Thread by @usnehal

@bansar7 @laxswamy On the topics of false belief/bias

would be careful citing “based on medical studies” from bygone eras

problems with this most obvious with racial bias

studies done by slaveholding physicians w/ intent to justify dehumanization and slavery

news.illinois.edu/view/6367/6092…

@bansar7 @laxswamy The history of black women and healthcare is downright horrifying and appalling and there are direct parallels to individual clinician behavior and clearly measured outcomes today that show how the “fathers” of medicine/specialities shaped the field

history.com/news/the-fathe…

@bansar7 @laxswamy Physicians/scientists seeking to justify their own actions (like owning slaves)

conducted unethical & biased experiments

that gave biased results

Most do not know this history and think they are following evidence based medicine and scientific results
nytimes.com/interactive/20…

@bansar7 @laxswamy This results in current day biases based on race or gender (by themselves) as well as when those intersect

This is so pervasive and deeply embedded in medical culture, education, training, hypothesis generating

that it is a lot more common than many realize

@bansar7 @laxswamy The very nature of these culturally taught biases is to observe pain and trauma and harm

and not register it

to have a mental block against actually “seeing” reality, blinders, blindspot

So a human being can be treated like this and be 🤷🏽‍♀️and carry on

history.com/news/whipped-p…

@bansar7 @laxswamy A parallel approach to control women and keep them in their place

was not as physically violent but psychologically

so, gaslighting, and “shutting up”

those so-called “hysterical” women (with “wandering uteri”), literally and figuratively

broughttolife.sciencemuseum.org.uk/broughttolife/…

@bansar7 @laxswamy We see the “shutting up” of “hysterical” women in different ways

In this case it is described that the woman *was* given painkillers

Though, per data, women more often sedated when they report pain. Sedatives are what you might give someone “hysterical”

health.harvard.edu/blog/women-and…

@bansar7 @laxswamy There is a “shut up and get out of my ER so I can take care of the really sick patients, not you, taking up a bed” attitude towards “non-acute patients. Whose pain is not believed & put into that mental category? And to get the person to leave give them some meds, turn the bed

@bansar7 @laxswamy Imagine understaffing or overcrowding could also play a part

Stresses or increased cognitive load, common in ED, can bring biases to the surface more

It is plausible but not well studied

Curious to hear @DrHowardLiu’s or @AliRaja_MD thoughts on it

ncbi.nlm.nih.gov/pmc/articles/P…

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD Have been citing examples on racial bias cuz clear examples of how that has been built into medicine and the “evidence” we rely upon

to explore the topic of “bias” broadly

though the original case is about if gender bias played a role in missed diagnosis despite multiple visits

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD Why did multiple people at multiple time points all miss the same thing

seem to share the same blindspot

not actually register what they were seeing/hearing?

Maybe all incompetent/bad clinicians

Maybe all too rushed, not doing their jobs

Or maybe role of bias

Or some combo

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD Personally, I have seen this so much in healthcare

literally one charge nurse referred to those triaged as non-acute: “get this garbage out of my ED”

bias affects triage decisions of who is labeled so-called “garbage”

if such language used will those patients ever be heard?

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD personally have heard sexist and racist remarks from those on my team delivering because care, including “high empathy” types at the bedside

I am unsure I can provide safe, quality results if I am on the same team as people overtly displaying so much bias towards patients daily

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD And sexism cuts both ways, harms men.

1- men overtreated, risk for error, side effects, harm
2- men not allowed to show emotions or humanity

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD Example for #2:

A newborn suspected for seizures, being tested, probes all over tiny head

Dad broke down, cried for hours

In break room on floor, I heard “Why can’t he get it together?” & “man up” comments

Anger/disgust expressed towards dad (by women) for normal emotions

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD The attitude was the mom was “allowed” to be “hysterical” but the dad should “man up” to “handle” his wife

no allowance for a father to have his own visible grief

Rather, the expectation from those on the floor was his job was to “manage” the “emotional” woman

Pervasive sexism

@bansar7 @laxswamy @DrHowardLiu @AliRaja_MD *bedside care