I recently had a house staff teaching team and as an experiment we added a “problem” onto the end of each patient’s problem list called:

Bias.

[A thread]

With humility, I admit I Didn’t think this project would bear as much fruit as it did.

After all the problems of ACUTE HYPOXEMIC RESPIRATORY INSUFFICIENCY and SIRS, I would ask the team to consider how the patient’s race, gender, orientation, nationality, ethnicity, language, socioeconomic status, addiction, etc. was affecting their care past or present.

Like pretty much everything I do with learners, I didn’t plan this out. It just popped into my mind in a patient’s room so we did it and then we did it again.

We made some interesting observations as a team:

1. Pretty much every patient was potentially affected by at least one form of bias. Age, gender, socioeconomic.

You really can’t tell just by looking.

This may be a result of working at a county hospital. We care for many patients vulnerable to stigma.

2. One of the more common results of bias was visible in ~how far the medical system went in pursuit of a diagnosis.~

How soon symptoms were attributed to nothing. Or “idiopathic.”

The bias was visible in how soon the system gave up hunting for a medical cause.

3. The other common place we say bias was in attributing symptoms to substance abuse.

This patient was a social drinker with undiagnosed heart failure. That patient had alcoholic cardiomyopathy.

Both patients had a similar drinking history.

I’m going to keep doing it.

Ending every presentation with:

- DVT prophylaxis
- CODE status
- Bias

Interestingly, since I always round with teams at the bedside, the patients got to hear the discussions too.

I would say they found it interesting to say the least.

Sometimes they would add in a story of their own. A time when they felt dismissed. Or “not heard.” There was catharsis. A chance to discuss something that hurt. Be heard where before they had been ignored.

It has been good doctoring.