The Subconscious: A Hidden Monster

A man and his son were in an accident, and each was rushed to the emergency room. As the young boy was wheeled into an operating room, the trauma surgeon took one look at him, then quickly left the operating room exclaiming, “I can’t work on him. He’s my son.” Who is the surgeon?

This riddle was brought to the table by a classmate in a lecture about implicit bias. Murmurs could be heard around the room as various answers were shared. The loudest- voiced opinion was, “It’s a gay couple.” That was a very insightful guess, and actually my first thought. However, the surgeon was actually the little boy’s mother. Many gasps of sudden enlightenment filled the room as everyone thought, of course! Even many of the girls in the room failed to get that one right. And, it was so easy. However, the role of surgeon is still instinctually given to the male population, despite the rising number of females in that field.

That riddle highlights one of the unfortunate effects of our society. Implicit bias is basically the biases held by our subconscious. We are not aware of them, but they still shine through in our actions and facial expressions without us realizing it. Everyone has implicit biases, no matter how accommodating and accepting they may see themselves. Most were probably formed in early childhood based on the biases of our parents and family. We get them from the news and traumatic events. Some religions teach them. You may encounter a person from a particular race or ethnicity, have a bad experience with them, and begin generalizing his or her qualities as those of an entire race or ethnicity. These thoughts become engrained in our minds and buried deep in our subconscious where we aren’t even aware they exist. They only rear their ugly heads when we aren’t paying attention. They peek out in our body language, our tone of voice, our facial expression, and — most importantly for physicians — in the treatment we provide our patients.

The lecture made me realize that I do have unintentional biases. It is a horrifying thought. I try very hard to treat everyone equally, but I do realize that my instinctual (I guess you could say) reactions do spring out when I least expect them. The last thing I want to do is offend someone over something so trivial and meaningless as race or ethnicity. And by that I mean, we are all people regardless of those two identifiers. Race or ethnicity should not be a factor in how you treat another human being. But, how do you fight something that you can’t see, feel or control? You might not even know it is there. It’s like trying to capture a teleporter. As you dive at it, certain you have a handle on it, it will disappear and stay hidden in your subconscious until you encounter the subject of your bias again. It will then pop right back up with a sneer and a cackle.

I really enjoyed the lecture that day, but we recently had a session that I enjoyed even more. It profoundly affected me in a way that I never thought it would, and it brought my unconscious biases crashing down around my ears once more. It was, by far, my favorite lecture of the year. The lecture was titled, “LGBT Patient-Centered Care.” Seeing that title I thought, ‘This must be about fighting prejudice against this population in our area of the country and preventing healthcare disparities.’ You could say that was true, but it was really so much more.

I personally support the LGBT community, and I always have. It hurts me to learn of any population being treated differently in the healthcare setting, but it occurs with most minorities. There have been studies that show that African Americans are given pain medication less often than Caucasian patients with the same injury in Emergency Departments. Similar disparities exist with other ethnic groups, but the problems faced by the LGBT population are a whole other ballgame. And, due to my implicit biases, I never would have considered them.

After about an hour of lecture, four members of the LGBT community agreed to serve on a panel and share their experiences. They included a lesbian, a gay male, a transwoman, and a transman. I was blown away by their stories and profoundly saddened by how they had been treated in the healthcare setting.

For one, people born with ambiguous genitalia are referred to as intersex. I have never heard that term before the panel. I also learned about a few major issues faced by the trans-community, such as the humiliation of being called by their birth names in front of a waiting room full of people and having to request a screening for the gender opposite of their new gender identity because they still have the anatomical features that are common cancer targets. I had always wondered why “Preferred Name” was included on patient information forms.

The panel members had so many stories, and I learned so much about their community that I had never known or thought to learn. They are subject to higher risks for many conditions, and because they are often misunderstood, looked down upon, or completely unaccepted in the medical setting, they often avoid the doctor altogether. Or, they resort to driving hours to an office that is considered affirming. No one should be subject to worsening health due to fear of being ostracized.

Being in support of that population for so long and knowing several people belonging to it made me feel as though I would be perfectly capable of treating them appropriately as patients. However, I realized that the monster of my subconscious bias was preventing me from actually taking a second to truly think about what they go through on a daily basis. Perhaps one of the major drivers of bias is fear of the unknown. I don’t understand gender crises, and I will never understand. But, my misunderstanding has prevented me from learning and considering issues.

In asking those four guests questions about their experiences with health care I learned so much, and I intend to use all of their advice to avoid offending my future patients. I hope to take all of the information about health considerations I should have with LGBT patients — ways in which they wish to be treated, phrases to avoid, and ways to make them more comfortable in my practice — and store it in my brain to push my little bias monster farther and farther into a little corner where he will disappear into the shadows. I may never be able to fully understand the LGBT community, but hopefully I can now imagine the problems they face and help in a small way to alleviate them.

This school really pushes learning about how to treat a large variety of patients and teaches us the special considerations you need to keep in mind. Every population has limited access to some area of health care or is at higher risk for some kind of medical problem. It is important that we are aware of all of them so we know how to provide the best care for whoever walks in the door. I’m not sure if every school introduces its students to such issues. I’ve heard that it is an elective tract in other institutions that students can choose. Well, I think it should be mandatory — regardless of the political, cultural or religious beliefs of medical students. It doesn’t matter if you disagree with how LGBT members, for example, live their lives, because it is a guarantee that every physician will have to treat them. Without exposure to their specific needs, you won’t know how to handle their health care in the future.

This topic is extremely important, and I’m glad I made the choice to attend this medical school. I am learning so much outside of a regular medical school curriculum, and all of it is priceless. This school is not only teaching me how to be a doctor. It is teaching me how to a more considerate, caring and culturally-knowledgeable person.

Tori Seigler

I am from North Augusta, South Carolina, and I am a born and bred Carolina girl. When it came time for college, I happily made my way to Columbia to attend the University of South Carolina (USC). I started college in Biomedical Engineering because I figured it would be an acceptable fall back plan. The only problem was, I forgot just how dismally boring the combination of calculus and physics could become. Also, all of my medical volunteering and biology classes made me realize that medicine was actually the best match for me. I loved it. So, I made one of the more difficult decisions I’ve had to make in life and switched to biology, committing myself to a medical track. Graduating from USC with a major in biology and minor in chemistry was a big moment for me, because I was among only two or three people in my uncommonly large extended family to receive a college degree. And, I was the first to be going on to further my education. I am very excited to be starting my medical education here at USC School of Medicine Greenville on behalf of my family and myself. It is going to be an adventure and it will be difficult, but my experience here so far has made me feel that I definitely made the right choice.