How does bias impact health care?

Bias plays a significant role in the provision of healthcare, but not necessarily always in the way you may think.

Race and bias

I bet most people immediately think of racial bias. There’s no doubt that it can play a factor even in people who don’t view themselves as racists. For example, studies show that African American women who present to a hospital emergency room (ER) with stroke symptoms are misdiagnosed significantly more often than other patients.

I first learned of this phenomenon in a case I handled several years ago involving a young black woman who was misdiagnosed at a comprehensive stroke center in Houston’s Texas Medical Center. She went to the ER with classic stroke symptoms—her face was droopy on one side, she was weak on the same side, and her speech was slurred.

Without ordering proper diagnostic imaging, the neurology resident physician saw her and then quickly sent her home with the diagnosis of “neurogenic disorder,” which basically means “it’s in your head.” After deposing the doctor, I don’t think he was a racist, but he basically saw a young black woman and felt that she had been partying too much during the holiday season, and didn’t even consider the possibility of stroke.

 Well, it certainly was in her head, but it wasn't her imagination, it was an ischemic stroke. The doctor’s misdiagnosis meant that she didn’t get the clot-busting treatment with the drug tPA and will have a lifetime of neurologic impairments.

Jumping to a conclusion and bias

There is another type of bias, though, that I see more often when reviewing medical malpractice cases. Social psychologists and behavioral economists call it fundamental belief perseverance. That mouthful of a bias means that the human mind likes to jump to a conclusion and then stick with it even when there is significant evidence to the contrary.

I think that two of our recent cases illustrate fundamental belief perseverance.

I’m writing this article as Houston is experiencing some unusual weather, with overnight temperatures below freezing. During one of our previous cold spells, a woman slipped on ice and landed face first on the pavement, hitting her head. She was outside in the frigid temperatures for a while before emergency medical services (EMS) arrived to help her.

Although EMS felt that she had a potential head or spinal cord injury, once the patient got to the hospital, attention quickly shifted to warming her up. Unfortunately, that was their singular focus and the emergency department team sent her home without a proper workup, despite documentation of continued weakness. This is a clear neurologic sign of focal neurologic deficit that should have led to an order for diagnostic imaging.

What happened? The ER team received the patient and jumped to the conclusion that she needed warming therapy. Then fundamental belief perseverance set in. Even though they observed and documented clear signs of neurologic abnormalities, they let this type of bias cloud their decision-making. As a result, this woman is permanently disabled.

In a different case, a man was in a high-speed car wreck and EMS transported him to a hospital ER without a neck brace in place. Almost instantly, and without any diagnostic imaging of the patient’s neck, a nurse practitioner in the ER declared that his neck and cervical spine were fine and didn’t need protection. This is usually done with a c-collar.

A c-collar is an extremely valuable tool in trauma cases. When a patient doesn’t show any neurologic abnormalities, placing this rigid device around the neck stabilizes the cervical spine and prevents a spinal cord injury. While it is in place, trauma surgeons and medical teams can deal with life-threatening injuries to other parts of the body. After all trauma teams have to consider injuries from head to toe.

Incredibly, under the circumstances of this high-speed trauma, the physicians on the ER and trauma teams went along with the nurse practitioner’s poor judgment call. As they turned their attention to abdominal injuries, they were unaware of the patient’s unstable cervical spine, which caused a spinal cord injury as they were moving him around in the hospital. As result, he was rendered quadriplegic.

Later in the day, when the nursing staff noticed that the patient was having difficulty moving his extremities, the nurses and trauma team ignored it. Instead, they focused on hemodynamic issues related to the treatment that they had already validated, things like blood pressure and lab values. This is a classic case of ignoring new information that contradicts initial conclusions. It’s a classic case of fundamental belief perseverance, which is a danger to patient safety.

What you can do

If you find yourself in a situation where physicians, physician assistants, nurse practitioners, or nurses don’t seem to be considering the whole picture, be an advocate! Health care teams are busy, but insist that they slow down and listen. Tell your story and ask questions. That may be enough to overcome bias and in some situations save you from disability or even death.

If you’ve been seriously injured because of poor hospital, health, or medical care in Texas, contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.