Medicine is a human business. It is deeply personal. When you think about it, it is one of the most intimate things a person could do with a stranger. Baring your soul to a stranger regarding the most intimate secrets, things the closest people in your life may not know. “Do you drink, smoke, or do drugs?” “Have you had unprotected sex outside of your relationship?” “Have you ever had a venereal disease?” The questions alone are invasive, but that is only half the exam. After telling your secrets, you top it with the only thing that could be more uncomfortable – you bare parts of your naked body, with all its imperfections, to a person you may not know at all.
It’s a Coat, not a Cape
Despite all of this, it is easy to forget that doctors and nurses are just regular people behind that official clothing and medical jargon. They have the same feelings and perceptions as anyone else, despite contrary training. The fact is these natural thoughts influence their behavior. Strong anecdotal evidence and even some research demonstrate that some doctors and nurses take unfair issue with sickle cell patients. Assuming that most SCD patients are drug seeking, or cannot be trusted, or are generally lousy patients. Sickle warriors will tell you they can feel it immediately when it exists in the ER, or with the new nurse taking over your care on the next shift. When that ER doctor you just met – adjusts your long established level of pain management to a different dosage or drug, or both, resulting in inadequate pain management. Even though your treatment history is available for the doctor to see and verify.
While hospitalized I have on occasion had some nurses come clean and express their problems with sickle patients. Or ask that taboo question they really want to ask. I will get into all the issues that exist and why – in a future blog, but for now I want to focus on one place that causes the existence of these conflicts – implicit bias.
The Truth Behind the Veil
We know implicit bias affects humans and they are not aware they carry these biases in their decisions. The Ohio State University Kirwan Institute defines implicit bias in the following manner – Also known as implicit social cognition, implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.
So, doctors are not immune, even if they think they are above such behavior, science shows they are not. Repeated research shows blacks do not receive the same level of pain management as whites, this shocking disparity even occurs in pediatric studies about pain. I doubt very few pediatricians intend to provide greater pain management to white kids over black kids, but studies show it happens. Without any ill will intended, white doctors naturally empathize with white patients of all ages easier than with other races. See the Science magazine article Study Links Disparities in Pain Management to Racial Bias a University of Virginia medical study; the link is at the end of the blog if you want to read about this in detail.
Yes You Too
Now I am sure you are sitting high on your horse reading this and enjoying the scientific proof that the SCA community is mistreated by the medical community. Well remember we are all human, and implicit bias effects us all. So, before you wrap that superiority blanket around you, check out Project Implicit at https://implicit.harvard.edu/. It is a Harvard University study on bias. You can test your own feelings on a myriad of subjects and learn what you truly feel about them. Want to know what your true subconscious thoughts regarding obesity, drug addicts, gender, or race, well this is the website to learn who you really are. There are many other subjects to choose from, so I encourage everyone to take the test. Just forget giving the “politically correct” answer because the test will weed past your lies and find out what you honestly feel.
Implicit bias is not the sole reason for the issues existing with the sickle community and medicine. The problems are deep and long lasting, and implicit bias is just the tip of the iceberg. Now that we know, we must really examine how implicit bias effects SCA, the doctors and their approach to pain management.
Study links disparities in pain management to racial bias