Lamercie Saint-Hilaire, MD
Diana Wu, MD
-Far more common than conscious bias
-Incompatible with our conscious values
-We don’t know we have them
Some examples of biases and roots of bias:
- Low income, black and Latina women more likely to have IUD recommended to them than white women.
- Underlying Biases – Idea of women of color having “hyperfertility” and “hyperbreeder,” welfare queen or having children for money. Assuming women don’t want children or can’t raise children well, education level, intention for visits
- Father of OB/Gyn did experiments on enslaved black women and did experiments without anesthesia. His results still informs how we are trained in medicine
- Historically those deemed feeble minded, low-income and women of color have been sterilized against will. Today we see this as a TN judge taking 30 days of jail time if inmates had LARC or permanent sterilization.
- Everyday example of coercion – Giving LARC as first-line choice especially in adolescents and not discussing other options
Points of reflection and questions to ask yourself:
- Why are you recommending a certain type of birth control or course of action? Is this what is best for the patient? Also ask yourself, who are you recommending this birth control to?
- What data is supporting your decision making?
- Do you know why a patient holds a certain opinion or idea?
- What fears may you patients have because of previous trauma from the medical system?
- Are you trusting what your patients are telling you?
- What is the culture of where you trained and what is the culture of where you practice?
- Do you have a safe space to talk about personal and patient struggles with?
Ways to assess unconscious bias or techniques to minimize bias:
- Evaluate unconscious bias: Check out the Implicit Association Test from Harvard (see link above). Understand that EVERYONE has unconscious bias, not just “bad people”. Focus more on experience of taking test than results of test. Don’t get hung up that you did “bad”. Sit in discomfort; ask yourself what experiences may have lead to results.
- Be in touch with your emotions and stress: Stress in multiple forms (hunger, time, sleep deprivation, work) leads to bias coming out. Acknowledge to self that you might be vulnerable. In flight or flight reptilian brain and cannot tell self to stop making these reactions.
- Improve your communication skills, communication skills are paramount: Get out of bubble and learn about people with different backgrounds to extinguish biases. Watch movies, read books can also help debunk biases. No exposure to these women so no way to debunk.
Tips for becoming an ally:
- Educate self on historical events that feed into unconscious bias, read historical novels, Google searches. Education should not be on marginalized person. It is your responsibility become educated, not the marginalized.
- Listen more, speak less: We are used to directing and leading conversation. Give voice to marginalized.
- Calling out injustice and calling in those in community: Pointing out injustice, use voice and speak up. Calling in is restorative – call in other people in community if coming from someone who looks like you. Don’t ostracize but enlighten.
- Embrace emotion, emotional regulation: People often take offense but need to be ok with being uncomfortable
- Acknowledge privilege and power
Last thoughts and ideas:
- Don’t strive for cultural competency, strive for cultural humility. We need to shed ourselves of these stereotypes and learn how to interact with the individual in front of us.
- Go into the exam room with a clean slate. Take a deep breath and assess your stressors before entering the exam room.
- Be ok with not knowing what the the patient is going to bring to the table. Ask open, honest, and open-ended questions. For example, as your patient, “tell me more about your values and experiences so I can understand.
- We all have biases. We need space to discuss and unpack to foster internal and community healing from ancestral trauma. We also need to be compassionate to self and others. We can be radically compassionate and act as allies within this compassion.
- Trust your patients. It is trained into providers that there must be something the patient isn’t saying or something underlying that they aren’t saying.
- Move away from victim blaming. Be compassionate.
- We remember stereotypes that confirm our biases and forget those that go against our bias. Be aware of what you holding onto or what your personal narrative is.