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Association of American Medical Colleges Tomorrow's Doctors, Tomorrow's Cures®

Author Q&A: What Lies Beneath: Pioneering Surgeon Talks Bias, Patients

AAMC Reporter: March 2011

—By Gina Shaw, special to the Reporter

Eminent orthopedic surgeon Augustus C. White III, M.D., Ph.D., is the author of Seeing Patients: Unconscious Bias in Health Care. The Ellen and Melvin Gordon Distinguished Professor of Medical Education and professor of orthopedic surgery at Harvard Medical School, White was the first African-American department chief at Harvard’s teaching hospitals, the first African-American to graduate from Stanford University School of Medicine, and the first African-American orthopedic resident at Yale Medical Center. White received his Ph.D. in research on biomechanics of the spine at the Karolinska Institute in Stockholm, Sweden. Seeing Patients is available from Harvard University Press.

Reporter: You claim that many physicians are unaware of the biases they bring to their interactions with patients. What can individual doctors do to be more aware of these biases?

White: First, you must simply be aware that these biases and disparities exist, and recognize the groups that are at risk for receiving disparate care. Try to learn more about the daily thoughts and experiences of the communities you’re taking care of. Try the “teach back” method. At the end of a visit, say, “Miss Jones, I want to make sure I’ve communicated with you well. Can you tell me what your diagnosis was and what our plan is for treatment, to make sure you understand what I’ve suggested that we do?” Even though you may not be aware of any bias in your heart or mind, you will at least ensure you have had a more accurate communication with your patient.

Reporter: The Supreme Court has rejected admissions practices that are based on any single variable in favor of an individualized review that allows schools to consider all the ways an applicant might contribute to a diverse educational environment. How should medical schools respond?

White: I think we need to continue to look at the applicant’s journey. Where students come from and what they have been through is an important indicator of potential productivity. Grades are important, but no one has ever demonstrated a correlation between honors grades and the quality of a physician. In fact, there have been a couple of studies somewhat to the contrary, finding, for example, that underrepresented minority students amass an equal number of awards and accolades in their post-medical school careers as their majority peers.

Reporter: You entered medical school in the late 1950s, at a time when schools would take one African-American student a year. How has medical education changed since then?

White: We are seeing more of an effort to improve the explorative thinking of students and have them look beyond the simple facts of the disease to understand what is really going on with the patient. We recognize that we need a different educational experience, that the lecture format is less preferable than an interactive, seminar-type education. In essence, we’re trying to get at how doctors think.We also have a much more diverse medical student body now. Unfortunately, the faculty at most schools is still not very diverse. More underrepresented minority students tend to go into areas other than academic medicine, but I also think our current faculty do not tend to recruit and develop the academic careers of underrepresented students. It is not conscious discrimination; they just do not have that habit of thinking about these students as future professors.

Reporter: What is the most important lesson you have learned in your career as a physician?

White: That we are all more the same than we are different. I remember going to China in 1979 with a group of orthopedic surgeons. Here I was, a southern African-American doctor who’s lived most of my life in the U.S., sitting with one of China’s leading orthopedic surgeons. Our backgrounds were about as different as they could be, but we started talking about taking care of patients and within a matter of seconds we were almost brothers. We could relate as human beings in a very personal way.

Reporter: You conclude your book with a call for physicians to reconnect with the idealism they had as young medical students. How can they do that?

White: First, recognize your own privilege. The fact that you got here, with the education and the position of a doctor, means that you are privileged. This does not mean that you have to feel guilty, but it does mean that you should give back. Connect with the joy and satisfaction that comes with doing a good job as a physician. The Dalai Lama says we are put on earth to be happy. So how can you be happy? By helping others. A lot of psychological studies show that helping others makes you feel good, and in medicine you have a chance to do that 20 or 30 times a day. Take a little time to groove on that, embrace it, and enjoy it.