Bias is a topic that is receiving a lot of attention these days. Many US universities and businesses offer material on bias that every employee is urged to examine and take to heart. A recent event at a Starbuck’s store in Philadelphia, involving unconscious bias by a staff member, caused the company to designate a one-day “bias instruction holiday” for all their employees.1 Our university also offers bias training in an attempt to enlighten faculty to the destructive influence of conscious or unconscious bias/prejudice.2
We are all biased in one way or another. Some biases are positive. For example, as a cardiologist I have become biased against certain foods. I often refer to fast food hamburgers as “grease burgers” while encouraging patients and trainees to eat a more heart healthy diet.3 This is the result of my many-decades-long connection with the American Heart Association, as well as my enrollment in a nutrition course when I was a Harvard Medical student. The course was given at the Harvard School of Public Health and was directed by Professor Frederick J. Stare, who was, at the time, the leading US authority on nutrition.4 My many years as a fan of the Boston Red Sox is another positive bias, at least if you live in Boston and not in New York! So, not all biases are necessarily evil or deleterious.
There are a number of negative biases that physicians need to overcome. The first one that comes to mind is bias based on stereotypes of a given racial, ethnic, or sexual orientation group. The US population has a long history of bias against African Americans, Jews, Catholics, Native Americans, Chinese, Hispanics, and individuals who are not heterosexual, among others. In recent years, schools and workplaces have battled these stereotypes in an attempt to make our society truly democratic and egalitarian. For example, medical schools in the United States currently work hard at recruiting and effectively educating a variety of individuals from so-called underserved populations in an attempt to make our profession more diverse in character. When I was a medical student many decades ago, my Harvard Medical School class consisted almost exclusively of white men. That demographic has been completely overturned in 2019 with gender equality and individuals from different ethnic, religious, and sexual preference groups. In addition, the medical curriculum at the University of Arizona College of Medicine, similar to programs at other US medical schools, contains specific didactic material concerning the dangers of bias. The goal of this instruction is to make students aware of their own conscious and unconscious biases.5
Like every other human being on Planet Earth, I have my own biases, which I work hard to recognize and combat. Here is one: I have strong negative feelings when I encounter a patient weighing more than 300 pounds. The conscious thought that runs through my mind when I am the attending caring for such a patient is “How could you let this happen to yourself—don’t you realize how detrimental this is to your health?” I openly admit this to my trainees when speaking to them about fighting conscious and unconscious bias. So, how do I handle my bias? I do so in the following manner: I consciously say to myself before entering the patient’s room: “Remember your bias—think positively about this patient.” The result is that I end up spending more time with these patients than with most of my other patients, and I display a friendly countenance while talking and counseling these obese individuals.
The take-home message from this brief editorial is simple: Besides learning the huge volume of medical pathophysiology, diagnosis, and therapy, all physicians and health care staff need to search our personal attitudes about others in order to identify our conscious and unconscious biases. And then, we need to develop a professional attitude toward these patients that recognizes the worth of every individual regardless of their physical or other identifying characteristics. Initially, it was hard for me to recognize my negative feelings about morbidly obese patients as a bias. Once I did so, I was able to find a way to address that bias, and my reminder to myself with each patient encounter has gone a long way toward overcoming these feelings. I am sure that all of us can do the same thing.
As always, I am happy to hear from readers of The American Journal of Medicine about this or other editorials at jalpert@shc.arizona.edu. I promise to respond.
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-Joseph S. Alpert, MDa,b,
This article originally appeared in the August 2019 issue of The American Journal of Medicine.
