Week 2 SOAP

[Abdelaziz Mohamed]

S: Physician bias is a very sensitive topic to most physician in my opinion. As it is clearly evident and referenced in the article for this week, despite our Hippocratic oath and our strive to deliver care to all patients equally without bias it remains difficult to do so every single time as we are humans at the end of the day. I found myself in the face of being biased against a few of my patients just based on their age, race at times. I find that two patients I have seen in clinic this week reflect the implicit bias and how I tried to correct for it. (I should state that I took the Harvard IAF test about a year or two ago and I am aware about some of my implicit bias). My first patient is a young gentleman who comes in with chronic back pain and has been seen in our clinic in the past. Having already known that I might be biased I tried to eliminate my bias and adopted neutrality as much as I can when approaching his concerns. We were able to dissect his problems and we identify two major issues. At the point of formulating a plan of action for his management and treatment, which included pharmacotherapy and psychotherapy, my patient became very rigid and was insisting on getting a specific pharmacological treatment. He is getting it from friends and states he used to get it from a previous PCP. The therapy he is requesting does not address his problems and at best masks the problem and if anything, increase his risk of addiction. Despite our efforts to explain the appropriateness and the lack off in his pharmacotherapy he insisted not to comply and unfortunately, I was not able to help him. Taking his situation and what social background could have led to his rigid stance is something that I tried to consider, but unfortunately, I did not have enough time (plus that the patient is not a regular patient of mine) to have an elaborate discussion about his issues.
In contrast my second patient is also a young lady who has been suffering with DM for long time, and has been having very poor compliance and care in the past. On her very 1st visit she was withdrawn and no involved in her care. But she stated if I did not want help I would have not came here. There after despite not following most of our discussed plan in our 1st visit, on her return visit we had very fruitful discussion and we were able to identify areas where we could strengthen our patient physician relationship and use that as a base to improve her DM control and her health in general. She was able to point out where she felt are issues that she cannot cope with in her DM care, most striking was that she cannot afford to have 3 meals a day (due to lack of income or time) and that’s why she kept missing several doses of her insulin. Something that I would have never been able to identify if she did not open up and disclose her problems. Now having elaborated on two of my patients in clinic this week, and being honest I identify the source of my bias in each case, whether for my patient or against my patient
O: I have implicit bias, something that an objective test was able to tell, me even though I never knew about it. As from the above examples

A: The fact that physicians have implicit bias and that we might not be aware about it, is of some concern. coupling this with our unique population and the huge disparities in health care outcome for our underserved population might worsen the situation. The 1st step is that we need to realize the extent of the problem and dissect all the angles of it.

P: As explained in the article, I will start by admitting that I have implicit bias that I cannot control personally, and then in my efforts to not be part of health care disparities and undesirable outcome, I will focus on each patient as an individual, Mr. Tom, Mr. Howell Mr. so and so. Never address them in African American, Caucasian. No reference to their wt. gender, race, or socioeconomic status in my opening sentence and unless absolutely necessary.

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