Tuesday, April 24, 2007

Healing Bias

[Posted by reader_iam]

This article was just sent to me by my best girlfriend, who works for a mental health agency in Austin, Texas (she's worked in this field for years), along with a note: "This was sent out by an administrator in our agency. What a better place the world would be if all were so conscious as this doctor...." From the Washington Post article, written by Manoj Jain, "an infectious disease physician in Memphis and a medical director of Medicare's quality improvement organizations in Tennessee and Georgia":
At our hospital in Tennessee not long ago, I saw my picture on the hallway message board alongside those of other doctors in a display thanking us for our service. My Asian-Indian complexion set me apart -- it's something that I am rarely conscious about in everyday life. It got me thinking: When I walk into the room, do my patients see me as a foreigner?

Then I wondered: When I walk into a room, how do I see my patients?

The mental processing goes something like this:

When I enter the room in which a patient is waiting for me, I do four things.

First, in the seconds before our initial greeting, I automatically and often unconsciously activate my stereotype. Thus, I assume a young Hispanic man is likely to be an uninsured construction worker.

Second, even though I believe that I do not judge people based on stereotypes, the data show it is very likely that I do. When I see an elderly black woman I am more likely to ask her about church as a support structure than I am to ask a white man the same question because I assume she is church-going.

Third, after the encounter, my stereotyping affects how I recall and process information. A white man complaining of pain receives more attention than a Hispanic woman with the same complaint because I stereotype white men as being more stoic.

(Remember that stereotyping is different from medical profiling based on disease epidemiology. A young black woman with anemia is more likely to have sickle cell disease than an elderly white man is, based on biology and racial background.)

Fourth, my stereotypes probably guide my expectations and handling of the patient, resulting in a self-fulfilling prophecy. An elderly black man is unlikely to understand the details of a diagnosis, I assume, so I spend less time explaining his disease and its consequences. Ultimately, such a patient is less informed about his illness.

The most glaring result of black-white inequality in health care was found in a 2005 study issued by former surgeon general David Satcher. He estimated that closing the black-white mortality gap would eliminate more than 83,000 deaths per year among African Americans.
Meanwhile, there's this, in response to a psychotherapist writing about patients seeking therapist who are "like" themselves in some key way (gender, ethnicity, sexual orientation, etc).

Update: First link fixed. Also, Neo-neocon has some good commentary on both Althouse's post and the original article about understanding empathy, written by Dr. Richard Friedman.

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