PROCESS THAT PREJUDICE
In medical school, I vividly remember suffering from premature
closure. It’s a bias where you fail to consider other alternatives.
It bit me with board exams when I got caught up in buzzwords.
As a third-year, it bit me with pieces of the patient’s history. It
bit me as I was learning to create a differential diagnosis but
not yet able to see the big picture. That magical transition to a
seasoned fourth-year medical student helped. My intern year
finally broke me of this habit. Those differentials became broader,
better analyzed and more thorough. This happened because I worked
at it and became more mindful. I learned enough medicine to look
at the whole picture, and not just focus on the easy parts.
As Chief Resident, I vividly remember tackling another bias.
Morning reports at the Department of Veterans Affairs involved a
dry erase board and a story. The Chief recorded the data, “40-yearold
male presenting with dyspnea.” I stopped including the racial
designation because it was not relevant. We already know the conditions
more common for Black individuals, Hispanic individuals
or Ashkenazi Jews, etc. It was a subtle gesture, but it was a start to
get away from those stereotypical designations. But your inherent
biases still exist, and as a primary care physician these lurk inside
you in each patient encounter. I had patients that I thought were
difficult to connect with. They just stared back at me. They would
be late. They would not want medicines. They were distrusting. I
realized I was putting my experiences, my understanding onto these
patients, and that was not accurate. At the same time, I was fighting
against the assumptions about me: “You must be from someplace
else, you are not from here. You speak English well. You do not
know what it is like to be poor.” I knew what it was like to have
parents who were constantly working to make it in America, and
I knew what it was like to grow up modestly and to save, but that
was not enough. I did not have a shared experience with them. I
did not know the areas of town they lived in. I did not understand
the wait they encountered for the two buses, and the walk from the
bus stop for their visit to just come and see me, their doctor. I was
not seeing the bigger picture. I had to break my bias.
Thanks to the Leadership Louisville Center programs, as a
non-native Louisvillian, I have learned more, and understand my
patients more now. I have toured the Russell, California and Portland
neighborhoods. I have seen Shively, Rubbertown, Beechmont and
PRP. I have seen the lack of grocery stores. I have seen the hardship
of finding reliable transportation. I have seen the immigrant
communities who are making their first homes, like my parents.
The Harvard Implicit Bias test enlightened me even further.
Those unsuitable assessments of others, from my early encounters:
I could identify them now, recognize them as false and unhelpful.
By considering my thought processes and learning more, my understanding
increased. I could be a better doctor for my patients.
Mahatma Gandhi said, “Be the change that you wish to see in
the world.” I challenge you to recognize the biases, the unexamined
assumptions and conclusions, that each of us carries and acts on. We
can deconstruct these in ourselves. Only with making that change
for ourselves can we have a better understanding and appreciate the
reality all around, our shared reality with our community. It may
be brutal or bonny, but reality is where doctors ought to live.
Dr. Tailor is an internal medicine physician at Norton Community Medical Associates:
Barret.
JULY 2020 3