Blocking Bias: How to Speak Up For Your Health
Seeing your doctor is an exercise in vulnerability. Think about it: You’re talking about your body, discussing your emotional well-being and sharing details that are pretty darn personal.
Now imagine you’re in that vulnerable state, but your doctor isn’t listening to you. Instead they’re dismissing your questions and brushing off your concerns. Would you still trust that doctor? And would you believe you were getting the best possible care?
For patients who are part of an ethnic, racial, cultural or religious minority, this situation isn’t purely hypothetical — it can be a reality. Maybe it’s even something you’ve experienced firsthand.
“Healthcare disparities and biases really reflect inequities in society,” explains Dr. Leo Morales, chief diversity officer for the University of Washington School of Medicine. “It boils down to certain groups receiving more benefits than others, and that’s historic and present today.”
It’ll take a lot of hard work to correct centuries of systemic racism and bias, Morales admits, but the silver lining is that healthcare organizations, medical schools and doctors themselves aren’t shying away from addressing the tough stuff.
Here’s what they’re doing to tackle healthcare bias and how you can advocate for yourself to ensure fair and respectful treatment as a patient.
What healthcare bias is and why it matters
For the most part, people choose to become doctors because they want to help others. That’s what makes unconscious bias — learned or unintentional stereotyping — so difficult to pinpoint. A doctor may not purposefully try or even want to discriminate against you, but the fact is, they might still do it.
This form of bias is why some in the medical field can hold false beliefs, like the myth that black people have thicker skin or less sensitive nerve endings than white people. That, in turn, can lead to inadequate care and real health consequences for minorities.
According to a Centers for Disease Control and Prevention report on racial and ethnic disparities, black women were four times more likely to die from pregnancy-related deaths than white women. Another study found that 53% of Muslim women delayed seeking medical care because of modesty concerns and what they perceived was a lack of female clinicians.
In essence, bias means minorities can get subpar treatment for what are normally very treatable conditions.
What healthcare organizations are doing to help
Addressing bias and improving equity in healthcare is just part of what Morales is working on at UW Medicine. In 2017, a team of stakeholders including community leaders, faculty, staff and students drafted the Healthcare Equity Blueprint, which lays out clear objectives for reducing disparities, from increasing diversity in the workforce to partnering with communities to assess needs.
“Our goal isn’t to treat everybody the same — it’s to get everyone the treatment that they need, when they need it and where they need it,” Morales says. “The first step is to become aware, and the next step is to develop interventions to reduce those disparities.”
Currently, the healthcare equity team is gathering data to study how personal bias and unconscious bias play into how doctors interact with patients and how that factors into treatment decisions.
On an individual level, doctors themselves are focusing on becoming aware of their own biases and partnering up with community members and mediators to relate to their patients on a much more personal level.
“There’s a lot of cultural differences and stereotypes from both sides that you really have to overcome,” explains Dr. Nicole Ahrenholz, a physician at the International Medicine Clinic at Harborview Medical Center, which serves immigrants and refugees. “You have to be really aware of nonverbal communication and try to connect with your patients on a level other than medicine.”
For example, she partners with cultural mediators from Harborview’s Community House Calls program to understand a patient’s cultural or religious beliefs prior to the first appointment.
“I understand that a male Muslim patient may not feel comfortable shaking my hand,” Ahrenholz explains. “As a primary care doctor, I’m in it for the long haul, so I want to understand where you’re coming from.”
Even simple things that aren’t directly related to medical care — prayer rooms, staff who speak the same language as you, welcoming body language — can make all the difference. During appointments, Ahrenholz focuses on maintaining eye contact with her patients, even when there’s an interpreter speaking, to show that she’s really listening to her patients.
“For us at the international clinic, the minority is our majority,” she explains. “Wearing a hijab is normal here, so we’re very aware and proud of having multilingual medical assistants, patient care coordinators and front desk staff, in addition to in-person interpreters.”
How to advocate for yourself at the doctor
While many healthcare organizations and medical professionals are stepping up their game to address bias, you may still find yourself in that tough situation of feeling vulnerable and discriminated against.
If that ever happens to you, Morales and Ahrenholz encourage you to file a formal complaint. Most healthcare organizations have patient relations departments that are equipped to address these types of concerns.
You also shouldn’t feel stuck with any one medical professional. If you suspect bias is at play or simply don’t feel respected, move on to another doctor until you find a good fit.
“Patients should be aware that if they’re not being treated well, they should be able to report that and get what they need from a different provider,” Morales says.
It’s also essential to trust your gut. Did your doctor look into your symptoms or casually dismiss them? Did you feel your concerns were heard or were you talked over? Did your doctor listen to your personal values or did they judge what you were saying?
“A good doctor is someone who wants to know your whole situation, from family to stresses to what’s going on in your community,” Ahrenholz says.
Staying attuned to how you feel and what you need — and speaking up when you don’t think those needs are being fairly addressed — can make all the difference.
“This work isn’t one and done,” Morales says. “I think achieving equity is something that will be ongoing work, and it’s something that we need to be attentive to always.”