Thread by @gradydoctor

1/
Postcall Rounds. Last pt of the morning. Fairly straightforward. Not too exotic.

Chest pain and severe uncontrolled hypertension. Not his first time at our safety net hospital. Picks up his meds. And takes them, too. Always.

Young. Male. Poor.

Also? Black.

Just like me.

2/
It was almost noon. We’d been rounding for a few hrs. 

Me? Cognitively tired. Hungry, too. Worried about something at home. And a work deadline, too.

But.

Last patient of the morning. I am listening.

Young. Black. Male. Poor. Chest pain. High BP.

And at Grady.

3/ 
“Did you check a UDS?” I asked. 


“A urine drug screen? Uhh no. He’s never used. I asked him.” My intern’s blue eyes were wide and earnest.


Young. Black. Male. Poor. Here.
Hungry. Tired. Busy. So busy. Human.


“Let’s get one anyway. Just in case.”

Yeah. Just in case.

4/
My intern apologized. Said he didn’t realize he should check it even if no suspicion or drug history.

Just in case of what?


Young. Black. Male. Poor. Crack. Here.
Hungry. Tired. Meeting at 2PM. Pressured.


“Don’t be sorry.” That was my milquetoast reply.

5/ 
I meet the patient with the team. I ask questions. He answers.


Young. Black. Male. Poor.
Trying. Asking. Trusting. Tired. Scared. 


Sings in choir. Never tried a drug in his life.
Or even saw one.


Just like my intern said.

6/
Face now burning. Heart pounding. Eyes prickling.
Because patient still trusting. Trusting me.  The senior doctor. The only doctor on the whole team who is black. 

Just like him. 

He was happy to see me because of that, too. Safe even. I can always tell.


Always.

7/ 
The more we talk, the more I see.

Young. Black. Male. Brother. Believer. Dad. Son. Coach. Funny. Trusting. Trying. Relieved. 

So relieved. So safe. I can always tell. Always.

If only he knew what I’d just said about him in the hall.

8/
We finish up. The team disappears into stairwells and halls. And me, I am lost in my thoughts. Ashamed because I could see how he saw in me at that bedside.

Black. Female. Doctor. Attending. Mine. Here. Ally. Safe.

Whew.

Part he didn’t see:


Hungry. Tired. Biased.

9/
Wait. No.

I took those IAT tests. No. This can’t be. I had a “moderate automatic preference” for my people. So, I tell myself: “I’ve been burnt. Crack is prevalent.” Putting my bias blinders on.

No. I'm not biased. Just careful. Right?

But why do I keep wanting to cry?

10/ 
I stilled myself and thought about it. The truth was inescapable. I’d committed a microaggression against my patient. The one who looked like me. The very one who made me want to work at Grady in the first place.

The ones I vowed to protect from everyone else.

11/
This was implicit bias personified. The heart feels one thing but the mind goes rogue.

Yup.

Now I know. I’d stepped on a "bias landmine" when hungry + tired + worried + pressured entered the picture. And no. It’s not an excuse.

It’s just a fact.

12/
Walked into the team room. Surprised to find them all there. Man, I was glad.

So glad. 

“I thought a lot about our last patient. I think, no--I know that me asking for a UDS was out of bias. I saw young, black, male, and poor. And my brain said, ‘crack.’”

No one spoke.

13/
I told them I was wrong. And that I was sorry. That I'm trying hard to call out my own biases and do better.

“I think I fell prey to a single story. And I’m mad because I’m supposed to be protecting him.”

They were so gracious. They were.

14/
Ultimately, it proved to be a fine teachable moment for our team. And it created this space for us to acknowledge bias in real time.

Yes. We are all biased. But what I’m learning is that leaders coming clean about their own permits others to do the same.

Maybe.

15/
I've always wanted to protect my patients from monsters. I now know that I also have to stay vigilant about the monster in me.

Oh, and that UDS? We cancelled it.

#bias #keeptrying

I’m digging this discussion. More tomorrow when I wake up. 😂😴