Confronting Unconscious Bias in Healthcare

In this episode of the Community Check In, Dr. Mark Brown, Senior Medical Director at Excellus BlueCross BlueShield, explores unconscious bias in healthcare. Dr. Brown sheds light on the roots of bias, its impact on patient care and practical steps for both individuals and institutions to address and mitigate its effects. He discusses how to recognize and challenge biases in healthcare interactions, and how Excellus BlueCross BlueShield is actively working to combat unconscious bias through employee resources, diversity training and initiatives prioritizing member experiences.

Episode Transcript

(00:03):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram

(00:26):
and Facebook. I'm Joelamonico and welcometo the Community check In. Bias in
all its many forms, is essentiallyeverywhere, and it can impact how we
treat people or groups of people,how we react to situations or issues.
In short, bias is a partof our daily lives, whether we like
it or not, and whether werealize it or not. Bias exists in

(00:49):
healthcare too, and when that happens, it can lead to false assumptions,
misdiagnosis, negative outcomes, especially forminority groups, and it contributes to health
despair. It's a very complex topic, to be sure, but our guest
today is going to help us tryto understand unconscious bias, how it impacts
healthcare, and how stakeholders like excellUs Blue Cross Blue Shield are working to

(01:11):
prevent unc unconscious bias within healthcare.Our guest today is doctor Mark Brown,
senior medical director at excel Us BlueCross, Blue Shield. Doctor Brown.
Welcome to the community check in.It's good to have you, Thanks Joe,
it's great to be here. Goodafternoon to you. Doctor Brown is
a board certified family physician with overthree decades of experience in primary care and
in community outreach, and we're goingto be tapping him on both of those

(01:34):
topics today. When we talk aboutunconscious bias, I only scratched the surface
of it a little bit, doctorBrown, So I liked from your perspective
if you would please to tell usabout what unconscious bias is and specifically we're
going to talk about how it relatesto the healthcare sphere. So let's start
by just defining the term that we'regoing to be trying to unpack a little
bit in this episode. Well,thanks again, Joe. I want to

(01:57):
start with the good news. Goodnews is that we're all blessed with brains
that are amazing organs. They doso much for us and a lot of
what we do because it's wrote everyday, we don't have to think about
every single detail of all the actionsthat we have to take, Like say,
driving a car is very a verycomplex action, But our brain automatically

(02:23):
processes information in a way that fromour memories, our training, our experience,
we can make the appropriate decision atthe appropriate time. So that's really
the good news. Our brains actso rapidly that sometimes they even process information
ten seconds ahead of what we evenrealize consciously is happening. So it's important

(02:46):
that our brains can do that.But in certain interactions, particularly personal interactions,
that unconscious effort, all that stuffgoing on in the background in our
brains can actually deviate us from thecourse of what we really want to do
and accomplish, and that's where weget to an unconscious bias. It's having

(03:08):
certain beliefs about groups or groups ofpeople or certain types of people that cause
us to react in ways that arenot positive, that are not helpful,
that are not healthy, that arenot good for us or the other people
that we're interacting with. So whileautomatic processing is important, it's based on

(03:30):
individual life experiences. We might evensay sometimes stereotypes, which can lead our
actions to be biased towards other groupsof people. This is something then,
based on that definition and sort ofwhere we're starting our conversation that almost anyone
or should I say everyone experiences insome way. That is correct, that's

(03:54):
right on. When we look atthe human brain and how it works,
we understand that we all have thesebiases and it's something that we need to
be aware of, especially in healthcare, because it can lead to poor outcomes
in certain areas. And we'll getmore into that as we go into the
discussion. But every single human beingshould be able to look at themselves honestly

(04:18):
and say, where might I havesome of these unconscious biases that may affect
what I do, whether I'm inhealthcare or not, that may affect me
as an individual because of the waypeople perceive me, and be able to
take actions based on that. Sothen, from a position as a physician,
and you have had three decades ofexperience within this sphere, but it

(04:41):
predates you, where unconscious bias showsup in healthcare, I would suspect this
is historical, generational, and multigenerational where this has been an ongoing issue,
no question. When we look athistory, we see a number of
issues places times throughout history, especiallythrough the lens of racial equity, where

(05:10):
unconscious bias and implicit bias have playeda role, and some of that continues
into the way that medicine is deliveredtoday. I think most medical professionals,
when I talk about doctors, nurses, nurse practitioners, pas, they want
to do a good job. Theyreally are motivated to care for people and

(05:30):
deliver the best kind of care.So we, especially as healthcare professionals,
have to really examine ourselves and thinkabout what kind of biases might I carry
into the exam room, the operatingroom, into the home if I'm doing
home care, that sort of thing. And we want to know that it's

(05:54):
not just us, it's all ofsociety around us that affects our actions.
I could talk about a specific studythat was performed from Mothers where one in
five black and Hispanic women reported poortreatment from hospital staff, especially around women's

(06:15):
health care, and this was muchmuch less common with their white counterparts as
only being at eight percent. Sowe're looking at twenty percent versus eight percent,
more than double the number of experiencesof negative interactions. I can tell
a story, and I think SerenaWilliams has hit on this in a very

(06:39):
public way that I think is helpfulto large numbers of people. We all
know Serena. She's probably the greatesttennis player of all time. She chose
to become a mother like many womendo, and went through the healthcare systems.
But even with all her fame,all her money, all her notoriety,

(06:59):
when it came time of delivery,she had a complication. She spoke
up about that complication, but mostlyshe was ignored, and I think probably
because of her training, her experience, and some past medical health experiences that
she'd had, she insisted that therewas something going on and guess what,

(07:20):
she was having shortness of breath.She had thrown a blood clot from her
leg into her lung, which couldhave ended her life. And because she
was forceful enough to insist that thedoctors look into what was going on,
her life was saved. Now,what a tragedy that would have been to

(07:41):
lose someone like her, But unfortunately, many stories like that happened throughout the
United States every year, and ourlevel of maternal mortality is much much higher
than similar countries at similar socioeconomic status. So there are a number of cases
sickle cell anemia, for example,which predominantly affects African Americans, and the

(08:05):
way they're treated around the issues ofpain, very very clear indicators that not
all healthcare is being delivered in afair and equal manner. Doctor Mark Brown
is a senior medical director at excelUs Blue Cross Blue Shield, and he
is our guest on the Community checkIn, and we are talking unconscious bias
and its role in healthcare. Wecan spend an entire show talking about patient

(08:30):
advocacy, and we're going to comeback to that topic a little later on
in our discussion. But with thatstory you told about Serena Willis, I'd
heard that story that could have hadan incredibly different outcome. And patients are
the ones that are subject to andsometimes have no means or don't have enough

(08:50):
voice for themselves to become that kindof advocate. So what might happen to
a patient, just an average,non famous type person like the rest of
us every day we walk into doctors'offices or hospitals. If unconscious bias remains
unchecked, that is a good point. When we look at maternal health,

(09:11):
for example, our numbers are justway too high. We as a country
are behind most, if not all, of the countries that are silly advanced
socioeconomically as the United States. Blackwomen in particular have three to four times

(09:33):
the likelihood of dying in from pregnancyrelated causes as white women. So we
see that playing out in healthcare everyday. There's no doubt that biases unchecked
are going to lead to the kindof negative health outcomes that make the whole
nation look bad. I think,like I said, most healthcare professionals want

(09:56):
to do a good job, desireto really re shout and benefit their patience.
But we have to be conscious andaware that sometimes our actions aren'tn't intentional,
aren't the ones that we think thatwe're going to deliver. And I've
seen cases of this, and frankly, I've been a victim of it myself.

(10:20):
You think you're doing right, andyet you talked about at the beginning
of the program, how there aresome things that just happen in the brain,
that just connect and it leads tosomething that you do, and it's
unconscious. How you even pretend toGod there. So from your perspectives,
then in what you've seen, howprevalent is unconscious bias today as we stand

(10:43):
here this year where we are rightnow, and I know that conversations are
happening more often, at least Ihope they're happening more often how prevalent is
this still, it's very prevalent,unfortunately, And I want to frame this
in a sense that it's not justa black white issue or a racial issue.

(11:03):
Unconscious bias can come in to affectin the way women are treated,
in the way people with different sexualorientations from us are treated, in a
way that people who speak different languagesor come from different cultures are treated.
So there's a wide range of possibilitieswhere this can be seen. For example,

(11:28):
there's studies that show that women whenthey're in the exam room with a
doctor don't have their pain taken asseriously as men would. There are studies
that show that surveys performed on medicalstudents have about fifteen percent of them believe

(11:52):
that African Americans have a higher painthreshold pain tolerance. And so if they
if you think and there these arethe fifteen percent that are willing to admit
it consciously. So if you thinkthat a patient, oh, well,
you know, they can take painbetter than this other patient, or their
pain is important, then it's notgoing to be addressed in a fair and

(12:13):
equal manner. Just as just asa quick side note, how deep do
you believe that unconscious bias has madeits way into medical research and data.
One might suspect then that you goand you do research, you do homework,
you're studying to become a medical practitioner, Yet what you are getting in

(12:33):
data has been affected by unconscious bias. So again it goes back to what
we mentioned earlier. You might thinkyou're doing rights, yet you are using
incorrect or inadequate data to make thosejudgment calls in a surgical suite or in
an office visit very true. Theclearest example of that, and universities and

(12:58):
research institutions are attempting to make changesis when you look at the data for
many studies. Let's talk about heartdisease, something that we've really studied closely
and for an extended period of time. When we look at a study like
the Framingham study out of Massachusetts,on which a lot of the information around

(13:20):
cholesterol, how it should be treated, who needs to be treated, there
was an enormously high percentage of menin that study, particularly white men.
So you can't necessarily take the resultsof that study and transfer them to women,

(13:41):
to people of color, and sojust starting with the people who are
involved in the studies themselves we see, well, maybe that's true for everyone,
but because we didn't study everyone,we can't necessarily apply it to all
peace people. So that's just onesmall example. And I think the point

(14:03):
that you're getting at and that isso important, is that the research that
we go back to, and whetherit's you know, I'm talking to another
doctor or to a patient, orto thinking about the treatments that I'm going
to apply for my patients, thestudies that we go back to may have
been themselves somewhat flawed. Doctor MarkBrown, Senior medical Director with Excell's Blue

(14:24):
Cross Blue Shield, is our guest. This is the community check in our
topic this time unconscious bias in healthcare, and more of our conversation with doctor
Brown is next. For everybody whobelieves the care they deserve should always be
within reach, for everybody who wantsto be confident about insurance for the next
phase in life, for everybody who'slooking for the best way is to take

(14:45):
care of their employees and their families. At Excell's Blue Cross Blue Shield,
we're making care more accessible and affordablein more ways and for more people in
our community. Because when we dothat, everybody benefits, learn more at
excit LSBCBS dot com. This isthe community check in. Our guest is
doctor Mark Brown, senior medical directorat Excellus Blue Cross Blue Shield. Our

(15:07):
topic this week unconscious bias in healthcare. So this leads us right into my
next question is that we are allstakeholders, every one of US providers,
patients, health insurance companies like excellAs Blue Cross Blue Shield. There's a
lot of different ways that pressure canbe put on addressing unconscious bias within the

(15:28):
healthcare system. I know Excell's BlueCross Blue Shield tries to be very forefront
in all of their community touch pointsin this just being one of them.
But is this a Sisaphian task ofpushing a rock up a hill? And
where do you think maybe an entrypoint is to at the very least continue

(15:48):
to increase community conversations. Well,that it is a challenge, and it's
one where we can become so discouraged. As you mentioned, this is a
fantask that we set throw our handsup and say it's just not worth the
effort. But I want to pushback against that. I want to say
that it's so important to who weare as individuals and who we are as

(16:12):
a community and a nation that wehave to do the work, and it's
individual, it is. It takeseach person meaningfully making an attempt to educate
themselves. We talked about some ofthe studies and the research that's out there,
so knowledge that this is a realissue, and also to acknowledge that

(16:37):
they themselves have work to do insome area. You know, we haven't
talked about bias around body type,for example. I think that that's a
big one that we can all dosome work on race is a big one.
Implicit bias in socioeconomic status, that'sa big one. Just the way

(17:00):
we look at human beings and ourinteractions will be so much better if we
do the time to educate ourselves acknowledgethat we need to do the work to
make ourselves better people. Because ifwe just settle in and say, well
I am the way I am,I'm not going to change, then that
really is unfortunate and we're all goingto suffer as a result of it,
and those patients can lead to verypoor, very undesired outcomes as well.

(17:26):
So let's go back to that storyyou told us about Serena Williams, that
being a very public patient. Butwe are all patients in one way or
another, and we interact with thehealthcare systems. How what steps are we
supposed to take or can we betaking to protect ourselves and to give ourselves
the voice to be able to sayno, I don't understand something. This

(17:51):
doesn't feel right to me. Iwould like to know more. Is that
really just it to speak up andadvocate for ourselves. Is that a first
step that we can all take,Beth, extremely important, But one of
the things that we need to realize, especially in the area of healthcare,
is that we are so in vulnerable. We're so vulnerable as patients Number one.

(18:11):
We may go into the situation notfeeling well, not thinking clearly.
So you've got to do a lotof this work beforehand. Okay, say
it's a well check and you alreadyare planning for that visit, and you
can get ready for it, writingdown a list of questions, things you
want to have taken care of beforeyou get to that visit, and being

(18:33):
prepared, bringing someone with you,especially in complex cases like chronic diseases or
cancer, bringing someone along who canlisten along with you for the doctor who
can advocate for you. Whether it'sbecause you feel unheard or whether it's because
you feel unprepared for that kind ofinteraction. I believe that institutions and providers

(18:57):
have an enormous responsibility to translate thesegood ideas into actions, because I believe
most institutions are being encouraged, ifnot forced, for Medicare, by Medicare,
for example, to have someone onboard who addresses these issues of disparities

(19:19):
and inequity that come from unconscious bias. So it's critical for us to be
prepared to go forward to demand ofour institutions that they provide equal and fair
care to all people, and tolook at the options say something bad does
happen, who can I go to? And this is one thing that I

(19:41):
didn't even realize and I'm a doctor. I've been a doctor for thirty years.
One of the things that you cando as a patient who feels like
they've been a victim of bias issubmit a complaint number one to the institution
where it happened, and also tothe ensurer, because the insurer has a
responsibility as pair to investigate cases likethis to see if there's an ongoing pattern.

(20:07):
So you've got places where you cango to with complaints and excel Us
Blue Cross Blue Shield would definitely takeup seriously any complaints that our members would
bring forth to us. Yeah,that was an interesting point that you brought
up there. As a sell UsBlue Cross Blue Shield can find themselves in
being in a position of living inboth worlds where that then diagram crosses over

(20:30):
between physicians, healthcare providers and patients. The community stakeholders like excell Us Blue
Cross Blue Shield are right there inthe middle. Do you find that being
that intermediary can often help maybe clarifythe conversations between the two sides if they
happen to go through your team andthe resources available there. Yeah, I

(20:52):
think so. We as an insurer, we try to offer training for our
medical providers. We as an organizationkeep diversity, equity, and inclusion at
the forefront of everything we do.I think that there are resources that listeners

(21:15):
can check out online to see wherethey're at. I'll mention one in particular
that I found fascinating because it identifiesunconscious bias in a way that we might
not even be able to because thetest happens really fast. Is Harvard has
an implicit bias test that you canjust type in Harvard Implicit bias tests into

(21:40):
Google and it'll bring you to thatsite and it can test you in various
areas, whether it's racial, genderbased, sexuality based, and see where
you rate where you fall on eachof those biases. So I think that
there's a lot that we can doas individuals and as an organization. Doctor
Mark Brown, as senior medical directorat Excell's Blue Cross Blue Shield, We've

(22:03):
been talking unconscious bias in this communitycheck in as we spend our last few
minutes here. As we alluded to, this is a topic that you can't
get fully your head wrapped around ina half an hour. So hopefully we
have encouraged you to maybe think abouthow your brain operates and how you see
groups and individuals and the world aroundyou, maybe a slightly different way.

(22:29):
But I appreciate the fact that Excell'sBlue Cross Blue Shield continues to have this
level of community engagement because keeping theconversation up is not only a way that
you can advocate for patients, butit is a way for you to take
and do your part to help healthcareproviders of all types elevate their understanding and
want to meet patients exactly where theyare for who they are, despite what

(22:56):
may be going on in the background, as you have those interactions about what
you think you're going to expect orget from a group or an individual.
That's a great point. I thinkwhen I look at the way the healthcare
system works in our area, Ithink, for the most part, we
do an excellent job that we asa healthcare plan provide care to our members

(23:22):
in a way that is at ahigh level. But we can always get
better, we can always do more, we can always improve and really accel
us his goal is to provide affordablehealth care to everyone in the community,
and that means bringing up the levelof those that haven't been getting great care

(23:42):
as well as improving everyone's care overall. So this area implicit bias is an
excellent place to look at how wecan make that care in the Greater Rochester
area Upstate New York even better.It's all about removing the barriers, and
there are in some group, somegroups, and some parts of the community

(24:02):
barriers that are there to healthcare.And if this is one that can be
minimized, you'd like to say torndown, but at least minimized to give
patients an additional voice to advocate forthemselves and for their care. That would
be a fantastic outcome. So wedo appreciate you, doctor Mark brownseeing your

(24:22):
medical director at excel Us Blue CrossBlue Shield, for being with us today.
Your team has a herculean task aheadof them and best to you as
you continue to bring this conversation intoour community. Thanks so much, Joe,
appreciate your time. Thanks for joiningus on Community check In, a
presentation of excel Us Blue Cross BlueShield at iHeartRadio. Podcasts of Community check

(24:44):
In are available on the iHeartRadio appor wherever you find your favorite audio content.
For more ways to stay safe,healthy and educated, visit excel USBCBS
dot com and follow on Instagram andFacebook