Seeing Patients: Unconscious Bias in Health Care is a novel written by Augustus A. White III, M.D. Dr. White grew up in the segregated southern city of Memphis, Tennessee before the Civil Rights Act was passed. This novel tells the story of this orthopedic surgeon’s life and explores his encounters with racism.
Dr. White, or “Gus” as he went by as an adolescent, struggled with injustice his whole life. Whether he was facing them on his own account or watching it happen to someone else, it was occurring. A specific example of this is when Gus was trying to narrow down what colleges he wanted to apply to. He had his criteria of sports offered, good pre-med programs, and the last, “how did it treat Negroes?” This was an absurd criterion, but there was another aspect to this: Did the college even accept students of African American decent? Some colleges did not accept any Black students, while others operated on a quota system. This is an obvious injustice because even though an African American student may be just as qualified, if not more than a White student, they most likely cannot enroll in a school because of race.
Issues with power are seen throughout this book, most of them overlapping with injustices. The front flap, however, sums up the issues that Dr. White views in healthcare. It states, “The key to getting the very best medical care: be a white, straight, middle-class male.” While working as a scrub nurse one summer before he attended medical school, Augustus, witnessed a situation where a Black woman was powerless. She came to get a cancerous tumor removed by a white surgeon. The surgeon was disrespectful towards her before the surgery. During surgery, the woman was hemorrhaging, but the surgeon kept cutting and eventually let her die. There was no dignity involved. Had this been an unconscious or maybe even conscious bias of that surgeon? If the patient were a straight white male would the surgeon had explored another option?
This book certainly reminds me of works such as John Lewis’ March and MLK Jr.’s “Letter from Birmingham Jail.” There are many things related to civil rights because Dr. White grew up during this time. Dr. White, in his own way was contributing to the fight for civil rights. He held a lot of the “first” positions. That is, he was the first black American to accomplish things. Dr. White wants his readers to know about the biases in healthcare, but also to know about prejudices and racism of the past and present. This work certainly inspires conversation related to injustice, power, and identity.
The below podcast was recorded by Josh Pelland and James Schubert.
Captions are available in the above YouTube video. The full text of the transcript is also included below for your reference.
0:01
All right. Hey everybody, my name is Josh Pelland. My name is James Schubert. Today we’re gonna be talking about socioeconomic status and its effects on health. So kind of the background story on this is that I saw a research poster in Ohio State’s exercise science labs to the effect of disproportionate obesity among Hispanic women. And after digging into this a little bit, there’s definitely a clear positive relationship between obesity prevalence and declining socioeconomic status.
0:30
So this comes as a relationship between the higher consumption of fast foods, sodas and other hypercaloric options in these populations. And this is definitely a big cause of this may be due to cost. And it seems almost like a paradox where people from higher socioeconomic statuses would have more money at their disposal so that they could spend it on you know high calorie foods, but in reality, it ends up being that these higher caloric foods end up being cheaper than Organic options such as stuff from grocery stores, like Whole Foods and farmers markets, and even then farmers markets and Whole Foods might not even be available to these people in from these lower economic backgrounds, especially in their own communities.
1:16
Yeah, and, I’d like to address a common misconception that a lot of people have. So a lot of people would assume that the direction of causality between socioeconomic status and poor health would be so somebody becomes poor and thus their health deteriorates, because they might not have access to sufficient health care professionals, etc. But actually, the research would indicate otherwise. So a low socioeconomic status at birth is what predicts subsequent poor health down the line. So kind of on that same note, with regards to the gradient between socioeconomic status and health, only about a third of that gradient is explained by lower socioeconomic status leading to more health risk factors. So Examples of this include poor water quality, smoking and drinking. So that’s a disadvantage they’re already at. But again, that only explains about one third of it. So there’s a couple hypotheses related to this. The first one is like the psychosocial hypothesis. So there’s this idea of having low social capital. So if you feel like you have a low ability to actually change your circumstances that somebody This is situation a poor person might find themselves in so that this stress response can actually deteriorate health itself. And probably the more pertinent to our discussion. This second hypothesis called the Neomaterialist hypothesis. So this is the idea that as income inequality grows, there’s less of a direct benefit for the wealthy to improve public resources. And as a lot of us know, wealthier people tend to have more resources and more influence in order to lobby and actually influence whether these public resources are improved, so as this gap increases, we see the lower income groups having less access to these public resources that might actually influence their health.
3:14
Yeah, and this is also related to what Spivak has told us about the concept of whether or not the subordinate can speak. So we’ve all heard this term of the either the silent majority or minority, whichever one. But in this case, the lower income groups don’t get a proper seat at the table for the issues that impact them, because they can’t necessarily do as much right now to change their situation that like that is currently at hand for them, because they don’t have the same resources that were previously mentioned as someone from a higher socioeconomic status, because it’s not as easy as you know, going outside and changing your life and you can’t do that like at the snap of a finger. It takes a lot more time and it takes a lot of money to you know, choose these healthy options at the grocery store, pay for a gym membership and put yourself in positions that you can be an extremely healthy person sometimes. So in these lower income situations, the harsh reality of it all might be that some people have bigger problems to worry about. They might not necessarily be going through their day thinking that, oh, I need to go get my 45 minutes of exercise and when you know they need to go work and they need to pay their electric bill or they need to pay their water bill, it really comes down to what they what they deem as more worthy of their time. And sometimes as sad as it might be health might take back a backseat to all this because making ends meet is really more important sometimes than living a healthy lives lifestyle. Like you have to everyday we make sacrifices. And sometimes the sacrifices need to be made so that we can even continue to live, whether that’s healthy or not. We have to make that we constantly fight to make that decision of whether or not you know I want to go on this walk or if I’m going to finish the 35 minutes of of homework that I need to do, it comes down to what you see is more beneficial to your everyday life. Right. So, and kind of jumping off that, you know, like, there’s definitely implications related to you know, we got to pay the bills, we got to
5:13
get the kids to school, whether we’re working one job, two jobs, three jobs, whatever. I think this also relates to the concept we’ve learned in this class, like basically throughout the whole semester related to othering. So from the concept of from the perspective of the one, they might think that the lower like, essentially that their health is a choice and that, you know, it’s very, it’s very simple in theory right, exercise sufficiently, meet the national guidelines for exercise throughout the week, and, you know, choose healthy foods, eat an appropriate amount of calories during the day and that, that’s all you have to do. It’s a choice, whereas I think they kind of lack a true a true empathy for this popular In terms of their ability to, you know, the disadvantages that they’re at in order to actually achieve those things, and I think that kind of links in with what James has been discussing, as it pertains to, you know, what are their true day to day worries for for these people, right, like if they have to work extra jobs, they’re not worried about getting those extra 60 minutes of.
6:22
Go ahead.
6:24
Yeah, so sometimes it’s, it’s, we, we kind of touched a little bit on this, but it’s like, more easier said than done. Not all these things are, you know, it’s it’s not the easiest thing for some people to find the amount of time that they can really spend, because at this point, time, time realistically is money for a lot of people. And they could be either working for you know, those couple of hours a week. So I guess if you do an hour a day, instead of working that five hours and making however much money at that, at that rate, you end up choosing to sacrifice that to, you know, be healthy, which isn’t necessarily a bad idea. But in the grand scheme of things, the money ends up playing a large factor in this because it really supports our everyday lives. And if you can find a way so that you can work it into your lifestyle to become healthy, and take the time, then more power to you. But sometimes you have to pick and choose your battles. And whether or not being the healthiest person or being a person who’s alive at this point is it’s one of those tough decisions that you have to make because either way, it could either help or hurt you.
7:36
So, a thought that just popped in my head kind of as it pertains to the current coronavirus situation. So, we know that like the federal government has stepped in and made like, essentially testing free for everybody. But how do you do you have any thoughts regarding like, how these low income groups might be impacted as it pertains to the current pandemic we’re experiencing? Whether they don’t have access to sufficient health care professionals or they’d, you know, rather not go to the hospital when they need to and spread the infection to more people. You have any thoughts on that?
8:13
Yeah, I so a sports fan, you kind of noticed or at least noticed that as this has gone on, you’ve heard about these, you know, these basketball players that are getting diagnosed with it, and then in two weeks, here they are, they’re fine now, or I guess in quotes, we’ll we’ll put that in quotes, fine. They’ve recovered and it’s all because of their situation puts them, like their profession of being, you know, a multi-million dollar basketball player gives them a lot more opportunity and resources to go and meet with, you know, the best medical professional in the country. Because, of course, as we all know, athletes have this had this chance to and it’s interesting because you’re only hearing about like this, you know, not the 1%. But you’re getting close to that 1% of people in the country that are really the only ones that can figure out a solution to this. And I mean, if I were diagnosed today, I’m not even sure what I would do, because I don’t know if I can afford to go and support myself and pay for a test and then pay for staying in hospital for however many like, days or however amount of time. And it’s just it’s interesting because this is like a direct example of the advantage of socioeconomic status, really playing a huge benefit, like for know, this small group of people because they, it’s really not a worry in their head. They kind of already know that they know who they can talk to, and that they can get it solved quick, but some people just don’t have that,
9:48
that blessing. So but my sister, she lives in Colorado, and she actually lived in Hawaii for a couple of years before she moved to Colorado. And I was talking on the phone to her yesterday, or maybe it was two days ago, but whatever, and she was like, yeah, I’m just like really thankful that I’m actually employed and I have health insurance right now because when I was in Hawaii the company I worked for I didn’t have health insurance so like, right that like this is and I would consider myself and my family to be like, like very privileged in the grand scheme of the country, let alone the world. So it’s just it’s just something interesting to think about.
10:24
Any final remarks? Yeah, there even a lot of people that I know who are currently graduating that their job search has jumped through the roof because a lot of places since you’re working online, they can’t afford to even hire people anymore. Like I have, I’ve had a couple internships come my way that haven’t really, they can’t, they can’t support them anymore because there’s no point for them and giving you know, some college kid a computer and teach them to work from home because it’s not, it’s not economically sound. But I can only imagine that all these people who are losing their jobs, I read something the other day that said, we doubled the amount of people applying for unemployment in the first month of the coronavirus epidemic than in the six months of the 2008 stock market crash. So we we have this huge influx of people right now who are losing job benefits, they don’t have their healthcare anymore and they’re kind of just on their own and they’re kind of they have to fend for themselves and try and stay healthy however way they can by isolating themselves.
11:30
It’s very interesting. And just last thing to finish up to kind of loop back around to that first hypothesis I mentioned related to psychosocial stress. So like a lot of people underthink this but the resultant psychological stress from these issues related to unemployment, lack of health insurance, etc. does not have an effect on their health. That, that stress in and of itself deteriorates health and we know the number one killer beyond all the death of the coronavirus is heart disease and that is very negatively impacted by a chronic state of stress, so I’ll just leave you all with that. Any last thoughts, James?
12:05
Um, I don’t think so. Just try and stay healthy and do what you can to stay as healthy as you can.
Within this past week, I witnessed two of my close friends purchase Plan B. As they were checking out, I couldn’t help but glance at the price tag- $49.99 before tax. As I was accompanying my friends, I couldn’t help but think back to my friend in high school who had to gamble with potential pregnancy because she couldn’t afford Plan B. 3 weeks later, we found out she was pregnant. My friends in college were able to handle a potentially disruptive situation because they had the privilege to afford to do so, unlike my friend back in high school. Plan B is a good example of systemic injustice because not everyone has equal means to obtain it.
The issue behind Plan B is similar to the injustices individuals experienced during the Civil Rights Movement. Minority groups are placed at a disadvantage from equal opportunity. From police brutality to the sanctions behind the imprisonment of Martin Luther King Jr. as described in Letter, and the availability/affordability to Plan B, systemic injustices encompass a variety of different scenarios.
In-store Emergency Contraception Pills (ECPs) cost anywhere from $40-$60. ECP’s found online, on the other hand, cost an average of $20. The discrepancy between in-store and online ECPs indicates that there is no reason for in-store prices to be as high as they are. Despite online ECPs costing lower than their in-store counterpart, they are less desirable as individuals run the risk of them not being delivered on time. Not to mention, it’s harder to keep the delivery inconspicuous, especially for minors.
Another issue we run into with ECPs is their availability. A 2018 study by the American Society for Emergency Contraception (ASEC) found that only 60% of drug stores carry ECPs. Of the ones that do carry them, 57% lock ECPs in a box, forcing the individual to seek out an employee for assistance.
With its high cost and minimal supply at available drugstores, teens and individuals from low-income communities are placed at a greater disadvantage and run a higher risk of accidental pregnancy. While there are many other factors contributing to higher pregnancy rates within minority and low-income communities, the high cost of Plan B adds fuel to the fire. With a statistical correlation between teen pregnancy and poverty, the punishing price of Plan B further perpetuates this inequality.
Recently, the new coronavirus spread around the world and make thousands of people suffer. Wuhan is the first city where this virus mass outbreak and its residents are the people who suffer most from that. Unluckily, the virus is not the only thing to make them in trouble. Their identity of Wuhan’s resident also makes them face injustices.
Due to the fear of the virus, Chinese people in other provinces tend to be away from Wuhan people. For example, if you are a Wuhan people and you go to another province. People would think that you get no sense of responsibility since you make all the people under the risk of being infected. Besides, although Chinese officials claim that they have warned against the discrimination against Wuhan people, some policy they set up, such as restrict Wuhan people’s normal use of state road, shows the discrimination to Wuhan people. Some local governments even set up road blockage in the road to Wuhan, which makes many Wuhan people who work outside can’t meet their family during the Lunar New Year.The Chinese government set up road blockage in the road to Wuhan
Also, in some big city, such as Shanghai and Guangzhou, the local government order the neighborhood committee to encourage people to report the Wuhan’s resident or Wuhan returnees around them, so that they can send them back to Wuhan.
When Wuhan people are suffering from the virus, as their compatriot, we are supposed to try our best to help them go through that, however, some unreasonable policy Chinese government set and discrimination some Chinese people express make Wuhan people face so much injustice. The video below is an interview with a Wuhan people living in Beijing, she narrates can make us know more about the current situation of Wuhan people I describe above.
The injustice Wuhan people are facing reminds me of the “The Story of My Body”. People think Ortiz is “dirty” since her different physical looks and Puerto Rican identity (Ortiz 436). Similarly, Wuhan people are treated as “The Other” by their compatriots while they are suffering from the virus. In some Chinese people’s sight, Wuhan’s residents are already not their compatriot, but just the virus which needs to be segregated. This circumstance not only expresses some Chinese people and government’s unreasonable attitude of facing the plague, but also the systemic injustice Wuhan people are currently facing.
Currently, there are over 60 countries that have had outbreaks of the coronavirus and more than 90,000 people have been affected. Of that, 3,000 have died due to the virus, creating a global epidemic. Many countries have travel bans such as Italy, South Korea, and China. This disease is very harmful to infants and elderly people who already have weakened immune systems. There is currently no vaccine for coronavirus, however, they are trying to make one.
This past month we have been receiving lots of notices about the Corona Virus. OSU actually stopped all travel to and from China until March and they are making anyone who traveled there recently partake in a 10-day incubation to make sure they have not gotten the illness. The media and gossip make it seem as though all Asians are to blame for the spread of this disease. I had a student walk up to the front of the class and say he was not contagious because he was so afraid of what others would think of him. I think Americans are classifying Asians as the culprit for spreading the disease when in fact, diseases evolve on their own. It has been unfortunate that this virus started in Asia, but Asian’s should not be blamed for the spread of this virus because they did not intentionally spread it to be harmful to the public.
A lot of people are now saying that if you buy products from China then you will become sick with the coronavirus. This is another misconception that attacks Chinese businesses. You cannot get the coronavirus from buying a lot of international products. The virus does not stay alive for very long on services and is mainly transferred through sneezing and coughing.
The people in these countries are experiencing “Othering” as mentioned by de Beavouir. They are being alienated by society for the country having the first outbreak of the coronavirus. They are being treated differently by the world right now in order to prevent the spread of the disease, however, they shouldn’t have to be treated like an “other”. Their culture and ethnic group are being attacked for “spreading the disease” when in reality it was not their fault. Viruses are uncontrollable, the Chinese did not intend to spread it. The countries who have travel bans and Asians, in general, are being attacked for unnecessary reasons over a virus that was bound to eventually spread anyways.
The obesity epidemic is a massive public health issue in the developed world. The below short podcast is a good primer on the epidemic and potential factors. It also mentions the populations it particularly impacts – low-income groups.
Through my involvement with the health/fitness field, I’ve heard about higher rates of obesity in certain populations. This disproportionality is in congruence with what is mentioned in the podcast. Further, in Ohio State’s Exercise and Behavioral Medicine Laboratory, I noticed a research poster to the effect of Disproportionate Obesity Among Hispanic Women. Since obesity can have a profound impact on one’s quality of life both directly and indirectly, this sparked my interest in the underlying cause of this disproportionality.
Data suggests that African Americans and Hispanics experience the highest obesity rates. Also, there is a clear positive relationship between obesity prevalence and declining socioeconomic status. A well-regarded explanation for this is a higher consumption of fast food, soda, and other hypercaloric options in these populations (Public Health, 2019). This may be due to healthy options being more expensive as well as “food deserts” in which poorer areas lack access to grocery stores with healthy options.
I read of another interesting hypothesis in Robert Sapolsky’s Behave. Sapolsky describes that feeling poor – being of low socioeconomic status in the presence of significant income inequality – may be a large factor. This is described by a lack of social capital (e.g. reciprocity and trustworthiness) resulting in psychosocial stress. These psychosocial stressors can result in physiological responses that deteriorate health and may influence factors related to obesity. Below is a representation of this theory from a 2001 paper by Kawachi and Berkman.
This is furthered by the neo-materialist hypothesis: as income equality grows, the less direct benefit the wealthy experience from improving public resources, and the more resources the wealthy have to lobby. The concept of de Beauvoir’s the One and the Other is in full effect as lower income individuals are seen as lesser. Also, this is related to Spivak’s concept of whether the subordinate can speak; lower income groups don’t get a proper seat at the table for issues that impact them. As a result, low-income groups may not get cleaner water, better public schools, or safer streets. These hypotheses compound and result in a systemic disadvantage of health and subsequent quality of life in low socioeconomic groups.
Within the past few months, the outbreak of the coronavirus has been a health concern especially in China where the majority or root of the outbreak has occurred. Ever since this spread of the virus, individuals have been taking precautions to ensure that the virus is contained, and that other people do not become infected. At Ohio State, there is a large population of students from China and other countries who have been wearing masks. This precaution is a part of the culture that is commonly used in order to prevent the spread of disease. However, there have been many instances of racial injustice toward these students. For example, it seems to be that the coronavirus is directly correlated to those from this culture and many individuals have avoided contact with these students if they are coughing, wearing a mask, or even just based on their ethnicity. This is an example of systemic injustice because it is a prejudiced belief that these students are more likely to be infected because they are from China or apart of the mask-wearing culture. On twitter, a student tweeted about a Chinese girl who was wearing a mask at the library. She wiped down her table and told this student that she did not have the disease and that it was safe for him to sit next to her and did so because she believed that the student was afraid of even just sitting next to her.
As of March 3, 2020, the Arnold Sports Festival has been cancelled for all spectators due to a fear of the threat of the coronavirus. As spectators are no longer allowed to attend the event, there are also less than 20 participants from other countries that will also not be allowed to compete. Competitors from China, South Korea, Italy, Iran, and Japan will not be allowed to compete because the coronavirus has had a serious impact in these countries. I believe that large cancellations like this play a role in contributing to the mass hysteria that has grown with the coronavirus and I think that it is going to continue to grow. The fear about this virus is causing people to take extreme precautionary measures and I think these actions will continue to contribute toward the systemic injustices toward individuals from these countries or those who ethnically represent the countries that have been hit the hardest with the coronavirus. Link:
The outbreak of the coronavirus has caused people to “other” individuals who are wearing a mask or represent an ethnicity whose country has been hit the hardest with the virus. deBeauvoir states, “Thus it is that no group ever sets itself up as the One without at once setting up the Other…against itself. If three travelers chance to occupy the same compartment, that is enough to make vaguely hostile ‘others’ out of all the rest of the passengers on the train” (1). Americans and others have been cancelling trips, flights, and other travel plans and taking precautions. However, these precautions have tended to lead to injustices and othering against individuals due to a newly developed mass hysteria and fear.
Previously I had written about blood donations and the surveys that are required to be taken before donations can be accepted. In this survey there is a question directly regarding sexual interactions within the past year. One of the questions is specifically geared toward male donors and asks, “Have you had sexual contact with another male in the past 12 months.” I had heard about this from a friend who happens to be a homosexual and he said when answering the question, “yes”, he was immediately notified that he was unable to donate blood for that reason.
I see this as a form of systemic injustice because as a result of the 1980’s HIV/AIDS outbreak in the homosexual community this policy is biased and discriminatory toward the homosexual community. This is reflective of old statistics that to date have become outdated as there are treatments that halt the progression of HIV and there are also medicines that can be taken for pre-exposure such as PrEP. Another reason as to why I find this a systemic injustice toward the homosexual community is that regardless of sexual orientation, when blood is donated, it must be tested for various deficiencies such as iron deficiencies, blood disorders, and blood borne diseases.
I understand this question is a precautionary step to avoid any donations of contaminated blood. However, I find it discouraging to the homosexual male community that even though there are other ways in which it can be determined that blood is contaminated, organizations resort to asking a question geared specifically toward a certain group of people. From the story of my friend, he has told me that there is no exception to answering “yes” to this question. When questions like this are geared toward certain communities, especially when it is the definitive answer as to whether or not that group may participate in something as common as donating blood, it implies a bias against this group. As a homosexual friend, my friend has decided that he will not even consider participating in blood drives, donations, etc. as a result of this discrimination.
Below are is a picture of the questionnaire used for blood donations, you will see two questions (19 and 20) regarding males having sexual contact with other males. The link below is the LGBTQ+ donor policies and when scrolling to the MSM tab, the red cross explains the federal regulations and their understanding the impact that it has had on the LGBTQ+ community.
Link: