On Prejudice: Avoiding Mastodons & People with Disabilities
What do Prejudice
By Rick Rader, MD, Editor-in-chief HELEN
This article is the first of a series on addressing intrinsic bias in healthcare for people with disabilities.
Sir William Osler, known as the doyen of medical education and one of the founders of the Johns Hopkins Medical School was once asked,
“When will doctors stop acting like God?” Osler thought for a moment and smiled with the response, “When the patients get off of their knees.”
For the most part patients have gotten off their knees (and not a moment too soon). The reality is that medical school is a trade school and not a seminary. Medical education is designed to teach about health, disease and treating patients. Since it’s not a seminary, we don’t expect graduates to assume the posture of being anything more than human — with all our flaws, imperfections and shortcomings.
And one of our most human flaws is prejudice.
Sociologists attribute some aspects of prejudice to evolutionary adaptation and survival. The mechanism involves avoiding threats and opportunities for harm and typically involves differences as signals. Once those preconceived notions protected us from monstrous creatures, but it’s been a while since we were threatened by mastodons. It’s time we jettison our residual survival tactics. We’ve long acknowledged that people with disabilities receive the bulk of negative consequences of clinician bias and prejudice. So let’s work individually and collectively to address how bias impacts patient outcomes.
One of the goals and aims of HELEN is to identify, describe and address the contributing factors of healthcare disparities. This article strives to provide a better understanding of prejudice and to expand our knowledge on strategies to extinguish them.
In this Psychology Today article, by Marianna Pogosyan we learn how neuroscience suggests we approach prejudice. Dr. David Amodio, a NYU based social neuroscientist, provides nine key insights:
Everyone has some form of prejudice; it is both automatic and deliberate.
Simply belonging to different groups based on arbitrary distinctions is sufficient to elicit prejudice. Competition between groups can exacerbate prejudice.
At the center of prejudice are human differences. Add to that competition, threat and fear and you have a formidable stew of hate.
Emotions fuel how we respond to other people and determine our behaviors.
Virtually every part of the brain plays a part in processing prejudice which makes it that much more difficult to control.
Our minds categorize objects in our world in order to respond to them. We begin to organize our thoughts about a person just 100 milliseconds after seeing a face. That hardly gives us enough time to defuse our responses.
Learning what situational behavior is necessary to undermine prejudice can be learned, but it’s not easy.
Ultimately the most significant antidote for controlling prejudice involves the structure of our society and institutions. On an individual basis self control appears to offer the best mechanism for behavioral change. Aligning oneself in a society circle that is committed to controlling bias is also a positive strategy.
We cannot control how prejudice influences our judgment and behavior, no matter how fair we think we act. Only policies and structures can ensure fairness.
In the next article, we’ll explore how bias in the treatment of individuals with disabilities can be addressed with training, technology and commitment.