Bias and Its Significance in Healthcare

by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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    00:05 Many people asked themselves why they should care about cultural intelligence and why should you care about bias; because we're not biased, right, we're great people.

    00:14 I have never committed a microaggression. Well, that's false thinking.

    00:17 And we should care because as human beings were going to be human and we are going to continue to judge, label, but, again, remember, the important thing about that is, how do you let that play out in terms of your interactions with other people? Are you advantaging some people and disadvantaging other people? And we're not talking about any additional characteristics.

    00:37 When I say people, I mean humans. Just thinking of us as humans.

    00:41 We all look the same when we think about humans and we should care because it's our professional, ethical, legal, and moral responsibility as healthcare providers.

    00:51 And, that, is guided by a lot of different virtues but especially respect, ethics, integrity, and honesty.

    00:58 And we have to practice all those with consistence.

    01:01 Another reason why we should care is because bias, does have an impact on interpersonal interactions and so that oftentimes, drives how we diagnose people.

    01:14 If I have a bias and I'm just letting that thing take over my whole ability to interact with the patient, then I'll probably will misdiagnose somebody.

    01:22 Why? Because I'm judging for whatever reason and I may not honor certain diagnostic or screening tests that people need. I may not do a full assessment on a person.

    01:33 Then I may be operating on the myth when it comes to pain management, labeling people for a couple of reasons.

    01:41 One is because of race, there is a myth that Black people have a higher pain tolerance than everybody else.

    01:49 That's absolutely a myth.

    01:51 Pain tolerance and whatever pain is, the level of pain is subjective and it's individual and we need to look at that again, from a human perspective.

    02:01 The other thing is, oftentimes, we have these stereotypes and stigma against people who use substances or people with substance use disorder, and so we withhold.

    02:13 Well, even though a person may have substance use disorder, if they're experiencing something that we know is painful, like a broken leg or whatever it is, we still have to offer some type of pain management to that patient and partner with the patient, because we definitely don't want to ever put someone in a setback and put someone who may have an addiction to narcotics or opioids on something like that.

    02:38 How can we work to get this patient out of pain and it's not up to us to label and make assumptions? The second of that, this part of the wise, is internal dynamics.

    02:50 Communication, we talked about that a lot in terms of emotional and cultural intelligence.

    02:56 How the lack of emotional and cultural intelligence have, can have a negative impact on communication.

    03:03 And also, thinking about how bias, if we don't have these strategies and tools readily available to ourselves, it would impact our communication.

    03:13 So we know that if we don't get an accurate history from a patient, remember what if it's something about me that's diverse, maybe it's a mental health issue, there's a stigma attached to that, I may not trust this provider because maybe they're going to weaponized that.

    03:28 Maybe I am an alcoholic and I don't want to tell you that because I already feel like you're being judgy towards me so I'm definitely not going to say that, and you may withhold treatment options for me because you might be labeling me.

    03:42 So just think about all those things and put yourself in that person's shoes.

    03:47 And I always say like, some people don't care a whole lot about themselves, but whoever you care about, that's how you treat that person that you're interacting with like you want them to be treated.

    03:57 Most of us who are parents would do anything, go to the ends of the earth for our kids.

    04:02 So think about how you want your kid to be treated or your parents, whoever it is.

    04:06 But I just want to give specifics of who we need to think about.

    04:10 Then, also, think about how we need to be collaborating not only with the patient but also with the families and also with other people on the healthcare team.

    04:20 And in that, we should be paying attention to those internal dynamics.

    04:25 So if you're a witness to someone on that healthcare team operating on bias, then you need to be able to somehow advocate either directly or indirectly and be an up-standard because your goal and your role, is to make sure that these patients have optimum outcomes.

    04:43 Then, if we talk about it from an organizational perspective and we think about performance reviews and we talked about that a little bit already, go back to those cultural values, preferences; go back to the types of bias which I will talk about shortly, and think about how your biases may have unfairly advantaged someone for getting someone a promotion or a raise, or unfairly disadvantaged someone from getting it.

    05:12 Now that sounds like a lot, but just think about it.

    05:15 You don't want to advantage someone unfairly that's the bottom line, and you don't want to disadvantage someone unfairly.

    05:20 And, then, in terms of, I've mentioned it a little bit, but compensation promotion usually, I won't say usually, in many situations, raises are arranged, and we don't want to allow our personal feelings towards someone to prevent them from getting what they actually deserve.

    05:38 And, then, one of the big keys to this is cost and waste.

    05:43 You saw in that health, sorry, in the future of Nursing 2020-2030, it talked about cost.

    05:49 Well, guess what? We spend so much money, $310 billion per year, because of biased induced care.

    05:59 Why? So think about it like this. Here's an example.

    06:02 Let's just say this person comes in and for whatever reason, I'm not going to do a full assessment on them.

    06:08 I'm not going to order the diagnostic test maybe it's because I feel like they can't pay their own insurance, they don't deserve it, I'm going to do the bare minimum. Well, guess what? I misdiagnosed because I didn't do enough screening or testing to accurately diagnose this patient.

    06:23 Now I'm treating them with something that's not strong enough or whatever it is or I've given them the complete wrong diagnosis.

    06:31 They come back and they're sicker because I didn't treat the correct illness or issue or disorder, and now, it's costing more because I have to hospitalize them.

    06:42 And when I could have done an x-ray on the front end now I need an MRI because it has gotten so much worse and that's more expensive.

    06:49 When they could have been on the floor if I needed to admit him, now they need to be in ICU.

    06:54 So thinking about those things and the exacerbation of a condition based on either misdiagnosis, undertreatment, whatever it is, in the long-term, that ends up being greater cost.

    About the Lecture

    The lecture Bias and Its Significance in Healthcare by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE is from the course Bias in Healthcare.

    Author of lecture Bias and Its Significance in Healthcare

     Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

    Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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