Medical Bias

Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I want to talk about the complex layers of Medical Bias. It is a pervasive problem, but also really difficult to address. I want to talk about what makes it hard to address.

The first challenge is that who we physically are is not just about our health. There are numerous biases that are based upon a person’s physical being. Things like your biological sex, your race, your weight and your age are all things that have biases associated with them (sexism, racism, fat phobia and ageism). But it is also true that these physical differences create different medical risks. The first challenge is how do you separate the very real and important clinical reality of medical risk based upon a person’s physical identity from the terrible and toxic biases that are often also associated with these traits?

The first important thing is that just because a health care provider is talking about one of these kinds of categories doesn’t mean they are falling into the trap of bias. Discussing someone’s risk based upon the physical identity that they have is an important part of preventing disease. We want providers to be offering mammograms to people who have breasts and we want providers to address the fact that African Americans are more likely to have complications from high blood pressures. It is important for a provider to discuss the risks of weight with a person that is over their ideal body weight. But all too often providers cross the line from good clinical practice into biased thinking. How does that happen?

Let’s take a closer look at one of the biases to better understand the complexity of how bias plays out in the medical setting. What sex you are born has a biological impact on your health risks and is a very important factor to consider in your health. But there is also the reality of gender bias in the medical system. An example of this bias is the reality that females are less likely to be believed that they are experiencing pain. [1] [2] [10] [12] For this discussion, for the sake of keeping things simple, let’s focus just on the issue of how pain is managed in the health care setting in context of reported sex.

The bias that exists regarding sex and pain is present in all of society. Parents respond to male and female children differently when they are in pain. [6] [7] [8] This means that society has rules for how males and females behave regarding pain that has been taught to all of us. Those lessons begin when we are children and our parents are responding to our pain reports. How our parents respond to our pain teaches us how we should be responding to and reporting our pain. None of us are leaving those biases behind when we go to an appointment regardless if we are the patient or the provider.

The majority of the research that has been done regarding pain has been focused entirely on the male experience. It has only been in the last decade that females have been included in this research to any meaningful degree. This means that there is a foundation of bias built into the medical knowledge. What providers are taught about the pain experience and the best treatment approaches are based on the male experience. This inherent bias in the system is one that a provider cannot avoid because they cannot use medical knowledge that we haven’t learned yet.

There is research that reflects that providers are less likely to medicate females. [3] [11] [12] However, it isn’t as simple as women not getting pain medication. Research shows that providers are more likely to medicate someone who is the same sex as them. This research also showed that providers tend to give higher doses for longer periods to those of the same gender. [3] Perhaps this means that we have an easier time assessing the pain of someone that is the same sex. But it may also suggest that the long standing polarization and division of the genders within our society has significant impacts on the ways that providers are making clinical decisions.

There are also fundamental problems with the manner in which procedures and products are researched and approved. Intrauterine devices (IUDs) are a common form of birth control. They are a small device that is inserted into the uterus to prevent pregnancy and can be used to help manage numerous health conditions. During the development and approval process of this product it was never required that the product be evaluated for the possibility of causing pain. Nor was it required to develop methods to treat the pain caused by this procedure. To date, “no preventative pharmacological intervention has been adequately evaluated in an RCT setting and been shown to significantly reduce pain associated with IUD placement.” [13]

This means that when providers are considering and choosing treatment options for their patients, they may not have the option to give them adequate pain control with those treatments. That limitation is often because of a flaw in the way that products and procedures are developed rather then the degree of compassion or empathy a provider might have for their patient. It puts the provider in the difficult situation of having the best treatment option being a source of pain that cannot be treated.

The biases within our healthcare system are woven so completely into the fabric that there are times that a provider cannot avoid practicing with bias. When they are taught based only on the male experience of pain because that is all that has ever been researched they cannot avoid that bias. When medical products are not researched or approved without bias, the provider cannot avoid bias. This means that if we want to remove the bias in our healthcare system, we must begin by looking at the very roots and foundation of that system.

This isn’t to say that a provider cannot take steps to reduce the amount of bias in their practice. They can put protocols into place so that every patient that comes in is screened and treated similarly. They can be mindful of their own personal biases and strive not to allow those biases to cloud their decision making. They can strive to create collaborative relationships with their patients rather then one of paternalism. They can create an environment that encourages a multidisciplinary approach which can reduce the risk of bias by increasing the number of providers assessing the case.

What can you do as a patient? It is important to understand that bias is woven into our system and because of that, it cannot be avoided. Advocate for yourself. If you are unable to do this, find an ally who can advocate for you. If you have someone supporting you as an advocate, consider making them your POA as well. If you don’t know anyone you can trust with this, consider finding a professional health advocate. [14] If you don’t feel a provider gave you adequate care, get a second opinion. Be aware of your own biases and trauma responses that might impact the conversation. In the end, if your provider isn’t helping find wellness it is time to find another provider.

Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like my rambling then click on that like button. It really does help! Until we talk again, you take care of yourselves!

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