The Lies We Tell — Social Bias, Myths & Blind Spots in Medicine: Part 1
Back to Childhood
Part of growing out of innocence is realizing that not all things adults say are true. Take for instance the association of monsters or bad things that move around in the dark. I remember being told not to play outside at night because of monsters lurking in the dark. This made me afraid of the dark, of course, but one question still lingered in my mind about these night monsters: why would they harm a good kid like me? I also didn’t understand why adults went out at night. Were they not afraid of the monsters? I was soon to find out the truth — about the monsters and other things — that adults sometimes traded in lies and shades of truth.
One year after Bruno, my first puppy, died, I learned from my aunt that he was gone forever. He was not on vacation, like granny had said. This was devastating to my four-year-old self. But, the ungilded truth was pivotal in my transition to understanding the world of adults. Reflecting on my experience, it appears that some harsh realities are made milder when hidden within idioms and metaphors.
Although various reasons and motivations can be given for the various lies we tell, that is not what I want to discuss with you. I’m interested in the half-baked ideas that first become insidiously incorporated into our cognitive schemas as truths, and then, once disrobed in the light of examination, turn out to be naked lies. It is these sort of lies — which we implicitly imbibe from all sources: parents, teachers, society — that we must guard against.
I contend that some of these lies inevitably result in biases and blind spots when group opinions become ratified as facts and perspectives are endorsed as truths. Naturally, since the practice of medicine itself is a human endeavor, it tends to be wrought with all the biases and blind spots of its practitioners. On a larger scale, unquestioned medical half-truths — for instance, the daily mandate of eight glasses of water to stay hydrated — become established as facts in the social psyche. Yet, further inquiry reveals these to be nothing short of myths, devoid of any grain of truth.
The troubling thing, according to the research, is that no one is immune to this problem. It is well established that sometimes, our brains make things up by filling in the gaps. The brain takes shortcuts through what is termed as processing fluency; the end result is false memories.
Depending on our life exposures and experiences, as well as fibs we have absorbed from childhood, we make certain assumptions about the world. False memories and half-truths then morph into social biases and blind spots. But, before we explore how this seeps into the practice of medicine, let me tell you a story.
Finding Middle Ground
When I first arrived in California, a friendly Uber driver picked me up at SFO. After a few pleasantries, we got into the usual topics of small talk. She inquired about my flight and purpose of my trip. “Doing a fellowship at Stanford,” I explained. “Oh, you must be smart,” she responded and then followed with: “So, what kind of work will you be doing? Are you like a doctor or something?”
This segued into a conversation about my life story — moving to the States and my journey into medicine. After some silence, she said, “Your story is one reason I don’t get blacks in this country. They live in the greatest country on earth yet complain about how bad they have it. An immigrant like you comes here, works hard and becomes a doctor. I mean, just consider the facts.” Unclear about what she meant by the “facts,” I asked her to clarify.
She mentioned how she had worked her way out of poverty in Appalachia prior to moving to California, and, in her experience, most people who were poor were simply lazy. I noted that her perspective was a mix of confirmation bias wrapped up in prejudice and untested assumptions. From there, the conversation devolved into facts about crime rates, homelessness in SF, poor neighborhoods in East Palo Alto, et cetera. My usual inclination in such a scenario would have been to cite counter-facts, but I was too tired to argue.
I found it unusual, given my own preconceptions about the broad-mindedness of Californians, that she would hold those views. I implicitly understood what she was suggesting about the American Dream, that somehow, it is within everyone’s reach. All one needs to achieve it is hard work. But this is another half-truth that has permeated the social mind, which we will explore elsewhere.
Not one to shy away from difficult conversations, I asked about how she felt about the treatment of women in America. “Oh, it’s just horrible,” she said. Then, I conjectured: “If that is a fact, can we agree that treatment of minorities, is also horrible?” She initially protested: “I mean…but those are not the same….” Later, she admitted, “Well…yea, I guess.” This was our middle ground.
Disharmony of Beliefs vs. Actions
Thinking about this exchange several months later, I find it instructive on multiple fronts. For starters, it highlights our tendency to dissociate our reality from those of others, holding ours as the standard of truth. But this behavior can become a blind spot, preventing us from recognizing intersecting realities. Focusing solely on our experiences, we lie to ourselves, like my uber driver did, when we fail to recognize the suffering or injustices of other groups to which we do not belong. Also, just because something appears to be true in one’s life, does not mean that it is universally true.
Consider for example, the all-American declaration, that, all men are created equal. The very stated ideal does not reflect the lived realities of segments of the population, who for centuries and to the present day have lost and continue to lose their lives in ways that suggest they do not meet the country’s definition of personhood.
The same dissonance between stated ideals vs. actual practice also occurs in medicine. We declare a premium on value based care, yet our health systems are set up to be antithetical to the provision of this type of care. We profess Hippocratic ideals yet place physicians in work conditions that lead to harm and suicide. We assert belief in gender equity and diversity yet turn a blind eye to gender pay gaps and limited advancements for minorities.
While it’s great for medical institutions to have noble mission statements, when their actions do not reflect the lived experiences of employees, the statements become no more than a soothing balm, just like the tales parents tell kids to calm their fears. Such a situation is dangerous because we lose any sense of urgency to reconcile the dissonance. Horrible things become normalized when our actions do not align with our declared beliefs, whether individually or institutionally.
From an individual perspective, the toughest lies to shake off are the ones we tell ourselves. These examples should be illustrative: Post-call, we know we’re too tired to drive but tell our peers, “It’s ok really.” Or, when asked how things are going, we say, “I’m fine,” when truthfully, we are depressed. We take work home, telling our spouse, “Oh, just 20 minutes and I’ll be done,” but in reality do not finish until midnight. Or, we don’t go on a needed vacation because, well, “my patients need me,” but in reality we feel burned out.
These may all seem innocuous, but we become what we practice. If we cannot be honest with ourselves first, how then can we navigate the blurred lines between perspective vs. truth, and opinions vs. facts? How would we reconcile the disharmony between stated ideals vs. the realities, which often arise in the imperfect science and art of medicine?
Truth Deficits
On a related note, I’ve observed a common phenomenon in my role as a mentor to several premed advisees. In talking to students about their pursuit of medicine, it’s become apparent that many are pursuing the profession with some truth deficits. One is the presumption that liking the idea of medicine is enough to get one through the rigors of training. Another is that acing tests, with some sprinkling of research and publications, is what it takes to reach the promised destination. Many have no inkling of the long, hard road ahead. But where do students learn these mistaken notions?
Probing further, some answers begin to emerge.
As soon as they transition from high school, premeds quickly discover how to check off all the right boxes in college: take the prerequisite courses, do some volunteering, lead some campus groups, and ace the medical college admissions test. The risk of such a formulaic endeavor is the construction of a cathedral built from the pillars of academic accomplishments, without a true foundation of purpose. This is further compounded by missed opportunities to explore profound questions: What does it mean to live a good life? How do I find my life’s purpose? What do I want out of life? Do I pursue something because I’m good at it, even if I don’t love it, or do I pursue only those things I love?
I certainly do not expect students to have answers to all these tough questions — I’m still wrestling with these myself — but exploring these issues early is an important first step to limiting self-deception and perhaps, finding the right reasons to enter medicine.
In addition to the above, lack of transparency within the medical profession leads to so much misinformation it is no surprise few know what they’ve signed up for once they decide on this path.
Until recently, many physicians suffered in silence. It was the rare occasion to read about the real day-to-day financial, administrative, legal, economic, and psychological struggles of doctors juxtaposed with the much acclaimed joys of training and eventual clinical practice. In an era of data overflow, we need to debunk myths and misconceptions about medicine by sharing our real stories with each other and with those looking to follow in our footsteps. It is also a way to keep the lies we tell at bay by increasing access to accurate information. This is how we begin to eliminate truth deficits.
How does this inform what I tell my students contemplating medicine as a career path? I tell them about the triumphs and failures of my own extensive journey: 4 years of college; 2 years of grad school; 5 years of medical school, which includes 1 extra for research and ethics; 4 years for residency, and 2 for fellowship. I also share this advice: don’t rush into medicine; take a gap year or two, if possible. Get to know yourself — find out what lifts up your spirit, what moves and inspires you, and above all, what grounds you. Take the time to appreciate the complexity of your own personhood.
Reclaiming Lost Innocence
As for the general community, what do we do about our lost innocence? How can we safeguard against the intrusion of social biases and half-truths in our roles as physicians?
We can start with self-honesty. This might mean reflecting back to our own childhood and considering what influences have shaped the views we’ve come to hold as adults. Performing this introspective exercise may open a window into self exploration and understanding of our own biases and prejudices. What practical steps can you take today to begin to address these issues? Here are some proven strategies:
- Get out of your social bubble; engage with others who might think differently from you.
- Be flexible and give yourself permission to change your opinions.
- Take an ethics course to learn about your own social biases and blind spots, and how to wrestle with complex cases.
- Get involved with social justice causes and initiatives; seek points of intersection where your empirical understandings of the world overlap with those of others.
- Distill opinions from facts; learn to question foregone conclusions.
- Hold your institutions accountable to their mission statements.
- Reconcile the dissonance between your stated beliefs versus actions.
Whether you’re just beginning your ascent or are already halfway up the mountain that is medicine, this is how you unburden your load. Get rid of the myths and half-truths and reclaim your lost innocence. As for me, while I’m no longer afraid of the dark — or its monsters — I’ve come to appreciate discovering the hidden meaning of things and searching for my own blind spots.
Charles A. Odonkor, MD began his love affair with medicine at Yale and is now a fellow at Stanford. He enjoys traveling, cooking and spending quality time with his wife. He is a Doximity Scholar and tweets@kcodonkorGH
