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Friday, February 4, 2011

Dealing with a doctor who's biased


By Deborah Kotz -

Thinking of having elective knee surgery, an organ transplant, treatment for heart disease? You might want to consider transforming yourself into a white, middle-class, thin, straight male -- if you aren't one already -- to get the best care from your doctor.
That's the message conveyed in the new book Seeing Patients written by Dr. Augustus White. He's a Harvard Medical School professor of medical education and a former orthopedic surgeon who served as the first African-American department chief at a Harvard teaching hospital.
Who better to write a book about bias in the medical world than White, who grew up in Tennessee during the Jim Crow-era and went on to become in 1966 the first African American faculty member at Yale Medical School?
(Nearly a decade earlier, Yale rejected him for its medical school because, he was told, the school only took one black student every two years, and he applied during the off-year.)
While White acknowledges that the health care field has become far more diversified in recent decades, he says bias still exists in medicine in terms of unequal treatment of patients based on their race, gender, religion, body weight, and sexual preferences.
He spoke to me about the problem detailed in his new book and what can be done to solve it. Here are edited excerpts from our interview.
Considering how far we've come to quash racism and sexism in our society, how can it be that bias still exists, especially in the well-educated elite world of medicine?
For doctors, I think a lot of it is below our level of consciousness, but it comes from prevailing societal norms. For some reason, white men are favored as patients even when they're being treated by black or female doctors. These biases mean that elderly women don't get joint replacements at the same rate as elderly men and that blacks often have to wait longer than whites for a kidney transplant. Obesity discrimination is still acceptable in our society, and doctors may blame overweight patients for their health problems. Patients, themselves, may have unconscious biases as well that interfere with how much they trust their doctors and how well they communicate with them.
What about your own biases? How do you overcome them?
I try to individualize a patient, try to be careful to compensate for whatever negative feelings I may have towards that person. I took a course that Harvard Medical School used to offer that taught me about my biases. I became aware that I had gay friends whom I was treating a little differently than my heterosexual friends; I was a little less comfortable with them. I learned through the course to change my attitudes and behaviors, so it wouldn't affect how I dealt with my gay patients. I eventually went on to teach the course.
But Harvard no longer offers it?
No, it was dropped for funding reasons, though the medical school still offers a course to teach students about various cultures they may encounter in the patient population they're likely to treat -- how, say, they shouldn't lump all Muslims into one category but should be sensitive to cultural differences within the religion. The American Association of Medical Colleges strongly recommends that medical schools mandate courses in cultural competence to teach future doctors not only about other ethnicities but to help them become self-aware with regard to their own biases. Unfortunately, most schools aren't requiring such courses.
What advice do you have for patients to minimize bias in their doctors?
They should try to relate to their doctor on a human level in some way. Talk about the weather, your grandkids, your job. You don't have to talk a lot, just enough to help your doctor see you as a human being. Try to bridge whatever cultural differences there may be. We're all fundamentally human and those qualities supercede racial, ethnic, and any other kinds of differences.


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