Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just had knee surgery, but the nurses weren鈥檛 letting her in to see him.
鈥淭hey told us he would be out of anesthesia in a few minutes,鈥� she remembered. 鈥淭he minutes became an hour, the hour became two hours.鈥�
She and her husband called the surgeon in a panic. He said that Khary had come out of anesthesia violently 鈥� thrashing and flailing about. He told Lazarre that with most young people Khary鈥檚 age, there wouldn鈥檛 have been a problem. The doctors and nurses would have gently held him down.
鈥淏ut with our son, since he was so 鈥榣arge and powerful,鈥� they were worried he might injure the medical staff,鈥� Lazarre said. 鈥淪o they had to keep sending him back under the anesthesia.鈥�
Khary was 6 feet tall. But he was slim.
鈥淗e wasn鈥檛 the giant they were describing him as,鈥� Lazarre said.
Lazarre is white. Her husband is black. Lazarre says there鈥檚 no doubt in her mind that the medical team鈥檚 fear of Khary was because of race.
鈥淚 understood, certainly not for the first time, that my son 鈥� and my sons both 鈥� were viewed as being dangerous, being potentially frightening to people who were white,鈥� she said.
She鈥檚 also sure the surgeon didn鈥檛 see it that way.
鈥淟ike most white people, I don鈥檛 think he was conscious of it at all,鈥� Lazarre said.
She and her husband insisted on seeing Khary. They saw right away that he wasn鈥檛 angry or violent.
鈥淗e was scared,鈥� Lazarre said. She and her husband leaned over and whispered in Khary鈥檚 ear: 鈥溾�業t鈥檚 going to be OK, you can calm down.鈥� And he began coming out of the anesthesia more normally.鈥�
Lazarre first wrote about this experience in 听鈥�Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.鈥� Though it鈥檚 been years since Khary鈥檚 surgery, Lazarre says there鈥檚 still so much that hasn鈥檛 changed.
Racial Disparity In Medical Treatment Persists
Even as the health of Americans has improved, the and outcomes between white patients and black and Latino patients are almost as big as they were 50 years ago.
A growing body of research suggests that doctors鈥� unconscious behavior plays a role in these statistics, and the of the National Academy of Sciences has called for more studies looking at discrimination and prejudice in health care.
For example, show that African-American patients are often prescribed less pain medication than white patients with the same complaints. Black patients with chest pain are referred for advanced cardiac care than white patients with identical symptoms.
Doctors, nurses and other health workers don鈥檛 mean to treat people differently, says聽, founder of management consulting firm Cook Ross, who has worked with many groups on diversity issues. But all these professionals harbor stereotypes that they鈥檙e not aware they have, he says. Everybody does.
鈥淭his is normal human behavior,鈥� Ross said. 鈥淲e can no more stop having bias than we can stop breathing.鈥�
Unconscious bias often surfaces when we鈥檙e multitasking or when we鈥檙e stressed, research shows. It comes up in tense situations where we don鈥檛 have time to think 鈥斅爓hich can happen frequently in a hospital.
鈥淵ou鈥檙e dealing with people who are frightened, they鈥檙e reactive,鈥� Ross said. 鈥淚f you鈥檙e doing triage in the emergency room, for example, you don鈥檛 have time to sit back and contemplate, 鈥榃hy am I thinking about this?鈥� You have to instantaneously react.鈥�
Doctors are trained to think fast, and to be confident in their decisions. 鈥淭here鈥檚 almost a trained arrogance,鈥� Ross said.
But some medical schools are now training budding physicians and other health professionals to be a bit more reflective 鈥斅爉ore alert to their own prejudice.
Places like the University of Texas Medical School at Houston, the University of Massachusetts, and the University of California, San Francisco now include formal lessons on unconscious bias as part of the curriculum.
New Approach Teaches Students To Recognize Bias 鈥� And Slow Down
At UCSF, all first year medical school students take a workshop led by , who coaches other members of the medical team, too.
鈥淎 lot of folks come to San Francisco thinking, 鈥極h it鈥檚 such an open-minded place, there are no biases here,鈥欌�� he tells a class of newly arrived pharmacy residents. 鈥淭hat鈥檚 not true. You鈥檙e going to see this in every hospital. It鈥檚 going to be an issue.鈥�
What Salazar wants these students to talk about isn鈥檛 other people鈥檚 biases, but their own. And not just the biases they know they have. But the ones they don鈥檛 know 鈥斅爋r don鈥檛 believe 鈥斅爐hey have.
鈥淟ike it or not, all of us hold unconscious beliefs about various social and identity groups,鈥� he says to the class. 鈥淢any times we think about bias and unconscious bias 鈥斅爐hey are incompatible with our conscious values, right?鈥�
Before the class, students were asked to take an , a series of timed computer tests that measure unconscious attitudes around race, gender, age, weight and other categories. Salazar asks who wants to share their results.
The students study their fingernails.
Salazar clears his throat.
鈥淲ell, I can share with you my story,鈥� he says.
When he took the test for the first time, it showed that he had a preference for whites 鈥斅爋r a bias against African-Americans. Research shows that who take the race test show an automatic preference for whites.
鈥淚 was struck,鈥� he tells the students. 鈥淧articularly being in the health professions and wanting to serve diverse communities, to learn that I had these biases 鈥斅爄t was a bit disheartening.鈥�
So he began to explore where these biases came from.
鈥淚 grew up in south Texas 鈥斅�99 percent Mexican-American. Mostly Latino. In my high school, we had one black student,鈥� he tells the pharmacy residents. 鈥淎nd so, up until age 18, you can imagine, a lot of my ideas 鈥斅燼 lot of my attitudes, a lot of my beliefs 鈥斅燼bout folks who were black came from what? The media.鈥�
A student named Amanda raises her hand. She asked聽that we not use her last name because she鈥檚 afraid that what she learned about herself could harm her career.
Amanda explains to the class that her parents made their way to the U.S. from Iran, and settled in Marin County, north of San Francisco. She took the version of the test that measures bias against Muslims, and another on light and dark skin tone.
鈥淚 kind of went in thinking that these are two areas that I would probably not have a bias, and that鈥檚 kind of why I chose them,鈥� she said.
But the results were not what she expected.
鈥淚t was like, actually, 鈥榊ou鈥檙e biased and you don鈥檛 like brown people and you don鈥檛 like Muslims,鈥欌�� she said. 鈥淲hich is interesting for me 鈥斅燽ecause that鈥檚, kind of, the two things that I am.鈥�
Traditional Diversity Training Didn鈥檛 Work 鈥斅燗nd Sometimes Backfired
The UCSF curriculum is based on a training program designed by Howard Ross, the diversity consultant. He says he developed the new 鈥渦nconscious bias鈥� approach to sensitizing people to their own predjudices after realizing that the traditional diversity training he was doing in the 鈥�80s and 鈥�90s wasn鈥檛 working.
鈥淧eople who seemed to have transformative responses to those [earlier] trainings, to have that kind of 鈥榓ha鈥� moment 鈥斅爌articularly people in the dominant group, [of] whites, men, heterosexuals 鈥斅爋ften, if you talk to them a month or two later, they actually felt quite wounded by the experience,鈥� Ross said. In some cases, he adds, participants seemed to become more defensive and hardened in their biases after those early trainings, not less prejudiced.
A 2007 study described in the examined diversity training programs at more than 800 companies over 30 years, and the results underscore Ross鈥檚 point. Overall, such programs seemed to do nothing to change people鈥檚 prejudices or improve diversity. Instead, in some cases, they reinforced bias.
鈥淲hat happens is, ultimately, we feel bad about ourselves, or bad about the person that made us feel that way,鈥� Ross said.
So rather than making people feel bad or awkward, Ross and Salazar say that, more than anything, they want people to accept that having biases is part of being human.
鈥淵ou know we all have them,鈥� Salazar tells his class in San Francisco. 鈥淚t鈥檚 important to pause for a second and normalize this. And be OK with this.鈥�
Salazar emphasizes that unconscious bias can鈥檛 be eliminated, but it can be managed.
鈥淪o how do we address our bias? What do we do?鈥�
One student says, 鈥淪low down.鈥�
鈥淵eah,鈥� Salazar responds. 鈥淎 trick that I use is that I pause before I walk in, take 10 seconds even, 15 seconds, just to try to clear your mind and go in with that clean slate.鈥�
It鈥檚 too early to know if these new types of trainings that explore unconscious bias are actually having any effect on what goes on in the exam room. Participants fill out evaluation forms after the class, and these anecdotal self-reports are often positive. But, so far, there have been no formal studies to measure if anything in patient care has actually changed.
鈥淲hat happens when that door closes? What happens in the interaction when I can鈥檛 see the patient and the doctor talking?鈥� Salazar said. 鈥淭hat鈥檚 a little hard to capture.鈥�
Still, UCSF is betting the technique will help. Salazar and other leaders believe the younger generation of health care providers could help shift medicine 鈥斅燽y learning early how to keep their own biases in check.
This story is part of a partnership that includes , and Kaiser Health News.