Medical Ethics: The Insideousness of Bias

Obesity biasThe New York Times had an enlightening article about bias in its Science section this week. Apparently a study of the interactions between patients and their primary care physicians suggests that doctors are more pleasant, encouraging, empathetic, kinder—just nicer, in short—to their normal weight patients than they are to those who are obese.

From the article:

‘“It’s not like the physicians were being overtly negative or harsh,” said the lead author, Dr. Kimberly A. Gudzune, an assistant professor of general internal medicine at the Johns Hopkins School of Medicine. “They were just not engaging patients in that rapport-building or making that emotional connection with the patient.” …While such expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients. And statements like these are no small thing. Studies show that patients are far more likely to follow a doctor’s advice and to have a better health outcome when they believe their doctor empathizes with their plight.

‘“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”’

This finding is alarming, but hardly surprising. Our biases manifest themselves in many ways, and often without our awareness of them or the damage they are doing. It works in the other direction too: my son was an unusually handsome child from the time he was a toddler, and it was obvious to his mother and me that adults responded to him with more smiles, attention and better treatment right from the beginning. This affected his development, and undoubtedly had an impact on other children who realized that they weren’t receiving the same kind of attention and positive treatment.

The Times article reminds us that overcoming our biases is more difficult than it appears. It is deceptively easy to say, as I have written, “your biases don’t matter as long as they don’t affect your conduct, and you treat everyone fairly.” This study shows that the illusion of fairness may be superficial. The many small and virtually imperceptible ways deeply imbedded biases affect how we speak to, look at, think about, assess and treat members of various groups and those with certain characteristics add up to massive inequities and disadvantages, as well as pervasive anger, cynicism and bitterness on the part of the group members so treated, over a lifetime. Yet the majority group members responsible, and most of those who know them, will believe that they have been completely fair, treating all the same regardless of race, religion, color, creed or love handles. In most cases, they are deluded.  “Bias makes you stupid” is an ethics Alarms slogan (if I could get a good design, I might make a t-shirt…), but another should be “Bias wears you down.” The collective effect of all that innocent, unintentional bias can be devastating.

We are all biased, and our life-long task is not to be complacent, and to realize that rooting out one’s biases is a never-ending job and obligation. Sometimes the way we speak to or behave toward a series of people will even alert us to biases we didn’t know we had.  We have to be vigilant, and we have to help each other out.  Many years ago, I pointed out to a superior that he always smiled and prolonged conversations with the young and attractive women on my staff, but avoided eye contact and spoke tersely to members of my staff who were less attractive or older. To his credit, after telling me I was imagining things, he monitored himself and told me, several days later, that I was right, and he was going to work on it.

We should all work on it, every day. The black, female, male, elderly, handicapped, attractive, unattractive, obese, skinny, Muslin, Christian, Jewish, Asian, tall, short, military, conservative, liberal people we live and work with, and many others, deserve no less.

And they have to work on it too.


Source and Graphic: New York Times

Ethics Alarms attempts to give proper attribution and credit to all sources of facts, analysis and other assistance that go into its blog posts. If you are aware of one I missed, or believe your own work was used in any way without proper attribution, please contact me, Jack Marshall, at

3 thoughts on “Medical Ethics: The Insideousness of Bias

  1. I entirely agree with this post. Nice job.

    (I probably wouldn’t comment just to say that, except that there don’t seem to be any comments on this post at all, so what the heck, I thought I’d add one. Plus, I don’t think I’ve left a comment here in a while – been busy.)

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