Do You Prejudge Your Patients?

Prejudice is one of our worst traits. It’s something none of us like to do or would like to be subjected to, but it’s really hard not to judge people. We do it out of preconceived ideas in our heads and usually in reference to particular stereotypes or generalizations. It’s something that we start doing early on in our lives which then becomes a habit or something we do subconsciously and automatically. You see someone and you form this idea of them which helps you protect yourself and create a general idea of how to deal with them and what to expect.

Doctors are no exception to this, and doctor prejudice isn’t just present, but it’s also very common. A survey found that about 40% of all doctors harbor biases for certain people. The rates are also even higher among certain specialties. It is as high as 62% for emergency doctors, half of orthopedists, 48% of psychiatrists, and up to 47% of family doctors and OB/GYNs. The specialties with the lowest biases and prejudices are radiology, cardiology, and pathology. Although it’s really hard to judge radiologists and pathologists because they don’t really see and deal with patients. It’s one thing for everyone to be biased and another for a doctor to be biased. That’s because a doctor is someone you need to trust to fully see you as you are and understand your needs. By misunderstanding you, the standard of care provided could be affected. On the other hand, if your architect judges you to be a certain way, that won’t affect how he or she rebuilds your home. There are lots of reasons for doctors being biased and lots of consequential effects as well. It’s important for physicians to eliminate their prejudice and deal with patients from a neutral perspective.

There are plenty of reasons doctors are prejudiced. The most common reason, as found in a survey, is due to a patient’s emotional problems, with the 2^nd most common reason being weight. Other causes are income level, race, attractiveness, intelligence, language differences, and insurance. Another reason that’s not discussed often enough is physician burnout. A doctor suffering from burnout has impaired judgment, which could lead to them relying on less accurate methods of assessing individuals such as through prejudices and biases. It’s also necessary to point out that doctors who are suffering from burnout tend to antagonize patients. When you’re looking to subconsciously antagonize someone, you automatically look for things that can make them seem less likable to you, even if you’re making them up in your head. So a doctor who has been working for too many hours for as long as he or she can remember might find it easier to accept a stereotype about a patient they just met, even though that’s not something they would ever do when in full mental health.

One of the ways we mentioned doctors may misjudge patients is due to their emotional problems. If you think a patient is too fragile, then the way you treat them won’t be the same. You may present bad news in a hurry or avoid returning their calls, which are all unethical things to do. The same goes for a patient who has poor insurance coverage. By realizing you may not get paid, you could provide suboptimal care for them. If you’re forming ideas based on race or gender, then you’re being completely unethical and racist, which are things no good doctor should judge for. In fact, no good doctor should judge at all. All these forms of judgment will influence your decision and almost always to the negative. You need to be aware of what you’re doing wrong and work on it.

We said that people create early judgments of others in order to protect themselves and create a general plan for how to deal with people, so why are we saying it’s really bad for doctors to do that? Well, because doctors aren’t there to protect themselves from patients or shield themselves. Doctors exist to help patients and you can’t help someone you already have a poor conception of. One of the key elements towards a patient improving and getting better is their relationship with their doctor. That relationship is entirely based on trust. Would you trust someone who you feel judges you? The answer is definitely not. Why would I tell you my sexual or drinking habits if I feel like you’re secretly judging me and creating a negative idea about me? No one likes to feel that way and by doing so, you’re alienating your patients. If they don’t switch doctors then you won’t be able to help them because you won’t know too much about them. Then of course there’s how these prejudices influence your decision. You see a patient has no or poor insurance and you think you probably won’t get paid. How do you react? You’ll probably give them less of your time, attention, and effort.

If a patient you’ve had for years can’t lose weight or quit smoking, you’ll form an idea that there’s no hope and that they don’t even care enough to help themselves, so you stop trying too. That’s the difference between a good doctor and a bad one. A good doctor doesn’t give up on a patient or think less of them. The only thing on their mind is how to get them to get better, regardless of appearance, financial situation, or attitude. If you’re visited by a patient who has spent time in prison, will you refuse to treat them? Legally you can, but why are you really refusing? It’s because you’re thinking they’re a terrible person and don’t deserve to be helped.

If one of your patients has exposed themselves as emotionally vulnerable, you could be reluctant to give them bad news. You shouldn’t though. It’s your duty to inform them even if you think they’ll end up crying for an hour and not leaving your office. You can’t tell someone else to tell them and you can’t deliver the news via email. It’s your job and legal obligation to do your best for your patients and having prejudices will only make your and their life worse.

Doctors have been through more years of education than everyone else. It’s a shame that some still hold onto their prejudices even after all these years. Let go of any misconceptions and stereotypes. Treat each individual case differently. Getting 6 patients with similar characteristics seeking narcotic prescriptions doesn’t mean that the 7^th person who walks into your office with these same features is also looking for the same thing. That 7^th patient could really be in pain and in need of your help. This is a perfect example of availability heuristic. You could end up causing him or her serious injury by assuming that just because there’s a resemblance between him/her and 6 of your previous patients then they must all be after the same thing.

Physicians are in a better situation to judge people than anyone else because they know everything about a patient. If someone’s doctors say that he’s lazy then they’re 99% right. That’s because doctors know people when they’re most vulnerable and learn everything about them. The mark of a good doctor is not to use that data to make judgments and assumptions, but to direct it in order to help the patient as much as possible. If you’re out there labeling each patient as cheap, lazy, fragile, or any other label then you’re wasting your time and the years of education you underwent have been for nothing. Sooner or later patients realize when they’re being judged because it shows in a conversation and in how the doctor deals with them. When that happens they’re going to go looking for another doctor who accepts them and tries to help them, regardless of their flaws.