President’s Message

NEUBERT 2017

“Of all the forms of inequity, injustice in health care is the most shocking and inhumane.”

-MARTIN LUTHER KING, JR., NATIONAL CONVENTION OF THE M EDIC AL COMMITTEE FOR HUMAN RIGHTS, CHICAGO, 1966

The Joint Commission began an April 2016 Quick Safety publication on Implicit Bias in Healthcare with this quote. The Joint Commission advisory goes on to state “There is extensive evidence and research that finds that unconscious bias can lead to different treatment of patients by race, gender, weight, age, language, income and insurance status.” While the natural inclination is to deny that this could possibly be so, further reflection on the evidence leads us to question what could motivate such inequity. Our November Society meeting took up the important issue of implicit bias. Arthur Breese, Director of Diversity and Inclusion at Geisinger Health System, provided us with a thought-provoking evening that served to expand our understanding of implicit bias and provided important insights into this phenomenon. The Joint Commission provides the following definition of implicit bias; “Implicit (subconscious) bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control”. Implicit bias is therefore something that operates under our radar and without our awareness. In many ways it reflects a defense mechanism by which we can quickly make sense of a barrage of information and categorize it in a way that is consistent with our understanding and experience. While implicit bias cannot be completely eliminated, it can be tempered by development of cultural competency. Cultural competency requires personal introspection in which one explores their own cultural values with specific attention to discovering assumptions and biases that influence our decision-making. An acceptance of the fact that there is more than one point of view and different ways to do things is fundamental in developing respect for individuals whose perspectives and actions are different than our own. The Joint Commission provides several suggestions for actions to combat implicit bias: • Have an understanding of the cultures from which your patients come • Avoid stereotyping your patients; individuate them • Understand and respect the magnitude of unconscious bias • Recognize situations that magnify stereotyping and bias Mr. Breese also provides the following suggestions for mitigating bias: • Recognize and accept that you have bias • Develop the capacity to use a flashlight on yourself • Practice constructive uncertainty • Explore awkwardness and discomfort • Engage with people you consider “others” and expose yourself to positive role models from that group • Seek feedback Mr. Breese also discussed a tool to aid in development of cultural competency. Project Implicit is a joint undertaking by Harvard University, University of Virginia, and University of Washington. I took his suggestion and visited the website and completed a number of the Implicit Association Tests (IAT) presented there. I must confess that it is been an interesting exercise in self-discovery enabling me to explore my own implicit bias that I would have firmly denied could possibly exist. I invite you to do the same. I hope you find the experience as enlightening as I have. In summary, let us commit to meeting the challenge set before us by Dr. King as his words continue to echo across the decades. Our patients and our society deserve nothing less.

A. George Neubert, M.D

President