From auditing data to acknowledging your anxiety, Lisa G. Suter, MD, professor of medicine (rheumatology) in the Section of Rheumatology, Allergy & Immunology in the Department of Internal Medicine, discussed how health care professionals can recognize their own implicit bias in a Rheumatology Grand Rounds talk on Jan. 21, 2022. Suter, the section’s vice chief for Diversity, Equity & Inclusion (DEI), titled her talk, “Enhancing Diversity and Reducing Implicit Bias in Rheumatology.”
“I’m learning in this new role, and I’m hoping to share my learning as I go,” Suter said at the beginning of her talk. “Many people in this audience have been teaching me, and I’m hoping we can all learn and advance together.”
Suter recognized Gary V. Desir, MD, chair of the Department of Internal Medicine at Yale School of Medicine, for prioritizing DEI. Desir, Paul B. Beeson Professor of Medicine, is vice provost for faculty development and diversity at Yale University. Desir appointed Inginia Genao, MD, as the department’s associate chair for DEI. Genao oversees a team of vice chiefs from each of the sections within the department, including Suter.
Focusing on diversity, equity, and inclusion is critical to the department’s mission. Providing a safe, welcoming environment for people of all backgrounds results in diversity of thought, and having a diverse team enhances the ability to provide excellent clinical care, research and medical education. Understanding implicit bias is an important step to fulfilling that mission, Suter said.
Implicit Bias in Medicine
Implicit bias is a thought process that happens without us knowing, about whom we choose to help and the fact that we tend to help people like us, Suter explained. It’s a blind spot that often allows people to see bias in others, but not in themselves. It occurs without conscious awareness and is frequently at odds with one’s personal beliefs. It increases when we are emotionally, socially, and physically depleted.
Implicit bias is not racism, nor is it the only contributor to health care and other disparities, she noted. But by moving toward our discomfort, we build new neural pathways that help us to overcome anxiety and work toward being more accepting and less relying on the initial assumptions that drive internal bias.
Suter shared several suggestions for understanding implicit biases.
· Acknowledge that we all have implicit biases and explore what your own biases are. The Implicit Bias Association Test (IAT) is an excellent way to gain insight about one’s own preconceptions, predispositions and preferences.
· Move toward your discomfort by joining activities with people you might not otherwise meet. This allows you to see individuals you might have biases or stereotypes toward in a different light.
· Recognize that each patient you meet is an individual and not a representative member of a group.
· Audit your data. Rheumatology has a best practice alert that reminds clinicians to screen for tuberculosis and hepatitis when prescribing certain immunosuppressive medications. She shared very early data suggesting that this recent quality improvement project showed differential responses by race.
· Acknowledge your anxiety, thereby reducing it.
· Practice perspective-taking, the cognitive component of empathy. It’s the ability to understand how a situation appears to another person and how that person is reacting both emotionally and cognitively to that situation. Having this recognition helps build a partnership with patients.
Suter mentioned a 36-year-old African American woman she encountered on service who was deemed to be noncompliant. “The phrase means a willful disregard, and I think it’s important for us to move away from words like noncompliant,” she said. Suter spent time talking to the woman, learning that she had lost a child 10 years earlier. Sharing this experience helped Suter move past stereotypes and recognize her patient’s humanity.
“If we can remember to pause and try to see the situation from their perspective when we’re dealing with someone we’re irritated by or scared of – it will make us a better practitioner. I try to remember this woman and what she’d been through when I’m trying to understand a patient I’m having a difficult relationship with,” she said. “It helps me realize all the things that I don’t know about the patient in front of me and reminds me to take a step back, listen and try to understand their point of view.”
The Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.