Welcome to Lessons in Veteran Centered Care. This is Unit Two, Segment Three. We're gonna focus on both systemic causes of health care disparities, both within the health care system itself, but also how that impacts individual, and the implication for health care providers as individuals. So when we think about systems, attributes associated with health care disparities, there's the health care system in terms of location, but there's also the impact that providers have on disparities. And those can be in issues around stereotyping or issues around bias. One simple way to think about bias, especially as we think about the difference between physicians and veterans, is just to look at a comparison of who comes to the healthcare encounter in terms of the physicians, and what type of exposures and professions they have. And then when you think about veterans, and you see from this slide that actually veterans, the population is actually quite more diverse, it starts to mirror the US population in general. Their professions go across the spectrum, whereas physicians are very specifically highly trained professionals with not as much diversity within their ranks. And this is true, you can follow it out across all healthcare professionals in terms of race and ethnicity, in addition to other occupational and managerial ascertainment. So when we think about healthcare providers, healthcare providers have a potential to both consciously and unconsciously treat certain patients different. It's one of the things we talk about in terms of stereotyping, implicit bias, and what those contributions might be to healthcare disparities. Stereotyping, if we look at the definition, is really about a general understanding of social groups or concepts. It allows our brain to organize very complex issues and it guides expectations and it shapes our personal interactions, specifically when we're talking about people, but also when we are thinking about general concepts. When we think about provider bias, that definition is regarding the unconscious and conscious disparate treatment that's delivered to different patient population across a wide variety of situations. So one of the things that helps us really explore what our implicit bias is, that is what might be unconscious, is the concept the implicit assessment association test. We'll hear a little bit about what that is. We will hear a little bit about how you might think about both your conscious and unconscious biases, which we all have, I have myself, and what those impacts may be on healthcare. Another interesting way to think about that is there's a case for diversity, that actually diversity leads us to thinking more broadly. It allows more resources to go into developing complex problems. And this video from Google really helps to elucidate some of those concepts around why you wanna think about your unconscious biases, and also what diversity brings to the table when trying to solve problems. >> What would the world look like if everybody were aware of the stereotypes that they have, and the biases that they have? When we talk about unconscious bias, we're basically saying our worldview can actually exert an influence beyond our conscious awareness. And it creates ambiguity. >> You go to an engineer who has built something extremely innovative, and you say who do you think your user is? This is where I have the most fun. My name is Stevie Rahman and I led the work on Android accessibility for three years. Right now, everything that you think you know about your user with respect to abilities, inabilities, special abilities, disabilities, almost every assumption that you write down on that white board about this is the user I think I'm building for is questionable. Because our various unconscious biases define the boundaries you are unwilling to expand. >> These biases, they are the shortcuts that our brain is created so that we can deal with the information that we process every single day. >> Right when we see anyone, whether we think about it or not, we are implicitly automatically making judgements about how warm and competent that person or thing is. >> All humans need to make decisions, and so we fill in the blanks, because our brains are wired to do that. And we fill in with things we don't know, with past experience. Oh, you pattern map to someone I think I should hire, so I'm gonna hire you versus this person cuz they didn't map, cuz I can't fill in the blank, cuz they don't look like me. Or they're not from my same background so I can't see how they're gonna the jump. >> Every single person is great at things that you may not expect them to be. But it's really hard for us to see that when we're so powerfully guided by the things we expect to be true in the world. >> I grew up surrounded with this conversation about what you can't do, and what you won't be able to do. My name's Enrico, and I'm an autistic software engineer. The first time I go through the performance review process, I was asked for five struts. It was the first time that I had ever been prompted to think in that way about myself, and it was a really life-changing moment for me. >> When we are working in our day to day jobs, we are still making judgements about the people around us. About the resumes we see, about the employees we're trying to decide whether to put them on teams or not. >> People are very wedded to the idea that they can perceive something objectively, and statistically they're wrong. But it's hard. You become attached to this idea that you can assess something by looking at it. >> These subtle assumptions we make about people can have lasting effects on who we're promoting, who we're hiring, who we're putting in leadership positions. We have the responsibility to understand the assumptions that we make, and understand the errors that we make. >> But it's not just for the collective good. If you take the time to understand more about this, there are things that you can implement for yourself that will help you develop as a leader and to do your job even better. >> It made me realize how often I have a very strong belief that is simply incorrect. When I look at one of these evaluation situations, the first question is, how can I eliminate the sources of potential bias and leave just the data so we can actually make better decisions? >> If you're not conscious of the biases that you have, you're just not contributing at the level that you could, and you're not innovating at the level you could, and so your products won't be as good, your results won't be as good. >> When you think outside the box with respect to the assumptions you made about how somebody would use this wonderful thing you've built, and then you sort of broaden that perspective as to who you're tailoring the work for, you build something even bigger. >> So when we specifically talk about provider bias towards patient, there's a prevalent structure among doctors, and that's where a lot of the literature is, about what bias it might bring to the encounter. And so one of the questions that positions might consciously or unconsciously think about is our patients are uninsured or underinsured. What is really the cause of the underlying ideology of the illness or injury? Are there certain skin color languages, style, or dress that might predispose you to think one way about a diagnosis? And do you have suspicious thoughts about treatment, or other reasons for patients to engage in the health care environment, these are all things that might shift the needle about what you might think about in terms of a diagnosis in the treatment options for patients. One way to combat that is to really think about and use a model for asset based community development, but it also can be used for asset based care. And, this asset based community development model thinks about focusing on the positive capabilities and strengths, as opposed to thinking about the deficit model, which is about negative terms and ignore the social network and social fabric that people bring to the encounter. One way to think about that in terms of a patient health assets is to think about what psychosocial background they have. What kind of social networks do they use? What wisdom do they have in their community? One of my favorite questions is, how can you as a patient help me as the physician in this case, but it might be a nurse, pharmacist, dentist. How can you help me understand better about what might be going on is a good way to understand what the patient brings to the encounter. If we think about the model of veterans, as opposed to thinking about a deficit model where they're the walking wounded, one way to think about veterans is the assets they bring to any encounter, they have a discipline approach to work. They know how to work in team. They have an attitude to keep moving forward. They have clear leadership skills because these are all the things that are instilled with them as the members of our armed forces here in the United States. It is those things that will actually help you. Once you elucidate them from their patient, bring that skill set to how you can actually help them improve their health status or deal with a current illness that they might be experiencing. One video here is to show you how what we might think as a deficit can really be an asset if you think about it in a broader spectrum. So some of the questions that you might ask a patient are things like what are you most proud of? What resources are available to you in your community and social circles that help us achieve the outcome, be it blood pressure, blood sugar, be it successful rehabilitation post surgery? And do you know anybody similar to you that's managed a similar condition successfully, and so you can tap into that level and expertise. So one of the things we wanna think about is which of the following are strategies are used to identify health disparities in the medical interview? Do you wanna ask patients about their political views, ask patients about the their present illness and social history? Talk to patients about their educational background, or address the patient's ability to understand medicine, and the medical practices. So I hope in unit two we've exposed you to thinking a little bit about personal and provider based biases. We've thought to expose you to what the concepts are about asset based questioning and bringing assets to the clinical encounter. And we want you to really think about what the system might be, what the implications of the systems are on the social determinants of health. So if we think about the end of Unit Two, we want you to engage in a discussion focusing on the impact of the social determinates, particularly for the veterans. So looking at this photograph of Mister Roberts, how might his experience impact how he seeks for mental care issues? Thank you, and you will have several opportunities to engage with each other.
