Addressing Medical Practitioner Bias in Pain Treatment
Addressing Medical Practitioner Bias in Pain Treatment
I was in the throes of being bounced from one medical office to another in hopes of finding answers to my intractable pain when I first noticed a peculiar, recurring feeling.
Sometimes this feeling surfaced in response to a practitioner’s facial expression or gesture so slight it was barely detectable. Other times I sensed discomfort or apprehension, or my gut screamed, “Something is off here,” even when what was not right was not obvious.
With some health and medical practitioners the signal flare of my intuition was confirmed sooner or later in no uncertain terms:
“You’re going to have to stop eating junk food if you don’t want to be in pain,” a nurse practitioner told me as she wrote “obese” in my chart in all capital letters next to my weight, not bothering to ask me what I ate or how often.
“It’s common for high achieving girls under pressure to unconsciously create pain symptoms,” a psychologist breezily commented. This was despite being well into my twenties and hardly the child referring to me as “girl” would imply.
Then there was the OB/GYN who said authoritatively that lesbians almost always have sexual abuse in their past.
The conclusion? My severe abdominal and pelvic pain was caused by an emotional problem and what I needed was a psychiatrist.
My identity as queer and not lesbian aside, the only time my sexual orientation had come up was on an intake form. Abuse, sexual or otherwise, was never asked about or discussed.
And how can I forget the pain specialist who, after inquiring about the origin of my name (Hebrew), proclaimed with a knowing look that, “Jews are often irrational, but intelligent.”
Stunned, my jaw dropped but words escaped me. I was, after all, near naked in a skimpy paper gown, many years his junior, and desperate for the relief his expertise promised.
Differences between explicit and implicit biases
The examples I have recounted illustrate explicit negative biases that are conscious and intentional. Even if a person does not act on prejudices, explicit biases are in one’s conscious awareness. Relying on weight stigmas, negative judgments about gender and sexual orientation or socioeconomic status, and applying racial and cultural stereotypes are all examples of explicit biases.
In many instances, though, an explanation for my intuitive alarm being tripped did not materialize in the form of overt or outright judgments and prejudices. On these occasions it is likely that I was detecting implicit bias.
In instances of implicit bias, judgments are made quickly and unconsciously. The prejudices and beliefs that implicit biases are founded on are not in the conscious awareness of the person making the judgment. In other words, implicit biases are unknown even to oneself.
Micro-aggressions such as not making eye contact, being condescending in tone and pitch, and using top-down communication are but a few examples of how implicit biases are acted out. But even if less obvious or overt, implicit biases are not any less harmful than explicit prejudices—and can even be more damaging because they operate under the radar.
Actions you can take
My experiences are unfortunately not unusual. In medical offices and exam rooms far and wide, unfounded judgments and assumptions are made as a matter of course.
We all hold a host of positive and negative biases, and bias is in no way specific to health and medical providers. But for patients from marginalized backgrounds seeking pain treatment, explicit and implicit biases threaten access to effective and equitable pain care.
Factors such as socioeconomic status, weight and body size/fat stigmas, and sexual orientation biases critically impact pain care and treatment. For people who are marginalized for multiple reasons, treatment disparities increase exponentially.
As pain endurers, those who care about people in pain, and others invested in equitable health care, it is essential that we take action to address explicit and implicit health and medical biases.
Visit projectimplicit.net to test your biases on a range of topics
Ask your health and medical practitioners if they are familiar with explicit and implicit pain biases, and whether they have participated in cultural humility, disability accessibility, weight bias, and other training
Encourage your health and medical offices to prioritize education that addresses issues underlying many common pain biases
Share information about pain biases with people in health and medical professions, and people who are interested in entering these professions
Discuss what you have learned about biases with friends and through social media
Support people you know from marginalized populations to become health and medical practitioners and administrators
I will be sharing research on race and ethnic, gender, and disability pain treatment disparities soon. Check back to learn more!
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For further reading about explicit and implicit bias in health care:
It's Time To Address The Role Of Implicit Bias Within Health Care Delivery
Implicit Biases Have an Explicit Impact on Healthcare Outcomes
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