AMANDA KOST AND MIKE SPINELLI
Start by reading this JAMA Piece of My Mind “Speak Up” which describes one physician’s experience with speaking up when witnessing micro-aggressions or biased comments or behavior in the clinical workplace.
Then read this post from STAT News that describes a medical student’s experience with racist comments during her clinical training and how it felt when no one spoke out against it.
Tools for Responding to Bias
Goal: Communicate a message of disapproval without damaging interpersonal relations
- Rehearse what you would do or say in situations before they occur
- You know what feels most natural for you
- Remember the Bystander effect
- No one else will probably say anything
- Consider saying something, even if it is a small effort
Decide whether to say anything
- Silence is often interpreted as passive complicity
- Consider saying something simple like “that’s not cool” or “I don’t appreciate that”
- You don’t have to take a dramatic stand if you’re not comfortable or not able
Consider taking more time if:
- You know you respond badly in the heat of the moment
- You fear retaliation or mistreatment and need more support
- The situation is not appropriate (ie during a patient care emergency)
- Try to speak calmly, or consider waiting until another time
- Try to avoid inducing defensiveness
Clarify or Restate what was said
- Make sure you are understanding what was said
- Make the speaker think about what they said
- “So I am hearing you say….” Or even “excuse me, what was that you just said?”
- If a joke was made, ask the speaker to explain it to you
- When identifying the behavior, avoid labeling, name-calling or the use of loaded terms.
- Describe the behavior; don’t label the person.
Appeal to principles
- “I’m surprised to hear you say that. I think of you as more… (egalitarian, open-minded, etc).”
Change the subject (more effective than it sounds)
- You may not change beliefs but you may change behavior
Reflect on what happened
- Journaling or meditation
- Debriefing with a peer or college mentor
It’s never too late to bring it up
- Defer until later: “let’s talk about this when we have more time”
- Bring it up later: “I’ve been thinking about what you said last week…”
Don’t get discouraged
- You won’t know the lasting impact you’ll have later on, both for the speaker and those who were present
Know your resources
- College mentors and college heads
- Other trusted faculty
- Student Affairs office
Traps to Avoid
Avoid making light of any comments, making jokes (which often backfire!), or getting defensive
Review the lexicon (covers important terms and definitions),explore socialization, watch a TED Talk on bias, and complete readings on narrative humility and reflection in medical education.
Learn about socialization. Ready all the sections in 3.2 Understanding the Meaning of Socialization and 3.6 Social Interactions in Daily Life.
This TED Talk reviews one woman’s experience with bias and an approach to address it.
This article discusses the concept of narrative humility in patient interactions.
Consider how reflection in medical education helps us learn.
This New York Times article, written by Harvard Professor of Economics Sendhil Mullainathan discusses how our identity shapes how we think about inequality and our advantages and disadvantages.
To Help Tackle Inequality, Remember the Advantages You’ve Had, by Sendhil Mullainathan
This PBS Newshour video and brief accompanying article by Kamaraia Roberts about young Black Republicans suggests that individual identities can be challenged by society and peers.
The stigma of being young, black and Republican, by Kamaria Roberts
Watch this compelling YouTube video by Director Vivian Chavez. Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility and the need for cultural humility to improve provider to patient interaction and care.
Cultural Humility, by Vivian Chavez
History has a profound impact on the lives and health of patients. Sins of the Father describes how personal and global history are evident in one child’s story.