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.
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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.
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/