I recently had a house staff teaching team and as an experiment we added a “problem” onto the end of each patient’s problem list called:

Bias.

[A thread]
With humility, I admit I Didn’t think this project would bear as much fruit as it did.
After all the problems of ACUTE HYPOXEMIC RESPIRATORY INSUFFICIENCY and SIRS, I would ask the team to consider how the patient’s race, gender, orientation, nationality, ethnicity, language, socioeconomic status, addiction, etc. was affecting their care past or present.
Like pretty much everything I do with learners, I didn’t plan this out. It just popped into my mind in a patient’s room so we did it and then we did it again.
We made some interesting observations as a team:
1. Pretty much every patient was potentially affected by at least one form of bias. Age, gender, socioeconomic.

You really can’t tell just by looking.

This may be a result of working at a county hospital. We care for many patients vulnerable to stigma.
2. One of the more common results of bias was visible in ~how far the medical system went in pursuit of a diagnosis.~

How soon symptoms were attributed to nothing. Or “idiopathic.”

The bias was visible in how soon the system gave up hunting for a medical cause.
3. The other common place we say bias was in attributing symptoms to substance abuse.

This patient was a social drinker with undiagnosed heart failure. That patient had alcoholic cardiomyopathy.

Both patients had a similar drinking history.
I’m going to keep doing it.

Ending every presentation with:

- DVT prophylaxis
- CODE status
- Bias
Interestingly, since I always round with teams at the bedside, the patients got to hear the discussions too.
I would say they found it interesting to say the least.
Sometimes they would add in a story of their own. A time when they felt dismissed. Or “not heard.” There was catharsis. A chance to discuss something that hurt. Be heard where before they had been ignored.

It has been good doctoring.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Medical Axioms 🇺🇸

Medical Axioms 🇺🇸 Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @medicalaxioms

1 Oct
I thought Texans were supposed be tough, independent and rebellious?

Instead they are letting their governor shut down their ballot drop stations? What a bunch of weaklings and pushovers.
“Don’t mess with Texas.”
😂😂😂
What a flimsy bunch of fake cowboys. Y’all need to sprout some ovaries.
Read 4 tweets
1 Oct
There’s this weird magical thinking that if you hang around with people who think different than you it will run off on you.

Or you’ll catch it. Get infected with some opinions you disagree with. 1/
Don’t be so afraid of people with different opinions than you. There’s no virus you might catch.

Guys back in the oldem days like Jesus and Buddha said this is actually good for you. 2/
Even criminals and your enemies. You won’t even catch the cooties from them.

Expand your little provincial life. Stop imagining how people think. 3/
Read 13 tweets
30 Sep
Are you more or less open, friendly, and welcoming to people who look, talk, pray, eat and live differently than you were 10 years ago?
Are you more or less open, friendly, and welcoming to people who think, vote, and source their news differently than you were 10 years ago?
We all engage in selective intolerance and acceptance.

Some welcome those who superficially look different, as long as they believe the same.

Others don’t care about ideas and opinions as long as the other person looks familiar.

And many other combinations.
Read 4 tweets
30 Sep
Opinionism: A form of prejudice whereby you assume you know everything about a person based on a single opinion they hold.
While other prejudices and -isms have lost acceptability in polite society, opinionism has gained support and is considered a totally reasonable form of bias.
People of all ages, backgrounds, and political stripes enjoy making snap judgments about people based on a single opinion.

(See @Twitter)
Read 9 tweets
29 Sep
Teaching physicians at academic hospitals love super-capable residents because they make us look good with a minimum of effort and worry.

That part seems kinda easy and obvious. 1/
Now the hard part. 2/
When you start out teaching residents, the opposite is true:

“Less capable residents make us look bad despite a lot of hard work and worry.”
3/
Read 11 tweets
28 Sep
My ratio of positive evaluations* of medical students and residents to negative is about 9:1.

*Above average to downright glowing

Nobody told me how to write evaluations of learners. Come along while I discuss what I have learned. 1/
First of all, realize that almost all learners you ever evaluate will become doctors. Decent ones, too.

The number of times your negative evaluation will save the world is zero. 2/
The scar you leave by intermingling a person’s character or value as a human being with their ability to remember labs or present at the bedside can last a lifetime. 3/
Read 22 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!