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Doctoring While Black | Implicit Bias 101

Doctoring While Black: Implicit Bias 101

Our perceptions are invariably informed by our own experiences and biases, both implicit and explicit. They may play out in various ways every day, often without an awareness of what is actually transpiring.

Our reactions and perceptions can often be influenced by what we see portrayed in the media so that when we are confronted by various situations, we can react as we have been trained or conditioned to act.

The medical profession confronts such perceptions and influences regularly. One of the most common perceptions is of the prototypical physician as an older white male. Of course, as with all professions, physicians are represented by men and women, people of different races, skin colors, sexual identities, and religions.

But what happens when a physician is not the prototypical? What happens when a physician tries to save someone’s life while not meeting the biased perception of others?

Doctoring While Black, case in point, Dr. Fatima Cody Stanford.

As the New York Times reported in November 2018:

“Dr. Fatima Cody Stanford was on a Delta flight from Indianapolis to Boston on Tuesday when she noticed the woman next to her showing signs of distress. So Dr. Stanford did what she was trained to do in more than a decade of experience as a doctor — she began to assist her.

But Dr. Stanford, who is black, said she had just started to help the passenger when a flight attendant approached and asked if she was a doctor.

Dr. Stanford said yes and, without being asked, she took out her medical license, which … has the letters “M.D.” after her name.”

Dr. Stanford told the NY Times that to combat perceptions that she “doesn’t look the part” of a doctor, she started carrying a pocket sized version of her medical license… Dr. Stanford, who practices obesity medicine at Massachusetts General Hospital and is a Harvard Medical School instructor, has carried the wallet-size version of her medical license with her since 2016, when she read about a black doctor who was asked to show credentials when she offered to help a sick passenger on a Delta flight.

However, even Dr. Stanford’s actual license may not be persuasive and may generate more implicit bias based skepticism, as it did on her Delta Airlines flight.

‘I Am Who I Say I Am’

According to the NY Times:

“The flight attendant glanced at it and walked away. As Dr. Stanford continued to try to calm the passenger, another flight attendant approached and asked to see the license. She, too, looked at it and walked away. Then the two flight attendants returned together and began another series of questions.”

Not persuaded that Dr. Stanford is indeed a physician, the flight attendants persisted in the interrogation and with their doubts

“Are you a head doctor?” one of them asked. When Dr. Stanford said she did not understand the question, the flight attendant asked, ‘Are you actually an M.D.?’

Then the second flight attendant spoke: ‘Is this your license?’ When the doctor asked what she meant, the flight attendant repeated the question.

‘Why would I carry someone else’s medical license?’ Dr. Stanford said she replied.

… Dr. Stanford said she was not challenged for the rest of the two-hour flight. As they were descending, she said, one attendant told her they would not need to check her license anymore because ‘it seems like you were able to handle everything.’

[Dr. Stanford] interpreted the encounter as biased because of the persistent questioning about whether she was a physician even after she had provided proof.  ‘It never stopped,’ she said. ‘I just couldn’t figure out why we were having this discussion.’

Delta apologized to Dr. Stanford … and said it was investigating, according to the email it sent her…. A Delta spokesman noted that the airline had changed its policy about medical credentials in 2016 to say flight attendants are not required to verify credentials from someone who says she or he is a physician, physician assistant, nurse, paramedic or emergency technician. [The spokesman] said the flight attendants working on Dr. Stanford’s flight, Flight 5935, on Tuesday were employed by Republic Airline, a Delta Connection partner.

Jon Austin, a spokesman for Republic, said in an email on Thursday that the airline was working with Delta to make sure its employees apply such policies. ‘We’re grateful to Dr. Stanford for her medical assistance onboard our Flight 5935 and are sorry for any misunderstanding that may have occurred during her exchange with our in-flight crew.’”

Delta’s 2016 policy change was prompted by another “Doctoring While Black” implicit bias incident when Dr. Tamika Cross offered to treat a sick patient during a Delta flight from Detroit to Minneapolis. Dr. Cross, who did not have her medical license with her, volunteered to help a passenger who had become ill. Before she could assist the passenger, a flight attendant demanded confirmation that she was an ‘actual’ physician, nurse or medical personnel.

According to the NY Tines, Dr. Cross had previously encountered assumptions that being a black woman, she was not a doctor. ‘I think minorities in general, especially in my field of practice — I feel that they are always questioned and always assumed to be the nurse or the nurse’s aide or here as part of the janitorial team or ancillary staff,’ she said.

Today, even in her daily medical practice at Memorial Hermann Pearland Hospital in Pearland, Tex., she is still occasionally mistaken for support staff. ‘I think that it is just going to be a lifelong battle,’ Dr. Cross said.

Is This More Common Than We Think?

As the NY Times reports,

“Both doctors’ experiences were widely shared online by colleagues to highlight offensive assumptions about diversity in the medical field.

The 2016 hashtag #WhatADoctorLooksLike, which was inspired by Dr. Cross’s case, was resurrected … to raise awareness about the doubts faced by many black medical professionals…

Dr. Cross addressed the airline on Facebook:

‘In 2016, you did not believe I looked like a doctor either,’ she wrote. ‘Hundreds of thousands of us across this country and even in other countries banded together to show you #whatadoctorlookslike but here we stand JUST 2 years later and your employees have not learned.’

… This is something that the medical community has embraced as a reality,” Dr. Stanford said. ‘When you Google a doctor, most of the pictures that come up are of a white man. There are other people who look like me,’ she added. And I should not be called into question about something I have worked for my entire life.”

Implicit bias can have insidious, demeaning, and tragic consequences. Effective implicit bias and cultural awareness training can be an effective means to educate people about how their perceptions and actions are invariably influenced by their own life experiences and biases. People should not be called to task and doubted because who they are differs from what others think they are or are not. Society should validate and accept all without the influence of bias and prejudice. As Dr. Stanford said, “I should not be called into question about something I have worked for my entire life.”

*Read some of Bruce Adelson’s other blog posts to learn about more developments in language access law, and be sure to contact us if you’re interested in a consultation about your own organization’s compliance with federal language access law. Also, check out the blog, ‘Implicit Bias in Health Care: Two Doctors’ Experiences’ for another perspective on this subject.

 

© Bruce L. Adelson 2018, special for Bromberg, All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq, CEO of Federal Compliance Consulting LLC is nationally recognized for his compliance expertise concerning many federal laws.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.

Mr. Adelson is an Instructor of Family Medicine, Department of Family Medicine, at Georgetown University School of Medicine in Washington, D.C.

He has also taught at Cornell University, Auburn University, and the University of Baltimore School of Law.

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