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<xTITLE>Implicit Bias is Everywhere: Even in the ER!</xTITLE>

Implicit Bias is Everywhere: Even in the ER!

by Phyllis Pollack
December 2019 Phyllis  Pollack

Recently, my husband handed me an article from the Washington Post which he saw while in D. C. on a business trip. It discusses implicit bias in the Emergency Room (ER) and thus, has nothing to do with mediation but everything to do with the biases we bring to everyday life (including to mediation).

The article written by Eve Glicksman, entitled, “Could doctor’s bias cause a misdiagnosis?” appeared in the Tuesday, November 19, 2019 edition. It begins by recounting the story of a woman in the 18 to 45-year age group going to the ER because she “experienced a terrible stabbing pain in the back of her head that became a migraine. Her left eye started drooping, her right side was numb, she couldn’t swallow. When she tried to walk to the bathroom, she felt as if she was intoxicated.” (Id.)

The ER doctor found nothing wrong and so sent her home. Still feeling these symptoms, she went to another hospital’s ER  where the doctor determined she had suffered a stroke and so admitted her for treatment.

Why the misdiagnosis by the first ER doctor? Bias.  (“Implicit bias occurs when a well-intended physician’s unconscious assumptions get in the way of objectively gathering or assessing a patient.” (Id.)) “Simply being a woman raised the risk a doctor would miss her stroke by 30 percent.” (Id.)  While it is difficult to determine if some missed diagnoses are the result of racism, sexism or a lack of understanding (experience?) that some diseases may appear with different symptoms in persons of different races, ages or gender, “…bias thrives in the void of expertise”, according to David Newman-Toker, director of the Johns Hopkins Institute for Patient Safety and Quality’s Center for Diagnostic Excellence.

Alyson McGregor, co-founder and director of the Sex and Gender in Emergency Medicine Division at the Warren Alpert Medical School of Brown University, believes that “women get the short-shift in health care.”:

“It’s the bias of a whole medical system.” McGregor says. “One -sex medicine,” she calls it, “when physicians are trained to identify symptoms only as they appear in white men.”  (Id.)

McGregor points out that many times, doctors will chalk up the complaints of a woman to hysteria or anxiety simply because the symptoms do not follow the script in the textbook.

Race is another example of implicit bias in that African Americans “… with severe depression are four to nine times more likely to be misdiagnosed with schizophrenia than white Americans with the same symptoms. Consequently, not only do they  fail to receive the necessary treatment and medicine to alleviate the depression but may suffer side effects from the  unnecessary schizophrenic medications.” (Id.)

While the article does note that doctors do get the diagnosis right 9 times out of 10, they do so using their System 1 thinking or taking short cuts to arrive at the diagnosis. Like any other professional, they are pressed for time with each appointment (especially in the ER) and so do not have the luxury of time to mentally rummage through a complete textbook list of every possible conceivable diagnosis. So, like the rest of us, they use the heuristic and take the  shortcut. (Id.)

To help the doctor overcome the bias, the article suggests bringing all your medical records to the appointment and when you disagree with the doctor who tells you nothing is wrong, press her on it by asking if there could be more than one thing wrong with you. If you are still not content with the response, get a second opinion. (Id.)

Whether the doctor is willing to concede the point, implicit bias is a BIG problem in the medical profession. Newman-Toke found that 86 percent of the 55,377 medical malpractice claims that he reviewed were due to judgment errors. (Id.)

No doubt, implicit bias is a BIG problem everywhere. So, no matter what the setting, be cognizant that it is your System 1 or shortcut thinking that is mostly getting you through the day and, in doing so, is doing a good job of hiding your implicit biases from your conscious brain.

…. Just something to think about.

Biography


Phyllis Pollack with PGP Mediation uses a facilitative, interest-based approach. Her preferred mediation style is facilitative in the belief that the best and most durable resolutions are those achieved by the parties themselves. The parties generally know the business issues and priorities, personalities and obstacles to a successful resolution as well as their own needs better than any mediator or arbitrator. She does not impose her views or make decisions for the parties. Rather, Phyllis assists the parties in creating options that meet the needs and desires of both sides.  When appropriate, visual aids are used in preparing discussions and illustrating possible solutions. On the other hand, she is not averse to being proactive and offering a generous dose of reality, particularly when the process may have stalled due to unrealistic expectations of attorney or client, a failure to focus on needs rather than demands, or when one or more parties need to be reminded of the potential consequences of their failure to reach an agreement.



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