According to a recent study published in Science Direct, implicit bias has entered modern discourse as a discussion topic due to our current sociopolitical climate. Several scientific articles have been published in this regard and the topic has been largely explored in the social sciences. It was highlighted in the landmark 2003 IOM report, Unequal Treatment, due to racial/ethnic health disparities. Implicit bias is the process of unconscious societal attitudes affecting our individual understanding, actions and decisions, leading to assumptions about groups. Clinicians should be most concerned about how implicit biases could negatively affect clinical assessments and judgments.1
We recently sat down with Jessica Daigle, M.D., FAAP, to learn more about her experiences examining her own implicit bias and, as a result, improving patient care. As a young girl, Dr. Daigle had a fascination with the book The Long Dying of Baby Andrew by Robert Stinson, a story written by the parents of prematurely born Andrew Stinson about their NICU experience. As she continued to grow, so did her interest in caring for babies. Dr. Daigle would spend hours searching the internet and learning about neonatologists and the NICU. When an elementary school friend's parent, a neonatologist, offered to let Dr. Daigle shadow her at the hospital, she jumped at the opportunity. "When I saw my first premature baby, I thought 'yes! This is what I'm supposed to do!'”
Dr. Daigle shared some recent experiences that inspired her to reflect on what it truly means to be a physician caring for patients and families from all walks of life. In her own words:
"No doubt, there are differences between all of us—skin color, culture, socioeconomic status, etc. The key is to acknowledge and understand this and use it to help the patient. When each patient comes before us, clinicians must have a mindset to provide excellent care to that patient and meet his or her needs. That doesn't mean it will be the same treatment because patient A might need medicine X, and patient B might need medicine Y. Nevertheless, you are still working to meet that patient's individual needs and should do it with excellence. We must seek to understand our differences and why they matter, and we must have the same goal—improved outcomes for all patients no matter their circumstances.
A few weeks ago, in the NICU, I treated an Indian baby who was growth restricted. I could sense a building frustration between the family and the care team regarding breastfeeding which seemed to stem from a lack of easy communication and understanding. Through an in-depth conversation with the parents about their culture, I was able to help the staff better understand the family’s needs and how we could help them best take care of their baby. We were able to decrease frustration between the family and the care team, and as a bonus, I even received some homemade butter chicken from the family, a delicious display of appreciation! I often make the remark that when we get our medical degree, we should also get a social work degree because so much of what we do extends beyond medicine; the social issues matter too.
Recently, I also cared for the newborn of a black 16-year-old mother. I heard from different staff that she would pull the covers up over her head when they went in to speak with her regarding her baby. Listening to this, I could have been biased towards her because of her age and circumstances. However, I went to her room and sat down in a chair facing her. I asked her politely to remove her covers, talk about what was going on, and I asked how I could help. From that conversation, I learned about her home environment, her struggles, and her concern about depression. I applauded her for her honesty and encouraged her to take steps to show us she can take care of her baby. I asked for permission to discuss our conversation with the social worker and her OB providers, which allowed me to facilitate the care and help she needed.
Through further discussion, I explained how perception and behavior could impact how people think of someone and treat them. If she's hiding under the covers, it may seem like she doesn't care what anybody has to say, which could be interpreted as not caring about her baby. I told her I believed she could take great care of her baby, and help was available to support her. She responded well, gave me an air hug, fed her baby well the rest of her admission and went home in better spirits than when she arrived.
As clinicians, we have a unique opportunity in medicine to help patients of various backgrounds with the same goals—improved patient experiences and outcomes. My attraction to medicine began by being fascinated by the times when house calls were standard, where physicians went to patients’ homes, took the time to learn more about their lives, and provide individualized care. It is different in this modern day. However, we can still provide that type of care; it starts with each of us. Ask yourself when you leave a patient’s room: Did I have the same attitude and concern towards this patient as the last one? And if not, why? Then ask yourself how can you do better for the patient’s benefit. Self-introspection is hard but necessary. And just like everything else, if you don't know, seek to learn more."
Throughout her career, Dr. Daigle has had many experiences similar to the stories she has shared, inspiring her to look at patient interactions through a new lens. She believes, like so many other Pediatrix™ physicians, that patient care transcends medical treatment. A large portion of a clinician's time is spent at the bedside, engaging in meaningful conversations with parents and families to understand their unique story and perspective. When entering a room, Dr. Daigle says she's always asking herself, "What do I need to know about their current situation to improve their care?" Whether that be easing tensions with family members, providing support in navigating mental health struggles, or identifying a simple lack of sleep, clinicians are to be committed to considering many potential variables, no matter the patient's race, culture, religion, economic situation, geography or background to provide the best patient care possible.
References: 1: Schnierle, J., Christian-Brathwaite, N., & Louisias, M. (2019, February). Implicit Bias: What Every Pediatrician Should Know About the Effect of Bias on Health and Future Directions. Retrieved October 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6652181/
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