By Doreen Agnese, MD
As the deadline approaches for this blog, I again wonder what topic will be interesting to discuss. I try to gather inspiration from prior blog posts, and as I scroll through the list of recent blogs, the one thing that I notice most acutely is how much older I am than all of the other contributors. Maybe this blogging is a young person’s game….but as I sit here thinking about what to say, I see a reminder about surgical grand rounds this week. The topic this week is “Unconscious Bias in Healthcare—A Primer and Strategies to Reduce the Impact of Unconscious Bias.” Included in the announcement is a link to the implicit association test, a well-validated web-based test to determine unconscious associations or preferences (https://implicit.harvard.edu/implicit/). I realize that we have come a long way with respect to explicit bias since I was a trainee, but women are still underrepresented in academic medicine. I took the gender-science IAT and was surprised to learn that I had a moderate unconscious preference for women in liberal arts and men in science. I did counter that with a moderate association with male with family and female with career. These results did surprise me, but point out the fact that implicit bias runs deep and it’s not something that we can really control. The times are changing, but how can we get at something unconscious? Is there hope? I think so.
Thinking of implicit bias made me think of 2 things that happened to me recently, one of which really fills me with hope for the future. The first was a pretty typical story. I had some time between cases and met a colleague in the café for lunch. She is also a female surgeon (urologist) and we were both in scrubs with our bouffant caps on. As we enjoyed our lunch, an elderly couple came in. The gentleman was in a wheelchair and his wife was trying to navigate between the tables. We came to her assistance clearing the tables out of the way so they could enjoy their lunch. She of course thanked us for our trouble and asked, as so often happens, if we were nurses. “No,” we replied, “we are surgeons here.” This situation is not a new one to anyone, and despite the widespread appearance on social medial of the “I look like a surgeon” campaign, all too often male nurses are confused for physicians and women in medicine are assumed to be nurses.
The second situation was a much more surprising one. I was leaving the hospital after a long day in the operating room on the same evening that there was a One Direction concert playing at the stadium. As you might imagine, campus was filled with quite young One Direction fans and my car was parked between the hospital and the stadium. As I left work in my scrubs (please don’t tell anyone—I know I’m not supposed to!), I saw some very cute kids, a boy and a girl who I assumed were siblings, who couldn’t have been more than 5 or 6. They were hurrying to the concert carrying their carefully crafted signs. As I walked up behind them the little boy turned around, saw me in my scrubs, and said to his sister “Look, a surgeon!” That was certainly a first for me! It renewed my faith that these stereotypes can be broken. We are not born with implicit bias. It is learned. And if we can adopt these biases, then I am sure we can employ strategies to address them. The first part is in recognizing the problem figuring out how to overcome our unconscious biases. The other key part is focusing on our young people, who have not yet developed these biases, and help them to keep an open mind.
Doreen Agnese, MD is Associate Professor of Clinical Surgery in the Division of Surgical Oncology at The Ohio State University. She was born and raised in New Jersey. She attended Drew University in Madison, NJ, and completed medical school and surgical residency training at Rutgers Medical School in Piscataway/New Brunswick, NJ. Dr. Agnese completed a surgical oncology fellowship and training in clinical cancer genetics at The Ohio State University. Her clinical practices focuses on care of patients with breast cancer and melanoma and those with significant personal or family history of cancer. She cycles in Pelotonia every year to raise money for cancer research.