A Black female surgeon feels invisible, and wishes to be seen for who she is (1). A Black male physician wishes he were invisible, instead of fielding the constant assumptions that he is a threat (2). When patients went to the emergency department of an academic medical center in Philadelphia complaining of chest pain, it took the staff significantly longer to order EKGs for Black patients than for white patients (3). Time matters when treating a heart attack, and an EKG is a readily available and standard test ordered for chest pain, so why the delay if you were Black? When outside examiners scored math tests of elementary school children without the benefit of knowing their names/gender, girls scored higher than when they were scored by their own teachers who knew the students’ gender (4). More female musicians are hired when they audition behind a curtain, than during open auditions (5).
In the search for truth, it appears, what we think we know can be a hindrance. Some call this implicit or unconscious bias, which in reality is a dressed-up term for prejudice. We all have prejudices and it is a life’s work to free ourselves from its obscuring effects. Structural institutional racism and sexism keeps us fixed in the harmful cycle of exposure to bias –> adoption of bias –> view the world through my biased lens –> reaffirm and reinforce my biased view –> act with bias –> expose others to bias –> repeat. And by definition, even just social actors acting within an unjust system cannot produce just results. The system itself needs to be dismantled and rebuilt on foundations of justice. But this is a task that requires a significant proportion of the population to be willing to not only view the building of a just society as an aim in and of itself, but also to reconsider the assumptions it makes about the greater society.
We all hold certain beliefs about specific human beings (our co-workers, families, friends, and neighbors) and groups in general (African-Americans, refugees, white Americans, the poor). These beliefs are based on assumptions we make about these individuals or groups, and they form our conceptual framework and inform how we live our lives. How we treat a co-worker will change, for, example if we are operating out of an assumption that competition drives productivity and we have to put others down in order to rise, versus an assumption that we are generally cooperative beings who enjoy seeing others succeed and that we will make the most progress when we work together. If members of a particular ethnic group are loudly talking and laughing, some might view this group as uncouth while others might interpret the group as warm and lively. We make these sorts of judgements daily, as we interpret our world. It is easier to get along if we assume we are more similar to each other than different. It is also easier to advocate for others’ rights and to work towards equity and fairness when we assume that we are more similar than different, with common needs and aspirations. On an individual level, rebuilding a just society necessitates, among other things, a willingness to analyze the underlying beliefs we hold about each other, and to reconceptualize these assumptions.
In the meantime, creating systems and processes to reduce the impact of implicit bias and promote fairness should be promoted. With the mountain of evidence for the impact and pervasiveness of implicit bias, we ought to more broadly implement blinded applications for jobs, promotions, grants, publications, and scoring of tests and assessments. In places of work and educational institutions, in boardrooms and decision-making places, blinding for decisions of consequence could be a means to institutionalize fairness. Doing so requires a level of humility – letting go of our egos and openly acknowledging that we all have biases that distort reality, and that being “blind” allows us to see the other more clearly.
Joanne Rowling was asked to publish the Harry Potter series under the more non-descript J.K. Rowling because the publisher feared boys would not read a book written by a woman (6). Had they not read her book, would it be any less captivating? If you are in the dark, how would you judge a lighted candle? By the color of the wax? What if instead of a candle we are talking about the light or capacity of a child, or an adult, does it make sense then to judge that light by the color of the skin or any other characterization? If we fish with a small net in the wide deep ocean we only catch small fish. We may conclude that only small fish live in the ocean. But if we started with the assumption that the ocean is vast and deep and might include a wide array of fish, we would design and fish with larger nets, to help discover this diversity. What we come to believe about others is colored by the “fishing net” through which we examine reality, and this “fishing net” that we use and develop through life experience, is directly shaped by our underlying assumptions. This is why starting with the assumption that human beings are essentially the same, with equal rights and common aspirations, is so important to restructuring a just world. If we start with such an assumption, we might have a chance at building systems that promote justice. Relying on our own observations of differences – explicit or implicit – differences born out of structural inequities designed to promote inequity – will always lead us astray.
References
- Oluwadamilola Fayanju. Hiding in plain sight. JAMA 2019; 322(22): 2173-2174
- Milam, Adam, Invisible Doctor: Black Men in Medicine, Jan 17, 2020
- Takakuwa, K.M, Shofer, F.S, Hollander J.E. The influence of race and gender on time to initial electrocardiogram for patients with chest pain. Academic Emergency Medicine, 2006, 13(8): 867-72
- Teacher Bias: The Elephant in the Classroom, August 27, 2018
- Claudia Goldin and Cecilia Rouse. Orchestrating impartiality: The impact of “Blind” auditions on female musicians. The American Economic Review, 2000.
- J.K. Rowling, About
About the Author:
Nasim Ahmadiyeh M.D., Ph.D. is assistant professor of surgery at University of Missouri-Kansas City School of Medicine, breast surgical oncologist and Medical Director of the Comprehensive Breast Care Program at Truman Medical Centers, the primary safety-net/essential hospital in the Kansas City, Missouri, metro area. Her recent research focuses on cancer health disparities among the safety-net population.