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mawalters08-blog · 5 years

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Implicit Bias in Health Care

Maysa Walters

What is an Implicit Bias?

Implicit bias, also known as unconscious bias is an attitude or stereotype that affects a person's decision, action or understanding in an unconscious manner. Implicit biases develop early in a person’s life, social stereotypes and prejudices are often a result. The biases can be contributed to parental influence, social media, and news articles. The bias is a result of the brain’s tendency to look for patterns in the world. These biases often lead to discrimination against African Americans. Thirty percent of African Americans believe that their health is dependent upon fate or destiny and only about 50% feel that health is a high priority. Overtime bias tests have been created, the tests measure unconscious/ automatic biases. A common test done in many health care organizations is The Implicit Association Test (IAT), which tests one’s overall conscious control. The test provides images while measuring the associations between concepts, evaluations, and stereotypes.

TED Talk: We All Have Implicit Biases. So What Can We Do About It?

Data from the IAT website suggests:

Implicit bias is pervasive; everyone possesses them

Most people are unaware of his/her implicit bias

Often predict behavior

The spectrum of implicit bias; some show higher or lower levels of bias

Body language and verbal communication can express an unconscious bias. In healthcare facilities, unconscious stereotypes have been found through the IAT. These biases can lead to different treatments and decision- making, leading to potential health complications. Although unintentional, a lack of communication and trust between patient and provider is a result.

Implicit Bias effect on Healthcare?

The health care disparities that are seen today can be a result of implicit bias. Unknown discrimination by caregivers concludes that racism is dispersed through the United States medical facilities. Health care providers have created a racial frame, not providing equitable health care to African Americans. A primary example of implicit bias in health care is Black women are three to four times more likely to die from complications during pregnancy and childbirth to those of White women. Lack of communication, concern and personal treatment are all a result of biases in health care. Implicit bias is not isolated to African Americans or adults it can be seen in minorities as a whole. African Americans are often targeted due to racism.

Who are the Primary Targets?

Minorities, in general, are those at the highest risk of being targeted with implicit bias. Primarily those of African descent have the highest rate of health complications after receiving medical treatment. However, demographics, prior health conditions, and socioeconomics are difficult to assess.

Examples of those at higher risk of implicit bias in health care include:

Race

Gender

Country of Origin

Financial Status

Specific health conditions tend to vary in the care given, and the severity of complications. Pregnant African American women have a higher chance of death during pregnancy than white women. The statistics prove this, African American women are three to four times more likely than white women to die from complications during pregnancy or childbirth. Black women are more likely to die after being diagnosed with breast cancer. These health conditions are all treatable, but it comes down to how our healthcare providers assist with the complication. Do they meet their patient's needs? Are they viewing the complications from multiple angles? Is the patient-provider relationship as strong as it should be? These are all questions the medical provider should be asking when dealing with his or her patient, regardless of their sex, race, and demographics.

The graph displays the interaction between implicit racial bias and racial discrimination predicting elevated depressive symptoms among midlife African American men in the Bay Area Heart Health Study

Chae, David H et al. “The Role of Racial Identity and Implicit Racial Bias in Self-Reported Racial Discrimination: Implications for Depression Among African American Men.” The Journal of black psychology vol. 43,8 (2017): 789-812. doi:10.1177/0095798417690055

Serena William’s Story

Serena Williams, 23 singles Grand Slams, mother and wife. She was a victim of the implicit bias in the healthcare system, and it nearly cost her everything. Williams’s experience began with an emergency C -section. Fortunately, Williams’s first procedure was successful without complications. Less than 24 hours, the new mother was fighting for her own life, based on complications in which she had previously informed her nurses and doctors about. Williams has a history of pulmonary embolisms (blood clots in the lungs), she would not take any chances if feeling the least bit unsure post-surgery. It took the tennis star to get out of bed and get providers' attention before even checking on her health. Williams had to tell nurses how to treat her condition before they even considered it to be a blood clot. No urgency or consideration for the athlete’s opinion on her body the nurse disregarded Williams’s wishes. Soon enough the doctors were performing ultrasounds. After continual advice, and concern from the patient, a CT was given and came back positive for blood clots. Due to her coughs from the embolism, it caused her C- section wound to rupture resulting in another surgery. Three surgeries later and Williams was able to think about her future with her daughter, and husband, Alexis Ohanian. This is one of many examples of how implicit bias can result in further health complications.

“That Face Is an Ace! Inside the Adorable Life of Serena Williams' Daughter Alexis Olympia.” PEOPLE.com, https://people.com/parents/serena-williams-

What Interventions can be Taken to Reduce Implicit Bias?

People are taking action regarding implicit bias in health care. Skills training, organizational support, and other resources are successfully reducing racism and increasing the quality of care patients receive.

Skills used to lower racial bias include:

Assignments to identify stereotypes, race, and racism through learning objectives

Mandatory Racial Bias courses in medical schools

Patient-provider partnerships; build a relationship between provider and patient and create a theme of working towards a common goal

To create a safe, bias-free environment in health care facilities the discrimination needs to be understood and addressed. By implementing programs that current and future hospital employees attend will contribute to reducing the bias. By eliminating implicit bias in health care patients will feel more secure and their patient-provider relationship will grow.

Works Cited

Allan S. Noonan, et al. “Improving the Health of African Americans in the USA: an Overdue Opportunity for Social Justice.” Public Health Reviews, BioMed Central, 3 Oct. 2016, publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4.

“How Training Doctors in Implicit Bias Could Save Black Mothers' Lives.” NBCNews.com, NBCUniversal News Group, www.nbcnews.com/news/us-news/how-training-doctors-implicit-bias-could-save-lives-black-mothers-n873036.

Nelson A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666–668.

“Racism in Health Care – For Black Women Who Become Pregnant, It's a Matter of Life and Death.” NWLC, 13 Apr. 2018, nwlc.org/blog/racism-in-health-care-for-black-women-who-become-pregnant-its-a-matter-of-life-and-death/.

Randall, Vernella, and Tshaka Randall. “Cutting across the Bias: Teaching Implicit Bias in a Healthcare Law Course.” Saint Louis University Law Journal, no. Issue 3, 2016, p. 511. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=edshol&AN=edshol.hein.journals.stlulj61.28&site=eds-live&scope=site.

Williams, Serena. “Serena Williams: What My Life-Threatening Experience Taught Me About Giving Birth.” CNN, Cable News Network, 20 Feb. 2018, www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html.

Reflection:

The purpose of my explainer on implicit bias in healthcare was to inform my selected audience in a way that was simple to understand, yet still academic. I wanted my explainer to be visually appealing in a simplistic manner. It was important to me that my explainer exploits the importance of this issue in the United States and that the biases can be reduced if action is taken place. My target audience is the general public, and users of social media, specifically young adults. My choice of medium was quite impactful for my target audience. Choosing to post my explainer on a blog allows all users of Tumblr to access my project. Including images, and specifically, a TED Talk into my explainer attracts social media users' attention. Using a TED Talk allows for information, in a quick, modern way. By keeping my explainer professional, yet appealing to the eye, helped meet my purpose of the importance of bias in healthcare. My audience was my final choice in choosing a blog. Blogs allow for other multimodal aspects within them that were also helpful in my decision making. I did consider creating a website but felt a blog was easier access for social media users and the general public. The most challenging aspect in terms of technology with Project 2 was creating my different forms of multimodality. Finding a video that was interesting and creating a hyperlink through the blog was the most difficult part. It took time to find a video that would appeal to my audience, and then adding it to my explainer and keeping the visual appeal took multiple attempts. The easiest part of the technology was using Tumblr, the website is very easy to navigate and make your post unique and professional. Overall the course work leading up to the final project was very beneficial. I was able to use what I learned throughout Project 1 and apply it to this unit. I enjoy that the project always for individuality and the choosing of our own topic. Lastly, peer review has been very beneficial to my overall growth as a writer.

Outcome A. “Analyze, compose, and reflect on arguments in a variety of genres, considering the strategies, claims, evidence, and various mediums and technologies that are appropriate to the rhetorical situation.”

At first Outcome A was difficult for me. I have never considered having to explain something to an audience as a rhetoric situation. Because this genre was new to me, I had to view a variety of examples before understanding the overall concept. Analytically I had to look at my material through a different point of view. The outlook from the general population helped me understand how to compose and phrase my writing. The different mediums and technologies worked well for me because I wanted it to be technologically relevant, thus the choice of a blog. I also incorporated a “TED Talk” into my explainer, I feel these are popular in today’s society and will help grab the reader’s attention.

Outcome C. “Use multiple approaches for planning, researching, prewriting, composing, assessing, revising, editing, proofreading, collaborating, and incorporating feedback in order to make your compositions stronger in various mediums and using multiple technologies.”

Outcome C worked well with the prewriting/ course work that was completed prior to Project 2. Much of my research for Project 2 had been completed in Project 1. The composition of my explainer revolved around Basic Features and Moves of Explainers, these examples really benefitted me and assisted in the overall format, and mediums to be used for the assignment. This project specifically I focused on collaborating with others by giving them the best feedback I could for them, as well as incorporating the feedback they give to me. By incorporating my peers and CAPS tutors feedback my explainer was able to reach a higher academic level, and hopefully became easier for others to benefit from my explainer on implicit bias in healthcare.

Outcome D. “Improve your fluency in the dialect of Standardized Written American English at the level of the sentence, paragraph, and document.”

Project 2 influenced my sentence and paragraph structure positively. I was able to add variety to my writing by having to explain to the general public about my topic. Because it was not a typical essay format I was able to use different styles to grab the reader's attention. For example, the use of headings, subheadings, and bullet points was new to my writing. At first it was difficult to identify headings that would grab my reader's attention and correlate with my topic, but eventually, I was able to connect the two. Fluency was hard to obtain because the audience was so broad. Revision of my sentences to make my document academic, interesting and interesting played a major role in Project 2.

#ImplicitBias Healthcare

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flintandpyrite · 5 years

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The “Knitting Lady” is a Surgeon, and She’s Paying Attention

Unlike Phones, Handiwork Does Not Distract

Original source: Medscape, 8/12/2019, Nick Mulcahy

Last month, Rhea Liang, MBChB, attended a professional conference in her homeland of Australia. She brought along her current crocheting project, a lap quilt that will be a wedding gift for her cousin.

Liang, an associate professor of surgery specializing in breast cancer at Gold Coast Hospital and Health Service in Robina, does "wool craft" during lectures to help her listen to and recall information.

Toward the end of one presentation, Liang and her crochet quilt were thrust into the meeting spotlight — a moment she (@LiangRhea) described on Twitter.

Invited presenter at a small surgical meeting- 'The knitting lady isn't paying attention'. 1. I'm a surgeon 2. It's #crochet, not knitting 3. I haven't taken my eyes off you. Why don't you pick on the guy next to me playing on his phone?#ImplicitBias#ILookLikeASurgeon

1,055 people are talking about this

The tweet set off hundreds of retweets and responses, mostly from healthcare professionals.

Dozens of nurses, physicians, occupational therapists, medical students, midwives, and others tweeted that they can't pay good attention — unless they knit, crochet, knot tie, macrame, sew, needlepoint, or doodle. Repeatedly, people said their mind wanders without manual activity.

Kathleen Wild, MD, general practice lecturer, University of Newcastle, New South Wales, Australia, spoke for many (@KathlWild): "Knitting helps me pay attention to what's going on, if I wasn't knitting I'd be daydreaming!"

Another Tweet was also representative of the responses: "I'm able to better pay attention to you because I'm knitting, not in spite of it."

Kerry Wilkins, MD, a psychiatrist in private practice, Millbury, Massachusetts, (@KerryWilkinsMD) provided neurological explanations about what others described anecdotally.

Wilkins' "illuminating" comments, said Liang, "back up what many crocheters/knitters have figured out empirically for hundreds of years." To wit: "Knitting grannies don't miss a thing," she summarized.

Before the tweetstorm, Liang believed her crocheting-while-listening-and-learning at scientific presentations was an "individual quirk." Now she sees it as evidence of "neurodiversity" and is grateful to have met so many similarly wired learners through her post.

Not all Twitter users were supportive.

Al Rush, former paramedic, Royal Air Force, UK (@RAF_IFA), saw Liang's crocheting as a problem. "Don't you think it might be a little disrespectful/distracting to the presenter and/or other delegates?" he replied to Liang's original tweet.

Liang countered: "Any more than everyone else tapping on phones, scribbling on paper, or typing on devices?"

Next, Rush, a retired paramedic, posted a photo of himself as a young man with three women, all kneeling by a Resusci Annie doll: "Me, teaching infant Emergency Life Support — too important for knitting."

In response, Liang pointed to sexism from the presenter at the surgical meeting.

"My original point stands — calling me out when I am paying attention, while not calling out the guy next me [who is] not paying attention — there are only ugly reasons #bias," she posted.

Related Science

Much of the understanding of how repetitive physical activities are connected to attention and cognition comes from brain imaging studies of people with attention deficit hyperactivity disorder and autism spectrum disorder, the Massachusetts psychiatrist Wilkins told Medscape Medical News.

However, the general population also has its own "regulation strategies" to enhance focus when there is "motor overflow" in the brain, which may occur when we confront big cognitive challenges (like listening to a scientific lecture), she said.

Think of the work colleague, Wilkins gave as an example, "whose leg is always moving up and down under the table during meetings, or someone who taps his pen when he's focusing intently."

Knitters, crocheters, and other handiworkers have not been studied in this regard. (A PubMed search turned up nothing.)

However, doodlers have been.

In a first-of-its-kind study, adults randomized to doodling recalled 29% more information on a surprise memory test than controls after listening to a mock telephone call (Appl Cogn Psychol. 2009;24:100-106). "Unlike many dual task situations, doodling while working can be beneficial," wrote study author Jackie Andrade, PhD, University of Plymouth, UK.

Jan Odom Forren, PhD, RN, agrees. "I have friends who knit or crochet in meetings. I doodle while I listen. For all of us, it helps us stay focused!" tweeted Forren, professor of nursing, Lexington, University of Kentucky (@JanForren), who responded to Liang's tweet.

The Surgery–Handiwork Connection

Today's medical school students are less dexterous than in the past, which may impact new generations of surgeons, argued a group of five physicians in a New York Times article published earlier this year.

The reason? The rise in screen swiping and decline of manual hobbies such as woodworking and sewing, they speculate.

Crocheting improves manual dexterity, shouted Twitter users after breast surgeon Liang's dustup.

Lisa Dietrich, PhD, behavior researcher, Stony Brook University, New York, humorously stated the obvious (@lldiedrich): "She [Liang] has nimble fingers. Just like...wait for it...a surgeon."

In vascular surgery, the relationship between crochet and surgery could not get any more direct: there is a "crochet hook method of stab avulsion phlebectomy for varicose veins," as described in an article published in the American Journal of Surgery (1996;172:278-280).

Manual Hobbies Are a Learning Aide — But Not a Fully Accepted One

As responses to Liang's tweet indicate, handiwork is a learning aide for some healthcare professionals.

Patricia Furey, MD, vascular surgeon, Catholic Medical Center, Manchester, New Hampshire (@drpfureymd), tweeted: "I spent the first 2 years of medical school knitting during lectures at Dartmouth 20 years ago."

But other people indicated that the practice is not routinely accepted.

Kayte Kett, MD, a pediatrician in the UK (@kayte_mccann) also knitted during medical school lectures: "But, I used to do it under the table in old fashion lecture theatres in case I got told off. It kept me awake and I was knitting hats for the delivery suite."

The fear of being caught was also expressed by Elva Robinson, PhD, senior lecturer, biology, University of York, UK (@Elva_Robinson). "Recently did some sewing during a course and it genuinely increased my concentration — but I was nervous I would be called out on it," she tweeted.

Liana Clark, MD, said knitting is not allowed in the pharmaceutical industry. She is senior medical director, Global Medical Strategy, Sanofi Pasteur, Swiftwater , Pennsylvania.

"Never had trouble knitting in peds/adolescent medicine. But pharma? You would think I was doing a pole dance! There's no knitting in pharma! #knittingislife," wrote Clark (@teendoc), formerly at the Children's Hospital of Philadelphia. "It's just the culture. Knitting seems unserious," she said.

Manual crafts are esteemed and tribal at some scientific conferences.

Sunae Reilly, midwife, Gold Coast, New Zealand (@saltwater_sunae), tweeted: "As a midwife, it's EXPECTED we knit or crochet at conferences."

Sarah Bodell, occupational therapist, Salford University, Manchester, UK (@OTSalfordUni), told Liang: "You need to join at the @theRCOT annual conference. We have zones for knitting, creating, sewing and more."

It's a Female Thing

Manual crafting or handiwork is perceived as a female thing, Liang said: "I think what the presenter conveyed was — 'I am uncomfortable that one of the audience is doing a generally female activity.'"

Practicing a golf swing would have been more acceptable, she quipped.

Gender-limited crafts are a loss for males, said Robert Hill, MD, chief executive officer, Harmonigenic, a cancer diagnostics and outcomes company in Rochester, New York (@harmonigenic).

"My son began knitting in 4th grade & started knitting on the way to school riding the bus, but wasn't able to continue with all the teasing," he responded to Liang. "More people should normalize it."

Manual crafts are not gender exclusive, observed Charles Jenkinson, MBBS, cardiothoracic surgeon, Fiona Stanley Hospital, Murdoch, Australia (@charlesj_au).

"My grandmother taught me to sew and knit in primary school...I still fix all of my children's toys — these days with 3-0 prolene or silk," he wrote, in response to Liang.

Also, Michael DeBakey, MD, artificial heart pioneer, "credited his surgical success to his Mom teaching him how to sew and knit," tweeted Sara Jiang, MD, associate professor, pathology, Duke University, Durham, North Carolina (@Sara_Jiang).

Final Thought

Among the Twitter respondents to Liang was Jelte (@JltJ), a general practitioner in Arinagour, on the island of Coll in Scotland, UK, who is living with primary mediastinal B-cell lymphoma and is recently 1 year with no evidence of disease.

The physician, who does not list her name in her profile, had some advice for Liang — via Batman — on how to handle future troublesome meeting presenters.

Oh so annoying when

- they pick on you for the wrong reason - people belittle you as ‘the knitting lady’ - they mistake crochet for knitting!

#knitting #crochet #stimming #neurodiversity #sexism #got told off for knitting during a training session the other day and it made me think of this article #I copied the whole thing because medscape is a shitty website to click through so here #long post

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