Bias in Unexpected Places
by Coley Bennett, CMM, CHA, CMDP
The racially biased treatment of our patients is an absolute violation of our medical ethics and threatens the very dignity and worth of our industry. With the civil unrest around the country, our Nation is facing the demons of our past. Racial bias in American medicine is also a part of this great reckoning. American medicine has a storied history of racial bias in the treatment of non-Whites with special emphasis on the discrimination against those groups that are classified as “Blacks”. It is an ugly truth that has been well documented throughout the past twenty years. Antiquated falsehoods were commonly taught to medical professionals across the country like “Black people’s skin is thicker than White people’s skin” and “Blacks feel less pain than Whites”[1] In fact, as late as 2016, some medical residents still believed these absolute falsehoods![2] However, what makes American medicine unique is not our ugly history but what we have done and are currently doing to exorcise the scourge of racially motivated bias in American medicine. As Healthcare Managers, we can be proud of what we are accomplishing to level the playing field, but we must stay vigilant.
No one wakes up and says, “Today, I am going to interfere in the healthcare of every Chinese, Islamic, Jewish, Hispanic, Black or White person I encounter”; however there may be instances where our decision making processes do, indeed, impede the ability of certain groups to access the same level of quality healthcare that majority groups enjoy. This type of bias is called implicit bias. As defined by the Kirwan Institute at the Ohio State University, implicit bias also known as implicit social cognition, refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.
This is not a black and white conversation. It is much more nuanced than that in the private practice setting. Every day we all bring our own set of personal biases to work with us. Some of us do an outstanding job of checking those biases at the door. Others struggle and it is the behavior of those who struggle with racial bias and prejudices that this article seeks to address. To be clear not every incident meets the standard of racial bias however it is appropriate and necessary to determine whether or not incidents rise to the level of bias and halt the behavior immediately.
Last year, I made an appointment to see a specialist regarding a low-level medical concern. I arrived on the day of my appointment appropriately dressed for the season, well-groomed and in a very pleasant mood. The check in process was seamless but it was during triage where I discovered how a medical professional’s personal bias toward racial groups can absolutely interfere with the perceived quality of patient care. During triage, the Medical Assistant asked the standard brief medical history questions, and my answers were clear and concise. I told her that I do not have an issue with my blood pressure, I am not diabetic, I exercise regularly and only eat meat once a week. She audibly scoffed and said, “I think you are the first Black person to ever say those words.”
As I glared a hole into her soul, I explained to her why her comment was highly inappropriate and diminished the value of position. She looked startled and said she meant no harm. The look on her face told me that she was being honest. Did I think she was a racist? Absolutely not. Did I think she was attempting to degrade or demean me with her words? Not at all. However, I do believe that somewhere in her professional history she created this image of Black Americans being diabetic hypertensive carnivores who lie about their medical histories. I was happy to inform her otherwise and made a point to explain to the Physician and Office Manager that my concern was not only for her errant words but more for her belief system.
I voiced my concern about the effect her thoughtless words may have had on other Black patients who did not feel they were in a position to correct her and speak to anyone on the staff honestly about how her careless utterance made them feel about the level of care they were going to receive. I explained to the Physician that it is not inconceivable that a patient could say if the Medical Assistant expects me to be racked with comorbidities and implies that I am lying about my medical history, it stands to reason the Provider will likely treat me the same way. I shudder to think how often situations like mine happen in medical offices across the country behind closed doors, outside of our earshot and the complaint never makes it to the Manager’s desk. After my experience, I began researching how we got here and better yet how we move forward.
Consider your reception staff and their interactions with your Patients. Are there particular patients whose calls are avoided or their appointments routinely overbooked? Take time to listen to the way your reception staff speaks to your patients. Does their tone and tenor change when they speak to certain patients? Are there patients who come for appointments that are made to wait while others are given a perceived preference? If so, as leaders in the Healthcare Industry we need to take a hard look at the motives behind their decision-making processes. Ask the tough questions of the people your patients trust with their lives. Your patients deserve fair and equal treatment and as a leader in the Healthcare Industry, you have the right to demand it for them.
With your Clinical team, be aware of longer than usual waiting times for assessment. Listen to the manner in which your Clinical team speaks to your patients. Do they use a more dominant perhaps condescending tone when speaking to certain patients? Is your clinical team limiting treatment options based on their assumptions about the ability of certain racial groups to adhere to treatment or medication regimens? When explaining test results or answering questions from a patient is your Clinical team using short declarative sentences in a tone that may make the patient feel like they are being bothersome or their questions are in some way invalid? Does your clinical team rush through appointments with certain patients while affording other patients extra time and consideration?
Answers to these questions can prove implicit bias and it is the type of bias that American medicine is working hard to eradicate. We, as leaders in the Healthcare Industry, can do our part by being ever vigilant and training our staff members to remain patient-centric even when their personal belief system is challenged. We are all deserving of quality healthcare and there is no room for bias of any sort in our industry. Frederick Douglass, Abolitionist, Author and Statesman, said “A smile or a tear has no nationality; joy and sorrow speak alike to all nations, and they, above all the confusion of tongues, proclaim the brotherhood of man.” American medicine has come a long way and there are miles yet to go but there is not a doubt in my mind that together we can continue to shine the light of knowledge and compassion on the dark corners of bias and prejudice in our industry.
References:
[1] Waytz A, Hoffman KM,Trawalter S (2014) A superhumanization bias in Whites’ perceptions of Blacks. Soc Psychol Personal Sci 6(3):352–359
[2] Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, M. Norman Oliver
Proceedings of the National Academy of Sciences Apr 2016, 113 (16) 4296-4301; DOI: 10.1073/pnas.1516047113
Coley Bennett, CMM, CHA, CMDP
Coley is a Certified Medical Manager, Compliance Officer, Healthcare Auditor and Medical Documentation Specialist. She has more than 25 years of experience in the medical industry and serves as the Chair of the National Advisory Board of PAHCOM and the President of the Rockville Chapter of PAHCOM.
PAHCOM Member Since 2016