Do Emergency Physicians judge patients on race, sex, sexual orientation, weight, etc.? St. Emlyn’s

wikimedia

wikimedia

A few years back I picked up a book at the airport by a chap called Malcolm Gladwell, a rather famous writer it turns out and one familiar to many EPs who has produced some excellent work. I like his books as they make me think, it’s work that challenges my past assumptions and in some cases raises questions that make me feel quite uncomfortable. I’ve read a few of his books now and all have their merits, but I think that the one I use in teaching the most is ‘Blink’. Blink looks at how we make rapid assessments and judgements in daily life and explores the positives and the negatives of this…., is this relevant for the emergency physician? Well of course it is. Our days are a constant stream of rapid assessment and decision making. It’s probably not a bad idea to stop and think about it once in a while.

Anyway, a small passion of mine is to try improve understanding around equality and diversity issues in Emergency Medicine. We’ve recently had IDAHO day and in Virchester we have recently had a whole week around Equality and Diversity training for all staff. In the ED our practice means that we see everyone regardless of who they are and where they come from. As one of my colleagues mentioned recently we ‘are’ diversity, with a really mixed population and staff, and we do some fantastic things to help our patients and staff support this. What about ‘you’ though, and ‘me’, and ‘your’ colleagues? Are we the sort of people who are truly free of any prejudice and judgement? Do we exercise prejudice in our work and do characteristics such as weight, age, race, skin colour, gender and sexual orientation influence how we deal with patients and colleagues?

I will take a guess and say that at this point most people reading this will say that it doesn’t. We would not describe ourselves as racist, sexist physicians (and all the other groups we can think of). We don’t consciously discriminate as that’s clearly contrary to the practice of being a good emergency physician, but are you sure? How would you know if you are the sort of clinician who links certain characteristics to certain group of people? How would you start to understand whether patient characteristics might affect you?

We might even ask if it matter at all if we treat patients the same? Is there evidence that race (as one example) influences us? Disturbingly there is. Just dip into Medline for a selection of the many papers around linked to the subject. We can go back to 2000 and Dr Knox Todd who showed that white patients received more pain relief in the ED, in 2006 data from the USA , more recently in 2010.….., I could go on. It looks as though we have an issue around pain relief and an association with race. That makes me think that this stuff really matters.

So, back to Malcolm Gladwell and Blink. It is here that I discovered  work around the concept of Implicit Association developed at Harvard University by Anthony Greenwald and Mahzarin Banaji. Implicit association suggests that we unconsciously associate certain characteristics with certain groups (e.g. skin colour) with the individual associating positive or negative influences against these characteristics. By assessing the degree of association the IAT builds a picture of how an individual associates certain characteristics as either a positive, neutral or negative trait. The literature behind it at the time, and since, is complex and beyond the scope of this post. You are welcome to read more including the many controversies around the methods and interpretation of results should you wish. My usage is much more basic. I think it’s a great way of challenging us to think about our own assumptions and the associations that we make about our patients.

What was fascinating in Blink, and borne out by the many colleagues who have taken this test is that nearly all of us have preferences for certain characteristics, and that they are not always in the direction and magnitude that we think. The great thing about the research is that the tests are available for free and online. You have to give some additional details to answer the question sets that cover a range of topics, but it’s worth the effort.IAT

Of course, it’s not just the Harvard team that have identified associations between characteristics and preference. It’s even something that we can detect in children, with kids expressing less of a preference to overweight characters in story books.

So, I’ll ask the question. Do you have racist, sexist, gender, orientation, weight etc. preferences and association? I don’t think you know, but if you’d like to, then you know where to take the test. The public and free demo tests are available across a range of topics. If you want to be a better clinician I think you’ll find them useful.

Posted by Simon Carley

Professor Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of BestBets, St.Emlyns and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. His research interests include diagnostics, MedEd, Major incidents & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester

  1. In words stolen from the immortal ballad in “Avenue Q”: You’re a little bit racist- that’s for sure. As are we all. You cite pain and race, but we could go to CP and gender, and recently attitudes of med students towards the obese for similar confirmation. Psychiatrists are required to endure some # of counseling and therapy sessions to discover their own biases so that they can be more aware when they start projecting. Some introspection and awareness on our part would be wise if we want to avoid errors as well.

    But Blink is the one Gladwell book that I would rail against since it’s central point I reject. “Thin slicing” and quick judgments are only valuable when there is a core body of experience and knowledge to give the System 1 of cognition the raw materials it needs to discern patterns before all the data points are in.

    There’s some interesting stuff in Blink, but quick “gut” impulses are useful only when experts in their fields do it. Kahnemann is a much more enlightening read on the topic.

    Reply

  2. […] can affect our clinical judgement and personal judgement. If you’ve not read the post on the effect of race on our practice then you should, it explains how the world around us can affect how we treat patients (with really important things […]

    Reply

Thanks so much for following. Viva la #FOAMed

Translate »