OPINION
DOCTORS' Lounge
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Taking Your Own Pulse First
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
W
hen it comes to cultural and
interpersonal bias in med-
icine, examine your own
conscience first.
Trying to accept all patients compas-
sionately and without judgment is one of
the most difficult aspects of practicing med-
icine. Doctors tend to be bossy and critical
types. We censure ourselves severely for
perceived mistakes, real or not. Yet we might
have shied away from censuring ourselves
for unconscious bias, which we all must lay
claim to as human beings.
I was thinking about this the other day
because of my irritation with some preau-
thorization type doctor far away who was
scornful about my patient’s need for both
an abdomen and a pelvic CT for her pain. I
thought, “This is a lady doc and still doesn’t
understand the exact issues.” I thought, “I am
failing to explain this correctly.” I thought,
“Female docs are not immune to sexism.” I
thought, “This is what I should expect when
they hire a pediatrician to make decisions
on adult patients.” I thought, “At least she’s
not a psychiatrist.” I thought, “Some ro-
bot bureaucrat has changed the buzzwords
again.” I thought, as always, “Why don’t you
get off the phone and come do your own
damn history and physical and see what
proposal you come up with to explain and
treat her pain?” (which so far, I have not
said aloud to any professional insurance
warden, although I have written it in some
form in appeal letters).
This case just ticked several boxes of
my own biases. I am disposed to belittle
the decision-making of people who are not
of my own specialty and equally disposed
to accept the decision-making of people in
specialties with a broader patient experience
than mine, such as emergency medicine. I’m
disposed to criticize harshly those doctors
who practice as insurance barrier setters,
instead of taking care of actual patients,
without knowing anything of their reasons
or circumstances of life. I’m disposed to
condemn bureaucrats at every opportunity,
remaining suspicious that both their goals
and their methods are designed to interfere
with patient care. I’m disposed to criticize
my own gender just as much as I criticize
men, because I expect more of a woman
and less of a man. This particular barrier
doc also had a Hershey, Pa., accent, which
I think is one of the most objectionable ac-
cents ever (even though Hershey Bars are
totally delectable).
I have learned at my peril not to discredit
particular items of a patient’s complaint.
What does not seem to make medical sense
often makes sense related to some issue or
trauma in that person’s life. When I was
younger and had not seen so many sad
things, I had to tamp down my internal
scoffing even more. Acting on these items
however can represent a real problem of
bias. Do I ask the patient to undergo ex-
pensive or invasive testing to explain his
theory of illness, or do I suggest some saf-
er temporizing measure of watching and
waiting while I wrack my brain further?
Because I certainly could be wrong, and
he certainly could be right, finding the best
course involves pinning down why I am
objecting. My vanity, his vanity, my caution,
his worry, my disinclination to give in, his
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