Bias In Medicine

sQ: Why don't providers ask men, in just as adamant terms as we ask women, about their birth control methods?

Q: Why do providers have limited education about basics like nutrition, sleep and sociology?

Q: Why are patients with kidney failure, but not any other organ failure, guaranteed government health insurance?

Q: Why was lobotomy a thing?

Q: Why do providers sometimes still prescribe opioids inappropriately for chronic pain conditions?

Q: Why are medication lists and problem lists sometimes incorrect?

Q: ​Why are medical errors arguably the third leading cause of death in the United States?



A: Medical providers are not immune to bias. We are humans. And humans create the guidelines by which we practice medicine.

We don't ask men about birth control because we as Americans are taught that men are less responsible for birth control decisions than women. This is a cultural bias. We aren't taught as much about nutrition because the medical paradigm focuses more on disease than on health. Patients with kidney failure (but not heart failure, liver failure, pulmonary failure...) are guaranteed health insurance because people who cared were good advocates, and Nixon signed the bill making it law. Lobotomy was a thing because the guy who came up with it was an excellent orator, and the world was desperate for a cure for severe mental illness. Patients are prescribed opioids inappropriately because it's hard to have the conversation about how unhelpful they are. Providers know how hard it is to stop taking them, due to the irreversible neurological changes made by opioid dependence. Medication and problem lists are sometimes incorrect because problems and medications change frequently, and it's hard to keep up. Medical errors are the cause of death because of communication error, time constraints, too many handoffs, and inadequate training.

...but these are just one provider's perspective from the top of my head.

I believe the more complete answers are complex, systemic, related to human frailty, and the challenges unconscious bias. Providers are biased because they are people. We are biased by the last study we read, by our loved ones' diagnoses, by the worst cases we saw as residents, by how close it is to lunchtime, by our incentives to do good work, by our own moods. We are influenced by the media and by the cultural contexts in which we work. We are limited to short visits, and the information a patient can give us both verbally and nonverbally. We are limited by the training we have received. 

Medicine is powerful. And those who practice it are fallible. Accepting the limitations of a human practicing medicine means ...

A decision about a diagnosis or treatment should be arrived at through thoughtful discussion between the provider and the patient who will be affected.

When I know something new, I work to make changes. But I'm human. I'm inconsistent, despite my best efforts. 

I'll keep working on it.

-Dr. Southwick

"All of this was just someone's idea. It could just as well be mine."
-Ani Difranco