UC Santa Barbara’s Health Professions Association’s Inclusivity & Outreach Committee, in collaboration with the African diasporic Cultural Resource Center and Los Curanderos, hosted a webinar to highlight implicit, unconscious and structural bias in healthcare, on Jan. 21. Terrell Winder, an assistant professor of sociology at UCSB, shed light on the historical and contemporary types and effects of institutional biases and interpersonal biases in healthcare. He discussed the underlying impact of patient interactions and healthcare settings in the context of medical mistrust, malpractice, stereotyping and pathologizing based on patient gender, ethnicity and race.
“African American and American Indian/Alaska Native females have higher rates of stroke-related death,” Winder said. “African American men are twice as likely as whites to die prematurely from stroke.”
Winder also shared that professionals should “[avoid] stigmatizing responses to patients [by] maintaining non-judgmental body language and [checking] your verbal tone and assumptions about patient behaviors, and [you] have to detach your own personal beliefs from the behaviors or the things that people are sharing with you … your expectations of your clients can influence a diagnosis[.]”
“[P]atients are only going to be as honest with you as they feel they can be in order to get what they need… patients will withhold information from perceived judgment,” Winder said.
Associate professor of Clinical Medicine and the Gold-Headed Cane Endowed Teaching Chair in Internal Medicine at UC San Francisco Dr. Denise M. Connor expanded on implicit bias in healthcare diagnoses.
Connor’s presentation focused on the significance of diagnosis when surfacing errors in medicine. She referenced the books “To Err is Human: Building a Safer Health System” by the Institute of Public Health, “Improving Diagnosis in Health Care” by the Society to Improve Diagnosis in Medicine, and “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” by the Institute of Medicine in her introduction to disparities in medical treatment, listed in the graphic.
Connor outlined the disparities in medical diagnoses, referencing the delayed diagnosis of appendicitis in Black children, delayed dementia diagnosis in Asian and Hispanic/Latinx individuals, and missed diagnoses in simulated cases of chest pain for heart attack and cancer in Black and Latinx patients.
Delayed and inaccurate medical diagnoses are an underestimated form of error in medicine, according to Connor.
“Diagnostic error is actually very hard to measure,” Connor said. “So it’s probably underestimated. It’s often the case that someone gets a missed diagnosis or inappropriate diagnosis, and [the] mistake may never come to light.”
Disparities in sustaining healthcare and providing accurate diagnosis may also be due to unconscious biases.
“[I]mplicit bias is triggered in certain settings … when you’re busy, when you have competing responsibilities, when you’re multitasking, when you’re under a lot of pressure, when you have less personal experience with a group or a person … and this describes clinical medicine,” Connor said.
Connor said her analysis of disparities in medical diagnoses concluded that medical professionals have to understand when to use pattern recognition and analytic thinking when diagnosing a patient.
Pattern recognition is when signs and symptoms are compared to previous cases, Connor explained, while analytical thinking is when signs and symptoms are evaluated by conducting certain tests and procedures for a clear-cut analysis.
According to Connor, mistakes can be made if a medical professional consults solely on pattern recognition or solely analytic thinking.
The second half of the webinar consisted of three selected individuals with experience in medicine and/or healthcare who participated as Q&A panelists to share their insights on implicit bias in healthcare: Nkiruka Chuba, an assistant clinical professor in the OB/GYN Generalist Division at the Department of Obstetrics and Gynecology at UC Irvine; Ebenezer Larnyo, a postdoctoral scholar at the Center for Black Studies Research at UCSB; Javier Guerrero, a medical student at UC Davis School of Medicine; and member of the Rural-PRIME program.
Kareena Johnson, the co-host of the webinar and a fourth-year biological sciences student at UCSB, posed a question asking how implicit bias related to the panelists’ personal experiences in healthcare.
“I see a lot of patients for chronic pelvic pain,” Chuba said. “There can be all kinds of reasons why somebody comes into the emergency room … do we treat certain people differently regarding their pain management because we think that they are stronger, or do we give a lot of pain medication to other patients because we implicitly think they are weaker?”
As Chuba described her experience with implicit bias in a hospital setting, Guerrerro shared his experience as a medical student working at a student-run clinic.
“For myself as a medical student, [I] see [implicit bias] creep up in small ways. I… was surprised to find out that some [patients] already had Medi-Cal, but yet they’re coming to our free student-run clinic because they felt like they’re really understood there. [A lot] of us spoke Spanish and had the same cultural background,” Guerrerro said.
The webinar set forth how implicit bias should be acknowledged and avoided in a healthcare setting. Johnson concluded the session by echoing a quote by James Baldwin used in Winder’s earlier presentation: “Not everything that is faced can be changed, but nothing can be changed until it is faced.”