And thank you for that, Dr. Gettleman. It's encouraging to hear that people really want to be better. It's an important topic. It's an important issue. And it's long overdue. I have no disclosures. I'm going to start with a case scenario. And I want you to think about what this makes you feel, especially if this is one of your family members. 65-year-old African-American woman with sudden onset of lightheadedness and visual changes while at home watching TV. EMS was called. She was evaluated by a 28-year-old veteran EMT and diagnosed with anxiety. She was not recommended for transport and asked to sign some papers. She continued to feel bad and called a physician she knew and trusted. That physician told her to go to the emergency department where she was triaged and then was also explaining that she felt weak and just mentally slow. She waited another hour in the waiting room until that same trusted physician intervened. The stroke protocol was ultimately initiated. She was diagnosed with an acute stroke. Thrombolytics were started a full seven hours after EMS was called. Why did this happen? We all know that that's not right. Well, maybe this is a one-time event. Implicit bias refers to the attitudes or stereotypes that affect our understanding, our actions, and decisions in an unconscious manner. It's different than explicit bias. Today, we're only going to focus on implicit bias because I can't help you with explicit bias. And this picture is helpful because these are all things that we think about when we meet people and when we engage with people. Evidence indicates that biases are likely to influence diagnosis and treatment decisions, as well as appropriate levels of care in some circumstances. In addition to affecting judgments, implicit biases manifest in our nonverbal behavior towards patients, families, and like eye contact and physical proximity. Examples of a few well-documented implicit biases in health care are listed on this slide. White male physicians are less likely to prescribe pain medications to black patients than white patients. Providers assume their low-income patients are less intelligent or more likely to engage in risky behaviors and are less likely to follow medical advice. Pregnant women face discrimination from health care providers based on their ethnicity and their socioeconomic backgrounds. Women presenting with coronary artery disease symptoms are significantly less likely than men to receive a diagnosis, referral, and treatment due to misdiagnosis of stress and anxiety. Are organizations really addressing this? MGMA has put a stat out that asked all of their organizations. And almost 85% of these organizations were not involved in implicit bias training. They didn't even know what it was half the time. There's evidence of racial and ethnic disparities in health care to numerous to count. Disparities are consistently found across a wide range of disease areas and clinical services. These have effects on patient outcomes. These patients wait longer for assessments and treatments. Less time is spent with patients of color on average visits. Deliberate different treatment plans have been given to patients based on characteristics. And sometimes these patients are even approached with condescending tones, and the patient feels devalued and unheard by their provider. There's racial disparities in orthopedics. And again, I can present extensive data on health care disparities regarding minorities and women, disparities in the workplace, in leadership positions, and pay gaps. But I want to go beyond the stats. We as physicians are taught to find flaws in studies and pick them apart. For those in the audience that don't look like me, the sheer volume of studies indicate there is a problem with implicit bias in medicine. For those that do look like me, we know there is a deeper problem on a much deeper level. The woman in this case scenario I presented at the beginning was my mother. I wish I could say that was a one-time scenario. This type of thing has happened to us multiple times. This has been my father. This has been me. And most recently, it's been my child. And I can pretty much guarantee that for those in the audience that look like me, it's happened to them and their family too. The world around us influences a lot of our beliefs. And we often act upon these beliefs in a subconscious way. Everyone has implicit biases regarding gender and race. Implicit bias in medicine occurs at multiple levels. Thus, this bias must be addressed at all levels to achieve sustainable change. The three levels of biases are micro or individual, which include collective bias, bias micro or individual, which include collegial and social relations, personal lives, your beliefs, your actions, your behaviors. At the meso level or organizational level, that includes institutional culture and practices and policies. And then at the macro level, at the sociocultural and political and economic level, at a much bigger, having much a bigger effect. For those of you that don't care, I do not have an answer for you. I can't make you care and that's why I'm not here. That's not why I'm here today. For those of you that do care, and I do believe that people in this room care, there's good news. It's not that difficult to help with this problem. It's just gonna require you to care enough to make actionable change. There's a bigger reason implicit bias exists. And this is a much bigger and more complicated issue than I have time to discuss. Some of it's even linked to our medical training. People have been taught that black skin is thicker and that there's different pain tolerances. But we've got to acknowledge that these presumptions that you have, these biases that you have, they are normal. Everyone has biases. It doesn't make you a bad person. But questioning them and acknowledging that you do have a bias, that's where our responsibility lies. It's our responsibility to make sure that our medical recommendations aren't subject to these biases. And that you consider the challenges of all of your patients' lives. The state of medicine has reached near crisis mode for us as physicians, and we all know that. Especially as it relates to patient loads and administrative burdens, decreasing reimbursements, which perpetuates the problem of having to rely on this bias. Your patient interactions impact society. Not addressing pain and pathology leads patients to find other and often less beneficial mechanisms to cope. They self-medicate. They don't exercise and their disease process progresses. They distrust the system, often having a profound effect on the lives of everyone around them. The challenges from an educational point of view is how you make these topics resonate with people, the people that can impact the most change, the people in this room. These tend to be very delicate topics that we tend not to talk about. People don't want to talk about it, it makes them uncomfortable. If we can create a space where we can explore these things and look into ourselves, it can be pretty amazing how it opens people's eyes that truly really care and want to be better. Individual patient interaction is the start. Here's what you can do on an organizational or institutional level. As leaders, ensure your fellows and residents that implicit bias exists and it can lead to poor patient outcomes. Encourage them to seek and understand these barriers and barriers to care and barriers in their blind spots. Most importantly, recognize that diversity of thought and representation of underrepresented people are paramount to addressing this problem. Continue to challenge your perceptions. That's how we're going to improve this on a societal level. Seek out your blind spots. How do you do this? Because that's the magic question. Believe those that are affected by these problems that may not directly impact you. And I'm going to say that again. Believe those that are affected by these issues that may not directly impact you. If everyone looks the same and thinks similarly in leadership positions, they're all going to have the same blind spots. The problem persists as it has. We have to diversify our environments in leadership, in mentoring, in your friend circles. Please know that you're going to fail sometimes, and that's OK. Keep trying. Engage your minority colleagues, your minority organizations. Some may be receptive. Some may not. That's OK. Keep trying. It's exhausting. It's exhausting for your minority colleagues, but keep trying. We've talked about these different organizations, and these are ones that I am personally a part of. There's so many people invested in this issue. Reach out for guidance. This issue is really a challenging topic for me to try to present in such a brief manner, especially that affects me in such a personal way. I hope I didn't dilute the message too much, because there's so much I could say and so much I want to say. But I wanted this to be receptive to this audience, because we have to remember who's going to be able to institute this change. So please, please go make actionable change. Believe that this is a problem, and I appreciate your time. Thank you.

implicit bias

healthcare

unconscious attitudes

racial disparities

diversity in leadership