Conversations about bias usually center on how we think about others. In this episode, I’m inviting you to take a slightly different angle on bias. Listen in if you’re interested in addressing bias in words and actions.
Hi. This is 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel. Right now, I’m at the Cleveland Clinic, and we’ve just finished a workshop with clinicians about bias in healthcare. It’s a hot topic. If you’re interested in addressing bias, listen to this episode to find out some of what the clinicians and I talked about when it comes to thinking about how bias shows up in healthcare–actions and words.
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That was a remarkable session at the Cleveland Clinic and I’m grateful to Dr. Windover and the Center for Excellence in Healthcare Communication for inviting me to work with them. Like the physicians in this session, many of you tune in because you value reflective practice, thoughtful use of language, and reducing health disparities.You’re aware by now that health disparities are due to many factors that are man-made. And that one of them is implicit or unconscious bias. You probably already know that everyone has bias, and that the implicit bias scores of providers are similar to those in the general population.
Conversations about bias usually center on how we think about others. But I’m inviting you to take a slightly different angle. As you might know, I’m particularly interested in the ways language use relates to equity, in and beyond the health sector. There’s a significant body of work on these relationships, and I’m drawing on it to offer some ideas that I hope will be helpful when it comes to thinking and action around bias.
How we think about others has a good deal to do with how we think about ourselves. And that’s where I’m going to park it for a bit. When we talk or write, we can all tend to think of the sentences we use–the words and phrases we choose–as normal, natural, value-free, or neutral. But it turns out there’s quite a lot going on beneath the surface of our ordinary, everyday language use.
I’ve podcasted before about how linguists demonstrate that our words reflect what we think is normal. Our language reveals our perspective on what James Gee calls “being ‘normal,’ ‘acceptable,’ ‘right,’ ‘real,’ ‘the way things are,’ ‘the ways things ought to be,’ ‘possible,’ or ‘what people like us do’.” (p.2)
We get these ideas about what’s normal–and the phrases we use to express them–over time, through the many communities we’re part of. These are reinforced through media we consume, or casual talk at dinner, or our social media activity, for example.
Why is this important? Because our normal can be linked to a different kind of bias. A funny thing about our perspectives is that they can become invisible to us. I still struggle on a daily basis to get outside of my own perspective–and my cross-sector work depends on my doing that!
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I’m not alone in this. There is an allegory in anthropology and ethnography, that my late professor Brian Street retold several times: the fish would be the last creature to discover water. It’s doggedly hard to notice our normal. So this allegory is used to caution researchers against what’s called the ethnocentric bias. You could think of it as our tendency to take for granted our own cultural practices. This isn’t so much of a big deal–until we interact with other people and their cultural practices.
That’s when another tendency can kick in, related to the ethnocentric bias: the tendency to describe something different from us as something less than us. You could liken this to going to a new town, or even a new restaurant: we might judge it according to what it doesn’t have that we’re used to having. We can focus on perceived weaknesses based on what we think is (or should be) normal. Basic. Fundamental. The way it ought to be.
That’s how the ethnocentric bias can get us in trouble when we don’t notice it’s there.
As health professionals, you have the most well-informed perspectives on health of anyone. You worked hard for many years to gain this perspective, and continue to work to deepen and refine it. You don’t expect the rest of us to be experts, or to know what you know.
You do, however, have expectations about what normal people should or ought to know, or do, when it comes to health.
Expert or not, we all have ideas about what counts as normal in health (and in healthcare). We each draw on a range of ways of understanding the body. The same can be said for how we make sense of science, procedures, insurance, nutrition, and more. Why am I telling you this? Because, as I said before, the real fun comes when you interact with other people and their potentially different ways of understanding health.
Remember that ethnocentric bias? Among other things, it can lead us to focus on a person’s perceived weaknesses, based on what we think is or should be normal, basic, or fundamental for people in general. Sometimes without noticing, we measure others up against some standard of ‘normal’ we consciously or unconsciously hold. When they seem too different from what we think of as normal, the difference can be perceived as negative.
When I talk to health care workers, I remind them about the ethnocentric bias, and how easy (and largely unconscious) it can be to think of other people’s ways of doing things as problematic. Especially when it’s not what you think is or should be normal, basic, fundamental, or common sense for people in general. This applies to how patients understand their bodies and act upon health information.
What you can do
To be clear: this isn’t about not having standards. It’s about being intentional and mindful about the standards you do have. This means examining your standards–including your assumptions about what’s normal for people in general–so they are what you want them to be.
I’ll invite you to slow down the speeding train of thought and interrogate some of your assumptions. Reflection plays a crucial role in this process.
- What do I tend to take for granted about being healthy?
- What do I consider basic or common sense when it comes to staying healthy?
- What do I consider ‘normal’ displays of intelligence?
- What does an appropriate show of curiosity look like to me? How about concern? Commitment? Affection? Attention?
Get to know your ‘normal.’ Have standards. Look closely at what yours are, and at what it means to hold those standards and not others.
If you get stuck on this, don’t worry; there’s a trick. Listen to yourself when you talk to patients or clients. Even for just one day.