My friend Leesha almost died due to unconscious bias against obese women when her doctors dismissed her extremely high blood pressure as simply nerves for being in the hospital.

Leesha went to see her doctor, complaining of shortness of breath and tachycardia (an abnormally high heart rate). She also has a history of blood clots (due to a genetic disorder) that have almost killed her multiple times. When you've had blood clots in your lungs before, you don't mess around with shortness of breath.

Her doctor took her blood pressure and it was at 189/117. Normal blood pressure is around 120/80 which is what Leesha's blood pressure generally hovers around. The doctor immediately admitted Leesha to the hospital for treatment. In this hospital, the hospital-based doctors take over care, and Leesha's doctor would only receive reports. 

By the time she arrived, her blood pressure climbed to 205/134. 

They ruled out blood clots and came up with a diagnosis? "You must have white coat syndrome. Maybe you should go home."

She went home and a friend, who happened to be a nurse practitioner came to visit and check up on her. The nurse practitioner friend took her blood pressure and found it to be 223/119.

Back to her doctor she went, and the doctor admitted her again to the hospital. The hospital doctors would not listen to her, insisting that for someone of her size what could she expect? Maybe she should lose some weight and reduce her stress.

A doctor tried to discharge her with a blood pressure of 228/126. Leesha held her ground. She wasn't leaving until she got treatment and a real diagnosis. She was placed in a room by herself for several hours, with doctors refusing to see her, even with nurses insisting they should. The doctors repeatedly insisted that she was safe to go home.

Finally, a new doctor came on, took one look at her and said, "this is a real problem. Let's run some tests."

It turns out that Leesha's kidneys were shutting down. They were operating at 30 percent and headed further south fast. She'd recently had strep, and the doctor diagnosed Post-Streptococcal Glomerulonephritis, a known problem with strep. The new doctor began treatment, and Leesha started to get better.

Unconscious Bias Against Women

While there isn't any direct proof that Leesha's very real symptoms were ignored by multiple doctors because she was fat and female, they absolutely were ignored. If she hadn't insisted on treatment, she could have lost kidney function completely and died. The other doctors refused to do tests.

A few years ago, Joe Fassler documented his wife, Rachel's, trip to the emergency room in The Atlantic article: How Doctors Take Women's Pain Less Seriously. He describes taking his wife to the emergency room where her serious pain was dismissed.

"My wife," I said. "I've never seen her like this. Something's wrong, you have to see her."

"She'll have to wait her turn," she said. Other nurses' reactions ranged from dismissive to condescending. "You're just feeling a little pain, honey," one of them told Rachel, all but patting her head.

The doctor diagnosed kidney stones--without doing a physical exam. His wife was in agony for hours before he finally hounded her doctor into looking at the CT scan. It wasn't kidney stones, it was ovarian torsion, which required immediate surgery. She had to wait all day for the surgery because the doctor and nurses refused to tak her pain seriously.

Fassler reports that while men wait for an average of 49 minutes for pain relief, women wait for an average of 65 minutes. 

Definitely a case of systemic unconscious bias.

Unconscious Bias Against the Obese

Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. 

My friend, being fat and female, had everything going against her. Without her own self-advocacy, she could be dead.

Unconscious Bias Against Minorities

Leesha is white, but if she'd been a minority it could have been worse. Minorities also find themselves on the bad side of health care bias. John F. Dovidio PhD, and Susan T. Fiske PhD, wrote in the American Journal of Public Health

Overall, racial/ethnic minorities receive poorer quality health care than do Whites in the United States, but disparities in health care are manifested in various ways. For example, Black patients are less likely than White patients to be recommended for surgery for oral cancers,and Latinas and Chinese women are less likely than are White women to receive adjuvant hormonal therapy, which decreases the risk for recurrence of breast cancer. Racial and ethnic minority patients are also more likely than are White patients to be recommended for and to undergo unnecessary surgeries.

When your HR manager prattles on about unconscious bias, it is so much more important than getting kicked out of  Starbucks or followed in Nordstroms. It literally can be the difference between life and death.

Flip it To Test It

Kristen Pressner, Global Head Human Resources, at Roche Diagnostics has a simple solution to battling unconscious bias: Flip it to test it. If Leesha's doctors had stopped and said, "would I be sending a skinny man home with this blood pressure or would I investigate?" she would (most likely) have gotten treatment much sooner. 

This works in all situations and doesn't require extensive bias training. Instead of trying to get people to confront their own biases, this method simply gets them to fix it. We can't overcome all our biases and it's silly to proclaim that we can. Instead, we acknowledge that it's a problem for everyone, and do this simple test.

Most or us don't deal with life or death decision making every day, like doctors and nurses do. But we do have decisions to make on who to fire, what to say to someone, and who to hire. Checking your own biases makes the world a better, and much safer place.

Published on: Aug 27, 2018