The bias of medicine can impact the relationship between patients and providers. Here’s what patient profiling is and how to avoid it.
Generally speaking, profiling is the practice of extrapolating information about a person based on known or perceived traits or tendencies - in other words, engaging in bias. The concept of law enforcement engaging in profiling - notably racial profiling - has been frequently discussed in the media lately; less discussed, yet still prevalent, is bias in medicine. In fact, one paper published in Current Opinion in Obstetrics and Gynecology argues that healthcare has lagged the business world in addressing diversity and unconscious bias.
In medicine, we are engaging in patient profiling when we make biased assumptions regarding our patients, their health status and their risk factors based on their demographics or appearance. Profiling can fracture the patient-provider relationship and contribute to inequitable care. Here's a look at how it manifests in practice and some simple ways to avoid it.
What does patient profiling look like?
Our era of medicine is defined by two trends: electronic medical record and evidence-based medicine. We have the luxury of tapping into the profound amount of data that's available and extrapolating from studies. As a result, it's easy (and may seem efficient) to see our patients as statistics. However, when we see our patient only as a collection of risk factors rather than as a person, we run the risk of being condescending and presumptuous. On social media, I polled individuals in the medical community about their understanding of patient profiling and how it manifests, asking them, "What questions do we ask? What actions do we take - or not - based on our perceptions of our patients?"
One medical student noted that as a member of an underrepresented minority group in medicine, she didn't believe that she had biases. However, during a clinical encounter, she assessed a white male in his 50s or 60s with a fairly vague complaint: problems with sleep. She didn't ask him whether he used illicit substances, but in discussion with the attending, she learned that he had a substance abuse disorder. Frequent use of cocaine was likely a contributor to his insomnia. She didn't believe she had biases, but she wouldn't have considered a white male with an excellent career to be a possibility for illicit substance use.
Similarly, when we follow our procedures for routine pediatric outpatient visits, we ask about food insecurity, yet some residents have noted that if they're short on time, they don't ask those questions when visiting with white families because they don't perceive them to be at risk. One resident noted that based on patient or family characteristics, providers may respond differently to how families discipline their children. They may be more likely to make a suspected abuse report if concerns are raised for minority children.
Bias in medicine can also be seen when it comes to which medications we suggest or other actions we take. For example, are we more likely to suggest daily contraception to individuals who are perceived as being more likely to take medication (for example, nonminority patients) or suggest nondaily contraception to individuals who are considered to be higher-risk for pregnancy? Obstetrics & Gynecology suggests that "unequal treatment of patients based on race/ethnicity is an ongoing problem in reproductive health."
4 steps to avoid patient profiling
Whether patient profiling is subtle or more overt, it serves as a barrier to equitable care. You might be asking yourself, what can I do? Here are three steps you can take to make you think twice about your bias in medicine.
- Understand unconscious bias. Implicit bias is far from uncommon; in fact, it is deeply embedded in the human condition, as the American Journal of Nursing suggests. Acknowledging unconscious bias for what it is - a set of internalized mental shortcuts that help us make quick decisions - can help set the stage for undoing its negative effects.
- Address your own bias. Take the time to think about your encounters with patients. Can you identify times when your bias played a role in your care? Is there a pattern that you can identify? The first step to avoiding bias is to understand your own.
- Standardize your approach. Many of the examples shared with me were related to choosing not to ask particular groups certain questions, and in some of these instances, that stood in the way of making a correct diagnosis. Standardize your approach. Ask all patients about related risk factors despite what you perceive to be their likelihood to engage in high-risk behaviors.
- Remember that patients are people. The best care is given when we remember that our patients are unique individuals with their own narratives. When you see each patient as an individual instead of a point on an algorithm, you are more likely to give holistic care.
While bias in medicine is a complex issue, we have the power as individuals to take steps toward providing our patients with better care.