I had a patient write me about a problem and ask for advice on how to prevent the problem from happening.
The patient has a medical condition – bipolar disorder. The patient has also been to the emergency department a few times and perceives that, once the staff learns that he is bipolar, a bias develops. To quote him,
I’ve seen a hesitation when it comes up while they are taking my history. Perhaps I’m reading too much into it, but it feels like they are mentally recalibrating their general impression of me.
The patient asks whether the bias really exists (“is there a tendency to immediately give
more consideration to a diagnosis of drug abuser or drama queen?”) and, if so, asks for suggestions on what to do to to overcome that bias.
I don’t think that anyone can say they don’t develop some type of bias from a patient’s history. Some instances of bias are worse than others, but they all go back to the healthcare worker’s previous experiences. For example, if a young child is attacked by a dog, that child will have a future fear of other dogs – no matter how friendly the dogs are in the future. Previous experiences have shaped future perceptions.
We have one schizophrenic patient who frequently comes to the emergency department for “antibiotics” to get rid of the “infection” caused by his previous interactions with various tadwry women in his life from years past. He believes that he is unable to get their “secretions” (my word, not his) off of his body. So once a month or so he comes in for his antibiotic shot and he leaves after getting a shot of “norMAL sahLEEN” or the really good stuff – “dihydrogen oxide” – which are “normal saline” or “H2O” respectively. And getting those medications helps him. Really. He’s happier. He thanks us, and he goes on his way.
But my experiences with that patient do give me a bias when I see in someone’s history that they are schizophrenic. I can’t help wondering – are they going to be like “him”? No matter what I do, that’s the bias that I sometimes start with.
When I meet a patient, their actions either refute or confirm any bias that exists. In other words, I may be inclined to think one way, but my mind isn’t set in stone. Be pleasant with me, interact normally, say “thanks, doc” and the bias is gone. Swear at me, pretend that you’re passed out from severe pain, or engage in floor throwing and the bias is substantiated.
I guess the bottom line is that I do believe a bias exists toward certain aspects of a patient’s history. I don’t believe the bias is huge, although with some providers – and depending on the complaint – I suppose it could be.
How to overcome the bias?
Be nice. Say “please” and “thank you.” You’d be surprised how much someone’s attitude about you will change if they think you appreciate what they are doing for you.
Don’t exaggerate your problems. Most doctors and nurses can tell when you are doing so.
Don’t act like a “drama queen” and in most cases, you won’t be treated like one.
If you have a history of going to the emergency department for pain complaints, be up front about it. You may not get the narcotic prescription to take home, but if you are in pain, most docs will do what they can to get you out of pain as long as you aren’t there every week. If you have been hopping from hospital to hospital and don’t tell the staff about it, most of the time the staff in the ED will call around to other hospitals to check you out. Once you’re caught hospital hopping, at most places you’ll go on The List and it will be harder for you to get your problem treated anywhere.
Hope this helps.