Physician Bias

[Kalyan Sreeram]

S: Physician Bias is a very real and often unavoidable presence in clinical practice. Regardless of whether it is a net negative or positive force, physician bias does create disparities in the way various groups of patients receive treatment. Since making sound clinical judgments often depends upon pattern recognition, it only follows that physicians will see certain patterns at a higher prevalence than others and will make decisions based on the patterns they witness. Therefore, there is an implicit bias that physicians will construct because they will use prior experiences to guide them through current ones. I would even contend that properly practiced evidence-based medicine is primarily rooted in the recognition of chronically successful patterns and the application of knowledge from those patterns. That said, physician bias can often lead to avoidable detrimental outcomes. The key is to figure out the value in our biases and how to steer them toward achieving the best outcomes.

O: One common source of bias is in the management of pain. Since complaints of pain are often difficult to objectively validate, we are more likely to use prior experiences in treating pain for someone. For instance, physicians are far more comfortable in providing commensurate pain relief for patients with cancer or Sickle Cell Anemia without much question, but less likely to do so for someone who may have a past as a recreational drug user. Further, we tend to begin associating individual behaviors to a group of people the more we see them occur; this group often gets characterized by socioeconomic factors including race, economic status, or even religious belief. It is our tendency to analyze cohorts of patients together and create a pattern of treatment rather than keep them all completely isolated. Sometimes this is of benefit as it helps, but sometimes we make wrong or negative associations. This will continue to happen, but what we need to do is recognize when it could be a negative outcome and prevent ourselves from making such associations in those instances.

A/P: In the management of pain, I want to make sure in my future practice that I do not treat it with different medications or measures specifically based on factors that are not purely clinically sound. For instance, I don’t want to find myself treating two patients with similar postoperative pain differently because one is White and the other Black. At the same time, I realize physician bias can be a positive force; if not for that, we would not have come to a conclusion that thiazide medications confer greater benefit to African American populations compared to other medication classes and for other races.

Ultimately, I want to be able to recognize my inherent biases and refine them to steer my patients toward better outcomes.

[Author]

Posts