Bias is something we all experience, but knowing how to account for our implicit biases versus
our explicit biases requires some self-reflection.
And so today, we'll review the discussion led by Dr. Craig Lillehei from the 2022 Update
Course in this week's Update Course Rewind.
Let's start out with a case.
A pediatric surgical intern leaves her team into a patient room for rounds.
She's an African American and the only person of color on her team.
She begins to introduce herself, but is interrupted by a white parent who says, "Finally, someone
has come to take my meal tray."
The white pediatric surgery attending is visibly uncomfortable and says nothing.
As a pediatric surgeon with a duty of compassionate care to patients and a mentor committed to
diversity, inclusion and protection of trainees, what do we do in that circumstance?
I wonder how often we're exposed to similar behavior and we may come up with any number
of excuses.
Well, it's a very stressful situation or I don't want to undermine that relationship
with the parent or I'll talk to them later and set this right.
Well, speak up and use the opportunity to correct the patient's mistake.
Another what we said to describe in our discussion of this is a surgical intern has been victimized
by racialized stereotype that could be characterized as microaggression.
Now microaggressions are verbal, nonverbal, environmental, slights, snubs, invalidations
or insults that send hostile derogatory or negative messages to individuals based solely
on their marginalized group membership.
Micro, it's anything but micro.
We sort of, they're referred to as small repeatedly that the individuals are repeatedly
experiencing them, but they have a cumulative impact, isolation, self doubt.
That's the kind of behavior that we've got to turn around.
And acting as a bystander without speaking up compounds the harm.
Unfortunately, it really can't be undone even if you come forward later.
So what's the personal practice change?
Well, what we're asking is that for us to be upstanders, bystanders who respond with
action to these microaggressive behaviors.
That's the only way we're going to change it professionally for our hospitals, for our
institutions, for our patients.
One of these references was Dr. Meera Kotagal.
Dr. Kotagal is a pediatric surgeon from Cincinnati Children's Hospital Medical Center, and her
research focuses on disparities in patient care and patient outcomes.
She's really worked to define and identify microaggressions in the hospital system.
Specific questions come to mind.
How do I not alienate the family?
How do I not create a difference or avoid making the intern more uncomfortable?
And I think one of the biggest things to think about in those moments is intent versus impact.
So very often families, what they're doing, those implicit biases are not intentional,
right?
They don't necessarily recognize that that's what they're doing in that moment.
If we separate intent from impact, it's easier to respond to understanding the impact and
talking about what the impact is and not worrying so much about what the intent is.
Because the intent is sort of irrelevant.
The impact already exists.
And so I think that helps alleviate us from that anxiety about how the family, you approach
it as like, hey, you maybe didn't intend this, but let me help you understand how that impacted
the person who was standing there.
Well, thank you, Meera.
And I hope that insight about intent will get rid of all those excuses that sort of
come to mind in my own.
Thanks for joining Dr. Lillehei and Dr. Kotagal, along with the rest of the APSA Professional
Development Committee for this update course rewind.
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