How do you “see” patients in your practice? Do you stereotype them or make assumptions based on their appearance? Are you able to individuate your patients, or do your biases cause you to unconsciously treat some patients differently? Does this make you responsible for some of the clearly documented disparities in health care in our country? And, if so, how can you become aware and make changes to help eliminate disparities?
As I read Seeing Patients: Unconscious Bias in Health Care, I was prompted to ask these questions of myself. I believe other physicians, especially orthopaedic surgeons, will do the same.
In this book, orthopaedic surgeon Augustus A. White III, MD, challenges both physicians and laypeople to shine a light on the often unseen problems of disparities in healthcare access and delivery for Americans. Part autobiography, part history lesson, part psychosocial analysis and self-awareness manual, and part health policy science, the book provides an overview of America’s journey through the civil rights movement, as Dr. White shares his personal experiences confronting racism and bias during a remarkable life of service and accomplishment.
Making the personal positive
Throughout his life, Dr. White has used his personal successes and accomplishments as a platform for promoting advancement and positive change for others, particularly those from minority backgrounds. Here, he chronicles his life growing up in the segregated South in the 1940s and 1950s, his medical training at Stanford University, his service as a U.S. Army combat surgeon in Vietnam, his studies abroad, and his faculty assignments—all of which led to his eventual position as surgeon-in-chief of orthopaedic surgery at Beth Israel Hospital in Boston.
The book’s autobiographical chapters also provide lessons in civil rights and orthopaedic history. For example, Dr. White had personal contact with leaders in the civil rights movement, including Mary McLeod Bethune, W. Montague Cobb, Bobby Seale, and Alvin Poussaint. He was also influenced by Booker T. Washington, Martin Luther King, and Nelson Mandela.
Orthopaedic leaders such as W. Montague Cobb, MD, PhD; Alvin H. Crawford, MD; Paul S. Curtis, MD; Wayne O. Southwick, MD; John A. Feagin , MD; Carl Hirsch, OD, FCOVD; Manohar M. Panjabi, PhD; Douglas W. Jackson, MD; and William W. Tipton Jr, MD, also left their mark. Fellow orthopaedic surgeon pioneers, including Timothy L. Stephens, MD; Charles H. Epps Jr, MD; James A. Hill, MD; Raymond O. Pierce Jr, MD; E. Anthony Rankin, MD; Randall C. Morgan Jr, MD; Claudia L. Thomas, MD; and Mary I. O’Connor, MD, have joined Dr. White in bringing healthcare disparities to light.
The intertwining journeys of both orthopaedics and civil and human rights are chronicled in Dr. White’s life and career. Despite the progress made in these areas, unequal medical treatment in this country still exists due to biases, stereotypes, generalizations, language differences, and cultural barriers.
Dr. White enumerates the healthcare disparities that affect the health and lifespan of members of many populations in the United States. Racism, sexism, and ageism are some of the major discriminatory activities, along with disparities in treatment for Hispanics and homosexual patients. Dr. White also examines the roles of unconscious bias, poor communication, and focus on biomedical information without considering the social context.
Advocating for change
Dr. White is currently focused on finding a rational approach to effectively address and resolve healthcare disparities, as outlined in the final chapter and epilogue. At age 65, after retiring from clinical medicine and the operating room, he became master of the Oliver Wendell Holmes Society at Harvard Medical School. In this position, he helped develop a curriculum to teach medical students how to deliver culturally competent care. His book details this initiative, and offers practical advice and suggestions for both physicians and patients.
Dr. White has always been an advocate for diversity and equality in orthopaedic surgery, and has been active in these areas at Brown, Yale, and Harvard Universities. He was instrumental in establishing the AAOS Diversity Committee (now the Diversity Advisory Board) and in founding the J. Robert Gladden Orthopaedic Society. He is a recipient of both the AAOS Diversity Award and the William W. Tipton Jr, MD, Leadership Award.
A must-read for practicing orthopaedic surgeons and orthopaedic residents, Seeing Patients: Unconscious Bias in Health Care illustrates Dr. White’s passion for treating all his fellow humans with compassion and cultural competency. He highlights the reality of healthcare disparities and encourages all of us to become “humanitarian role models” by the small actions we undertake in our daily interactions with patients. In doing so, we can help create the “win-win-win” situation he describes, with the victors being the patient, the doctor, and society.
Steven L. Frick, MD, is residency program director at Carolinas Medical Center, Department of Orthopaedic Surgery, Charlotte, N.C.