practice partner
Dr. Jonathan Hellmann
“ As professionals we’ re servants to the public good. The duty is to not abandon the patient”
Unconscious bias Value judgments can manifest in ways large and small. Sometimes the patient isn’ t even aware of how much their care is affected. Consider this scenario. Patient X has substance abuse issues. That’ s a hot button for his doctor, who has seen three other patients like X already today and finds many of these appointments to be frustrating. Here’ s the question.“ Are you giving the patient shorter shrift because of an unconscious bias?” asks Dr. Jonathan Hellmann, a Medical Bioethics Associate at Toronto’ s Hospital for Sick Children.“ We sometimes label patients. Maybe we don’ t give them enough time or probe deeper. Or we stereotype – because you do this, you must do that. We may not see them as the complex person they are. It’ s these subtle things,” says Dr. Hellmann, a neonatologist and former clinical director of the hospital’ s NICU. Doctors are encouraged to show empathy notwithstanding the patient’ s situation or decisions.“ But as humans we’ re often more empathetic with people who are like us, who strike a chord in our own selves,” Dr. Hellmann adds. Sally Bean, an ethicist at Sunnybrook Health Sciences’ Ethics Centre in Toronto, says value judgments can seep into patient files or discussions with colleagues. For instance, referring to someone as“ schizophrenic” instead of as a person who happens to have schizophrenia, or calling someone simply“ a smoker”.“ You’ re defining them by one trait or behaviour,” says Bean. One danger? That tag can shape the perceptions of health-care providers, even on a subconscious level.
Mutual understanding When values differ, Dr. Gibson says it’ s essential to anchor the conversation.“ It’ s quite possible to sit down with someone who holds views completely different from your own and have a therapeutic relationship. That has more to do with listening to and understanding each other,” she says. Dr. Hellmann gives the example of a parent who has chosen not to vaccinate his or her children.“ The first concern – how is this affecting their health? Will there be non-compliance in other forms? Give them as much information as possible, and also understand their reasoning,” says Dr. Hellmann. His colleague Dr. Randi Zlotnik Shaul( PhD), director of the hospital’ s Bioethics Department, says“ Sometimes you have pushback from clinicians –‘ Don’ t ask me to respect everything a family says because sometimes I don’ t.’ But speaking in a photo: arash moallemi
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Dialogue Issue 1, 2017