Our minds tend to develop implicit biases as shortcuts so we don’t have to burn energy thinking about everything many things. Some of these cognitive shortcuts are good. Others aren’t.
One of the big-picture conclusions of behavioral research is that everyone has implicit biases. Often we don’t even know they’re even there.
It should come as no surprise, then, that implicit biases also sometimes have a negative impact in healthcare.
Race, gender, age, and income level are common implicit biases that can have a devastating effect on patient safety. I saw this dangerous triumvirate impact the thinking of a neurology resident evaluating one of our clients for a potential stroke. Let’s call her Jean.
There’s no doubt that the neurology resident physician was academically talented and bright. Yet, he couldn’t overcome three powerful implicit biases in his mind, which led to his blatant misdiagnosis. Jean was young, female, and African American.
When I said blatant misdiagnosis, I mean it.
Jean was sitting on the couch watching television when her boyfriend suddenly noticed her slump over. He helped her up and then saw that one side of her face was drooping, she had weakness in her arms and legs on the same side, and her speech was slurred. He immediately called 911. Emergency medical services got her to a comprehensive stroke center hospital in less than an hour from the onset of her symptoms.
If you went to the nearest shopping center and asked 100 people what was causing Jean’s symptoms, I bet 99 of them would say “stroke”—and they’d be right. So, how did the highly trained neurology resident totally miss the diagnosis? I think the only explanation is implicit bias.
The neurology resident concluded that his patient must’ve been partying too much the night before and was having some sort of imagined medical condition (he called it a psychogenic reaction). He sent her home to sleep it off before she was evaluated by a fully-trained stroke neurologist.
No doctor or nurse spoke up when she couldn’t speak without a slur, couldn’t stand up on her own, and couldn’t walk out the door. A few days later, she returned to a different hospital, where she was properly diagnosed with an ischemic stroke. By then, though, she had an irreversible brain injury.
Overcoming implicit bias
One of my favorite books in the field of behavioral psychology is by Robert Cialdini. It’s called Influence. He describes these cognitive shortcuts as functioning like an old cassette tape player, with a click-whirr mechanism. You insert the cassette, press play, and then click-whirr and the music starts.
To overcome the effects of a physician or healthcare provider’s unintended implicit bias, a patient basically has to press the “stop” button. That halts the click-whirr mechanism.
Introduce conversation and engagement between the patient or advocate and the doctor or provider to stop mental shortcuts and force the physician or provider to see the patient as an individual. I suggest using open ended questions. Here are some examples that may have been effective in Jean’s case:
• How am I going to get her home when she can’t stand up or walk? This might encourage the doctor to conduct a physical exam or reassessment.
• Why do you think she slumped over suddenly about two hours ago? She had been up and walking around all morning. This may cause the physician to re-think that the symptoms are somehow in the patient’s head.
• Isn’t it strange that her facial droop and problems moving her arms and legs are all on the same side? This will make sure the provider understands the specifics of the symptoms.
• Does a negative CT scan mean that she definitely isn’t having a stroke? CT scans for potential stroke patients are typically used to rule out a brain hemorrhage or bleed, not to rule out an ischemic stroke.
If you’ve been seriously injured because of the implicit bias of a doctor, physician assistant, nurse practitioner, or nurse in Texas, contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.
