Who is the "gardener" in Medicine (and why does it matter)?

If you attended last Thursday’s WHEP seminar on Unconscious Bias in Medicine, you engaged in thought-provoking interactive discussions about these two TED talks and their relationship to clinical medicine:

https://www.youtube.com/watch?v=RBow84OuZ-E   (Dr. Tim Horner)

https://www.youtube.com/watch?v=GNhcY6fTyBM (Dr. Camara Jones)

 

Here are some of the highlights of the discussions that took place: 

What creates unconscious bias?

Unconscious bias is reinforced systemically through society and is culturally rooted. Segregated communities create different economic landscapes, which influence jobs, experiences, and what people in privileged communities (those with a Eurocentric history) view as “normal”.  The media rarely portrays communities of color in a positive light, thus generating fear of violence in underprivileged areas. In short, people of color have a limited voice.   

Dr. Horner's talk illustrated how unconscious bias is neurologically rooted in fear - specifically, linking safety to bias.  This starts with parental influence in early childhood and complicates our ability to recognize unconscious bias.  

In the Gardener’s Tale, Dr. Jones described the concept of institutional bias or racism in our society as differential access to goods, services and opportunities by race, codified in our institutions of custom, practice and law.   It is the gardener who has control over resources with the power to decide and act.  According to the students, potential gardeners within the field of medical practice included medical schools/admissions, government (local / state / federal), physicians, hospitals systems and insurance companies.

What is the relationship between bias/racism and health outcomes?

 

The discussion here centered on access to healthcare (location, lack of insurance), differences in disease presentation, inherent bias in presentation history, communication barriers, health literacy, food insecurity, and acceptance of the status quo.                                                      

How can one become aware of unconscious bias?

Noting that it is very difficult for individuals to become aware of their own unconscious bias, there were a number of suggestions for improving awareness and reducing bias:

• try to distinguish between quick judgments based on “experience” vs. those made because of unconscious bias.  Students stressed the importance of differentiating between a diagnosis based on race/color/gender vs. individual predisposition to certain conditions.  They felt that physicians should be more attentive to patients who are different from them, try to better relate to them, be aware of favoritism and common assumptions, and spend appropriate/equal time with every patient
• read articles on the subject – become knowledgeable
• “test” yourself to assess your unconscious bias – for example, reflect on uncomfortable situations and ask yourself “Why do I feel this way?”
• understand your community and its diversity instead of categorizing people strictly based on race / color 
• recognize how language barriers can lead to assumptions on the part of providers and result in missed information

Attendees also came up with a series of questions to pose to and discuss with a select panel of practicing physicians on Tuesday, February 9 during the second part of this important, provocative seminar.  It should be a very interesting evening.  Join us!!

                                                                                                                                  Judith Wolf, MD

                                                                                                                          Associate Director, WHEP