You might think you approach the world objectively — but you don’t. We all see the world through a subjective lens. Our lived experiences, culture, and education form our mindsets. And this includes the people who oversee our healthcare.
I have an intimate relationship with doctor’s offices due to living with several chronic illnesses. After learning about how bias impacts my treatment, I’ve started to become a better communicator with my medical providers. Yes, I feel more empowered as a self-advocate. I’m also starting to understand how I can break through the biases and move forward productively.
Of course, people with power should take responsibility to learn about their own biases. They need to make an effort to subvert them themselves. Additionally, a patient won’t always aim to strengthen the relationship. Sometimes, they just need to clarify the need to leave and seek a new provider who’s a better fit. I’m not the only person who thinks so: it’s clear in Dr. Lisa Sanders’s book, the inspiration for the TV show, House. She detailed her colleague’s cognitive errors throughout “Every Patient Tells A Story.”
Remember, people might experience these biases differently depending on their age, weight, ethnicity, gender identity, sexual orientation, among other personal factors. The patient experience will never be one-size-fits-all. Our healthcare systems need to start reflecting this concept.
Let’s say that you are a twenty-something office worker who visits your family doctor. You want to discuss how you’ve been feeling tired, dizzy, and experiencing significant joint pain. Your doctor chalks your symptoms up to stress, referring you to a psychiatrist. They conclude this because on average, most people your age are healthy and simply overworked. Unfortunately, you actually have arthritis.
Representativeness bias happens when we judge someone based on how closely they match what’s considered typical for a certain identity. Why is this dangerous? Your diagnosis will be delayed if you live with undiagnosed arthritis, but you’re referred to a psychiatrist instead of a rheumatologist. This delay means your quality of life will continue to deteriorate needlessly, and perhaps, irrevocably.
How do you express your pain? If you don’t present your pain in the same way someone else does, this might subconsciously lead them to believe your pain must not be as severe as you claim.
Egocentric bias occurs when our self-knowledge unfairly influences the judgments we make about others. If a patient seems dazed and quiet in the emergency room, the doctor might be dismissive. Particularly, if their own pain expression typically presents as moaning and crying. Unfortunately, they could be missing a serious issue they need to address urgently.
Many cisgender women, or people assigned female at birth, grow up feeling like they’re struggling to stay afloat with work and school. Finally — in their late twenties, early thirties, or even later — they receive an attention-deficit hyperactivity disorder (ADHD) diagnosis. Doctors missed the diagnosis for years because it’s known to be more common in people assigned male at birth.
When a doctor neglects to properly treat or diagnose a patient because a disease is considered to be less common or severe in their assigned sex, this is known as knowledge-mediated bias. Not only does this result in delayed diagnoses, but it also causes significant harm to a person’s self-image. This does both results in delayed diagnoses but also causes significant harm to a person’s self-image. They can spend years blaming themselves for allegedly flawed personality traits.
Many people who have experienced weight stigma share heartbreaking stories about having their symptoms blamed on weight when they seek medical attention. Imagine if you seek medical care about new, intense stomach pain. You weigh about 200 pounds, standing 5"4 tall. Believing that your “lifestyle” caused these symptoms, your doctor sends you home with the advice to change your eating habits. Yet, you actually have appendicitis. Your appendix ruptures, and you need to rush back for emergency surgery.
When we misjudge the role that an individual plays in creating their circumstances, that is a form of attribution bias called fundamental attribution error. Correspondence bias occurs when we credit a person’s behaviour or circumstances to their personal traits. When we do this, we blame the victim, creating an atmosphere of shame — and we ignore the many social determinants of health that influence our well-being.
I know I’m not alone in this: as a woman with a mental illness diagnosis, I’ve experienced extensive discrimination in attempting to seek care for my physical illnesses. I’ve presented to the emergency room many times with intense abdominal cramping. I’ll typically be given an ultrasound, which ultimately shows nothing abnormal. Often, they sent me home without further testing or referrals. Due to my medical history, the test results confirmed my doctor’s hypothesis that my stomach pain was “just anxiety.” In fact, I was living with endometriosis and adenomyosis. It took me more than fifteen years to receive these diagnoses.
When I received this treatment, I was experiencing confirmation bias. Confirmation bias happens when we look for evidence and understand it in a way that aligns with our existing beliefs and expectations. Confirmation bias clouds a provider’s ability to see their patient as a complex individual. This ultimately leaves that patient fighting for answers for years.
When patients describe their difficult experiences within the healthcare system, it’s not to complain. It’s not that we’re not grateful for the people who have dedicated their lives to keeping us healthy. It’s clear that providers usually care immensely about helping their patients. Yet their implicit biases can impede their ability to provide the care we need and deserve. We want to articulate our journey to validate each other and to normalize these issues. We want to hopefully instigate change and a future with better patient experiences.