unconscious bias education has been incorporated in the training of its learners and teachers. The topic is introduced at every new student orientation (and is a part of the yearly orientations of the medical students). It is a part of the enterprise-wide cultural competency curriculum of our resident physicians. It is an offering in the faculty development program. Why? The knowledge gained on unconscious bias through education and self-examination will ultimately allow us for the best interactions with our patients that then allows us to provide the most culturally-sensitive care to our patients. It is a matter of life and death.