LAUSR

Implicit bias defines the attitudes that impact our actions and decisions about people or things in an unconscious manner. In recent years, implicit bias training in higher education has provided a space for many clinicians to evaluate their own personal attitudes towards both patients and coworkers. Implicit biases are the often defined “hidden biases of good people”. As this understanding of implicit bias has taken root in our collective consciousness from the late 20th century to the present, the goal to confront bias in medicine has become an institutional value. Nonetheless, tangible improvement in minority health has been slow moving. The current Covid-19 pandemic exposes these deficiencies acutely. Although more and more clinicians are developing an intellectual understanding of implicit bias, this awareness has failed to eradicate racism in healthcare. A key deficiency of the current understanding of implicit bias, is that it allows us to view our behaviors as impersonal entities—good people involuntarily producing biased actions. Racism is a personal moral failing that is not solely a belief of personal superiority over another person due to race, but also describes the support of impersonal structures wired to adversely impact groups of people on the basis of race. Ibram X. Kendi defines a racist as “one who is supporting a racist policy through their actions or inaction or expressing a racist idea.” On the other hand, an antiracist is a person who supports “antiracist policy through their actions or expression of an antiracist idea.” Antiracism implies action always and dismantles passivity. In Kendiʼs view, this means that being a racist or antiracist is not a fixed identity. It is dependent on oneʼs actions at a point in time, from moment-to-moment. In addition, the tenets of antiracism hold that as long as we continue to concentrate on the fact that we are “good” we will never truly be convinced to fundamentally change our behaviors. Let us return back to the story of our patient with SCD presenting with leg pain. This interaction was televised in Lenox Hill, a new Netflix documentary series, which showcases the many challenges of being a physician in 21st century America. Medicine has been dramatized as well as mystified to the American public. In a world where physicians are often misunderstood and suffer from burn-out in their practice, Lenox Hill provides a humanizing perspective. Despite its efforts, episode seven, Pain, depicts the heartbreaking reality of mistrust between a non-black physician and her black patient. He presents with knee pain after a fall days previously. She shares with the viewers concerns of opioid addiction given his recent presentation to another emergency department with similar pain. She remarks to the camera that patients with SCD are, “Born with a disease that essentially makes you dependent on pain medication...If you give them one round (of opioids) they will get several rounds, and they abuse it.” While she examines him, she states phrases commonly heard by many patients with SCD: