Tagged: humanities

Black Man in a White Coat: Implicit Bias in Healthcare

On July 9th, I joined a group of about 600 people, from medical professionals to interested South Carolinians, and attended a discussion of Dr. Damon Tweedy’s Black Man in a White Coat.  The discussion, sponsored by SC AHEC, focused on the first part of the book; another discussion will follow on Tuesday, July 21st, and the event culminates with Tweedy’s virtual visit on July 29th.

As our nation awakens to the realities of systemic racism, the humanities hold an especially important role in highlighting narratives that illustrate individual lived experiences. As racial disparities become more and more evident in health care, it behooves us to listen to Tweedy’s experiences as someone on both sides of the stethoscope.

When polled about what surprised us the most about Tweedy’s book, the answer wasn’t systemic racism or inequalities in medicine.  It was his openness in talking about these things: in admitting that, even as a person of color, Tweedy experienced inherent bias against patients of color. One African-American physician spoke eloquently about how similar Tweedy’s thoughts, feelings, and biases were to his own, and to those of other healthcare providers of color.

Exacerbating the systemic racism at play here is the hierarchical culture of medicine itself. As with many high-pressure careers, this comes with the notion of “imposter syndrome,” especially for someone already considered different. In medical school, many medical students said, one is supposed to be “untouchable,” always “on.” As a person of color, though, one cannot be too aggressive, overconfident, or arrogant, or one earns the dreaded epithet of “angry” or overly “emotional.” This reminded me of Austin Channing Brown’s I’m Still Here: Black Dignity in a White World.  On her first day in a job, Brown’s boss tells her that he is there for her if she has any “concerns,” but, when she shares a concern about a racist incident, she is told that she is too “sensitive.”  It is a catch-22 that characterizes the lives of many professionals, especially in hierarchical settings like that of a medical hospital.

And bias is baked into medical training, too. One medical student perceptively reported that, when he was taught about sexual transmitted infections, most of the genitalia on the slides were dark. When it came to less stigmatized diseases, people of color were not represented. Curious, I did a “Google Search” for images of STD’s. They are too gruesome to post, but they were all, with the exception of one, images of people of color.

We all need to be aware of our implicit biases, of our racism, but health care professionals also have to make quick decisions regarding their patients. How, asked one doctor, do we “combine experience (good, thoughtful, meaningful experience) with an understanding of our own biases?”

The last question was, perhaps, the hardest: do we feel comfortable educating our colleagues, or our friends, about discrimination? It is hard—damn hard—to allow oneself to be “educated,” which reminded me of Robin DiAngelo’s White Fragility.  As one participant said, “we educate (people) about speaking up, but not about listening.” How do we listen, really listen, to our colleagues and friends?  To the people we will serve? How do we do this when we have been accused of bias?

These are really important questions, both in and outside of a healthcare setting. We need to interrogate bias because, as one elderly doctor said, the medical evidence is incontrovertible: bias makes people sick. Bias kills. And it is preventable.