reflections of a victim of unconscious bias

A few weeks ago, a primary care physician colleague (white man)—who I’ve known for over a decade—sent me the note below by way of our mutual patient’s caregiver (white man) open, not in a secured envelope.  In the past nearly 4 years the patient has been under my care, the colleague has not once reached out to me by email, phone, text, tweet, telegraph, or carrier pigeon regarding our patient.

 

He did, however, reach out to my boss (white man) and a hospital executive (white man) a few months ago when the caregiver (reminder, white man) first complained no one in the dialysis unit was listening to him (though the caregiver has never spoken to me directly about his concerns because, I just learned, he found me “intimidating”).

the meaninglessness of an eye flitter

A couple of weeks ago, I was the attending nephrologist for our hospital consultation service when I met Mr. Jones. He had suffered a severe heart attack. His heart was stunned into stillness and couldn’t effectively pump oxygen-filled blood to his kidneys or any of his other parts for the however many minutes it took for the ambulance to get to him and start resuscitation. Once he was transferred to the hospital, the cardiologists successfully reopened the major coronary artery responsible for the attack, but his kidneys weren’t working as well as they had been before. But his kidneys were the least of his troubles. My interaction with his family reminded me of an experience in my own life from about twenty years prior.

,

irrelevant words matter

,

It was Friday afternoon and the last patient of the clinic day had arrived. A new patient to me. While the medical assistant asked her screening questions (Do you smoke cigarettes? Do you have pain? Have you fallen recently?) and checked his vitals (blood pressure, heart rate, weight), I started to get to know him through his medical record. I began with the clinic referral to find out why he was in my clinic in the first place. Would I be figuring out why he had an electrolyte problem (like low potassium levels) or thousands of grams of protein in his urine (when normal is less than 30 milligrams)? Or would I find the usual, a case of irreversible kidney damage caused by high blood pressure and/or diabetes? The first line read: 70 year-old formerly incarcerated man with recent hospital admission for…

the ethics of the right care

Julie* was 22 years old, but she looked like a frail frightened 13 year old curled up in the hospital bed. She spoke like a petulant one.

 

“I don’t want to be here! I want to go hang out with my friends!” she yelled when I asked her what she wanted for her care. I was in her hospital room as a representative from the Ethics Committee, my goal to help relieve the conflict between her and the team of doctors trying to take care of her.