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How I Learned to Treat My Bias

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.

It is painful to write these things. As health-care workers we try to be unbiased in our delivery of care.

Once I became aware of how I thought when I encountered patients, I was able to start changing. Though I initially saw a patient as an elderly black woman, my forced reflection helped reduce the stereotype. As our conversation developed, the stereotype melted away. I began to see my patient rather than his or her social group.

I hope that patients have done the same for me. I hope that they did not see me only as a brown foreigner but recognized me as a doctor keen to be a partner in their health care.

As a society we can overcome prejudices in health care by facing our tendency to stereotype. Medicare and its contractors -- quality improvement organizations -- are training doctors in a "cultural competency" program in which they receive free educational credits and become aware of biases in care delivery and cultural perception of illness. (I am taking the course.)

As for patients, I have another suggestion. The next time you see a worker at a fast-food restaurant, ask yourself: What stereotypes did your mind automatically activate?

Awareness is the first step to change.

The writer is an infectious disease physician in Memphis and a medical director of Medicare's quality improvement organizations in Tennessee and Georgia.


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