Clinical Grind 10 #Bias

“Clinical Grind 10 – Bias” with our hosts Andy, Drew, and Tanner

Post by Spencer Willette, OMS-III

 

Whether we are aware of it or not, bias has the ability to dictate many of our thoughts, actions, and decisions. In this episode, the guys run through a scenario where bias played a major role in patient care.

Imagine you are working in your internship year and are presented with a non-English speaking patient complaining of a headache “after sleeping on a friend’s couch”.

There are no associated symptoms and the physical exam is unremarkable. Cranial nerves intact and no ataxia. The patient denies trauma, fever, and travel. No previous history of headaches and no red flags. It is determined this is most likely an MSK related headache and he discharged with NSAIDs.

The next evening the same patient returns with an identical headache. He again says that the headache is from “sleeping on a friend’s couch”. Again, there are no associated symptoms, the physical exam is unremarkable and there are no red flags. Lumbar puncture is not performed. Given “headache cocktail” and discharged.

The following night the patient returns to the emergency department, after experiencing a syncopal episode at home. His mother and friend are now present at this visit. The friend relays information that the patient had experienced a head-on-collision during a soccer match a few days ago. The patient did not give this information on previous visits! His mom noted a recent episode of vomiting in the bathroom before passing out and hitting his head earlier in the day. Vital signs become unstable, so intubation occurs prior to CT scan. Imaging shows multiple subdural hematomas and the patient goes into neurosurgery. Patient makes full recovery with no long-term disability.

 

Discussion:

“Patients don’t have to prove that their sick, I have to prove that they’re not.” – Andy

In this case scenario, there was a non-English speaker, from a subset of patients that has an unfavorable reputation at this emergency department for high utilization regarding trivial complaints. Bias can present in many forms whether it is towards a demographic, high utilizer patient, chief complaint, age, etc.

Bias is real and we either acquire it over time or through the systems we revolve around. So how do we react when we notice our bias?

 

Systemic bias

  1. Are there processes in place that lead to bias?
  2. Can they be fixed?
  3. Include multiple players in our systems for overview
  4. Set apart time to review the system and identify parts for improvement

 

Personal bias

  1. We have the most control over
  2. Our experiences can dictate
  3. Colleagues viewpoints can distort our own

 

This is a constant work in progress professionally and personally. In this clinical situation, bias could have been avoided by talking out the case with another colleague. Spoken words tend to have more meaning than internal thought. Sometimes the case can appear too straightforward, so by gathering input from outside sources, we can come to the realization of the proper decision.

 

Take home points:

  1. Bias is real – everyone has it – what are you going to do about it?
  2. Approach bias with a growth mindset.
  3. By addressing bias as we find it, we can expand our views and become a better provider and human being.

 

 

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