“Do the best you can until you know better. Then when you know better, do better.”
This famous quote by Maya Angelou, the award-winning author, poet, and icon can apply to anyone at any time. For me, this is especially relevant when it comes to our own personal biases and mine as a multiple sclerosis (MS) patient.
The vast majority of people I know, personally and in medical circles, do their best when it comes to treating everyone as an equal. They also work to keep presuppositions at bay.
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However, people are imperfect and those biases can come into play when it comes to medicine. Assuming that an obese person, like me, has no self-control or believing that an African-American patient will not follow basic medical instructions are biases that can negatively affect health outcomes.
These are not attitudes that are front and center in our health care provider’s minds when working with a patient. It is simply a back-of-the-mind thought that can color perceptions of certain groups of people.
We all have biases. If you are a living, breathing sentient being, you have a bias. It would behoove non-believers to take any one of the infamous Harvard Implicit Association Tests. I have taken some of the tests. It was a harsh wake-up call. I did have implicit biases around certain subjects and it was painful to read. I looked back at my memories to see if I had done anything that negatively affected another person.
In all of that soul searching, I was heartened with the knowledge that I had not operated in a purposeful way with the intent to hurt. That is the important part to remember about implicit biases. They are just that, an imperceptible belief can leak into medical care and can be lethal, as it almost was with me.
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I was sent to a care facility to start rehabilitation on my knee. I had dislocated it and torn 3 out of 4 ligaments. As I went through the check-in process I had my medications brought to me along with admission paperwork. I am a stickler for medical forms and as I read my files the nurse approached me with a hypodermic needle loaded with insulin.
I stopped him because I am not, and never have been, diabetic. How did that get into my file? The nurses at the facility assumed that an obese African-American woman had to have Type II diabetes because all overweight people are diabetic.
It was their implicit bias regarding weight that could have killed me that night. That piece of information was incorrectly inputted into my medical paperwork. This is a real-life example of how implicit bias in health care can operate.
These nurses were not trying to kill a patient. They simply decided that they could rely on their past experiences with fat patients that live with diabetes. They relied on their own beliefs instead of what was in my charts.
The next time you deal with a patient think about any biases that may exist. It is possible you have made certain assumptions without asking. It could be a quick note in a chart or a way of speaking to someone. It could be changing advice based on what you think the patient can handle or withholding treatment options. Step back and think about how that advice might be different for another person. Is it based on direct communications or is it based on unspoken assumptions? It is only when you are actively working to eliminate biases in your medical decisions and advice are you living up to Maya’s quote and doing better.
