My bias declared publicly. Could you declare yours?

For quite sometime I have been active in quality improvement, leadership, patient safety, human factors and related areas. My interest includes discrimination in general but healthcare in particular and especially doctors. This relates to discrimination in the western world particularly in the UK. We know bias plays a part in this discrimination. Government and organisations have taken efforts in dealing with discrimination, this takes the form of law, training in equality and diversity and monitoring selected data. We are told how to deal with discrimination and how to avoid discrimination.

We were never asked to assess, quantify and declare our bias.

Bias is a part of life. For better or worse our history, legacy and as humans our capacity to pattern match means that bias gets in. We could even argue that bias is a normal part of life. However when bias affects the career, livelihood, reputation and freedom of certain segments of the population, it ceases to be normal. While bias could be accepted as normal, the positive or negative effects of bias that affects segments of population repeatedly can never be accepted as normal.

How do we prevent bias from affecting others?

In my opinion unless we assess our bias by a common method and then declare it publicly we cannot begin to tackle discrimination.

Once our bias is published publicly, then we can start having methods to take that into account in our decision making by appropriate counterbalances, algorithms, adjustments etc.

I cannot ask others to publicly declare their bias unless I have done so myself.

Currently, the Harvard Implicit Association Tests are a good (but not totally proven) method to assess our bias. https://implicit.harvard.edu/implicit/takeatest.html

I have taken the test that relates to race and I am posting the results by screenshot here.

I am aware that this test relates better to the USA and refers to the black-white races. I also took this test thrice; twice the same result came up that I had a moderate automatic preference for white people and once the test showed no preference between white and black people; on the occasion that the test showed no preference, I had deliberately slowed down to take the test.

So does that make me a racist? I do not think so. Does that make me biased? May be it does, but since I have known this for sometime now, I make deliberate conscious effort to overcome my Harvard IAT data based moderate automatic preference for white people. I think very deeply on how my actions are impacting. I take extra effort to review decisions before implementing them with the awareness of my bias to ensure that my actions do not affect black and minority ethnic people adversely.

If I was an examiner, investigator, police, judge, etc I would want my decisions to be counterbalanced by a formal algorithm to prevent my bias from hurting BME people.

I am not in an unusual category as far as my bias is concerned; I am part of the largest category of persons who have taken this test. How does this affect the society?

We need to start somewhere.

I encourage you to take the test and post it publicly. I am happy to add your test result to this blog if you send it to me. Let us make a change. Let us reduce bias. Let us take the first real step by publicly acknowledging our own bias.

Here is the list of persons who have agreed to go public with their bias tests. My sincere thanks for permitting me to add their names:

Dr Kim Holt: 'slight automatic preference to black people over white people'

Dr Joe Karthikapallil (Ophthalmologist) : 'moderate automatic preference to white people over black people'.

Dr Joydeep Grover: 'no automatic preference between African Americans and European Americans'

Dr Vivek Chhabra (ED): 'no automatic preference between black people and white people'

Mr Bhavik Patel (Financial Sector) - ' slight bias towards white individuals compared to black individuals'

©M HEMADRI

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M Hemadri’s mini e-book 'Standardised Management Conversation' is available - click http://www.amazon.co.uk/Standardised-Management-Conversation-Hemadri-ebook/dp/B018AWBJTU 

Honoring the Mothers of Gynecology

Honouring the Mothers of Gynecology

This blog was written after hearing Shankar Vendantam’s excellent podcast from the NPR Hidden Brain series on the mothers of gynecology.

The history of healthcare, the history of the noble profession, doctors, nurses, scientists and others has an underbelly of unethicality and double standards. This is often justified by the rationale that the practices were compatible with the ‘standards of the time’. That is one of the fundamental issues, the wrong question is whether it was compatible with the standards of the time, a possibly right question would be whether it was compatible with some of the eternal principles of medical practice. We will find again and again that actions of many of our predecessors in modern healthcare were not compatible with eternal ethical principles of healthcare.

An infamous example of an individual was the American physician J Marion Sims, who acquired black women slaves for the purpose of experimental surgery to resolve vesico-vaginal fistula. He operated on them without anaesthesia when anaesthesia was available and he operated on white women with the same condition only when he had completed his experimental surgery on black slave women after his technique was perfected on these black women. Who were these black women? It seems there were 14 of them; we do not even know their names except three of them. Anarcha, Betsy and Lucy.

In the NPR podcast historian Vanessa Gamble alludes to some potential motives. The women with vesico-vaginal (abnormal connections between urinary bladder and vagina) and recto-vaginal (abnormal connections between rectum and vagina) fistulas that happened after traumatic childbirth, meant that these enslaved women could not work for their ‘masters’ and could not reproduce creating more enslaved people to benefit their ‘owners’. So, it seems that it might not have simply been the desire to progress the frontiers of surgical science that was the primary motivator for Sims to have acted unethically. The view that he might have acted unethically is not just from retrospection, he was challenged about it even within his time.

Vanessa Gamble and Bettina Judd (a poet) talk in the NPR podcast about how these women whose life, living and bodies were used without consent could be recognised; there is some talk on statues along with the one that exists for Sims. Recognising and honouring these women is not tokenism, it is a fundamental for progress of humanity. Statues will act as symbols but they will have the constraints of geography and history whereas Sims will continue to have universality.

The mothers of gynecology should have universality (while Sims would become a lesser part of history). With that in mind I propose the following:

1)      Anarcha should be referred to as the mother of gynecology.

2)      The vaginal speculum currently known as Sims and its variants should from now be known as the Betsy speculum

3)      The surgical procedure to repair vesico-vaginal fistula should be called the Lucy’s repair.

While these three are important, it is also important to stop referring to Sims as the father of gynecology.

These suggestions stem from the principle where an immoral or unethical person is disassociated from any glory that is derived from the outcome of such person’s activity. The new world demands a new kind of approach, the sins, crimes and injustices of the past will remain – the benefits from those should not. The ignominy suffered by these women must be honoured by making them the main story; Sims of course needs a place on the page which he will have as an incidental footnote in the history of gynecology. Success in Healthcare demands these actions, we cannot allow healthcare to fail by not giving the mothers of gynecology their rightful place.

Organisations and persons working for equality and justice should lobby the gynaecological profession to adopt these changes so that they become the norm.

M. HEMADRI 

Links

http://www.npr.org/2016/02/16/466942135/remembering-anarcha-lucy-and-betsey-the-mothers-of-modern-gynecology

https://en.wikipedia.org/wiki/J._Marion_Sims

http://www.medscape.com/viewarticle/479892

PS: I started writing a blog called ‘What are the nasties in healthcare we may regret in the future?’ and intended to use the mothers of gynecology as an example. Once I started writing it I realised that it will be yet another injustice if the mothers of gynecology did not have their own place in these blog pages.

©M HEMADRI

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My mini e-book 'Standardised Management Conversation' is available - click http://www.amazon.co.uk/Standardised-Management-Conversation-Hemadri-ebook/dp/B018AWBJTU 
till 31 December 2016 all my earnings from the sale of this book will be donated to charity  http://successinhealthcare.blogspot.co.uk/2015/11/standardised-management-conversation.html