If you haven't been on the receiving end of health bias before, then consider yourself lucky. Taking care of your health by going to the gym or visiting a doctor is not a place where you would expect to encounter bias. But surprisingly, more and more stories and statistics are coming out that show how rampant it is becoming. Read below to learn more about health bias, statistics and stories on its presence in society today, and things you can do today to help reduce or prevent it from happening to anyone else.
What is health bias?
Bias in itself is by definition, " a personal and sometimes unreasoned judgment." In health and wellness, such bias can come in many forms such as the exclusion of women from certain exercises or healthcare providers assuming that overweight people or women are faking or dramatizing symptoms when going to the doctor, for example. This type of bias is harmful because it can make people who are targets of such bias not want to seek health supportive services. In turn, this places such people at higher risk for chronic diseases and illness over time.
Statistics on health bias
A recent study shows that over 56-percent of women report being harassed when going to the gym as compared to 21-percent of men. And only less than 10-percent of such comments, unwanted advances, or ogling were reported. This may be because being the one encountering bias from someone else can be embarrassing and humiliating to a point where you want to pretend it didn't happen. It's not clear for what reason these women were targets of bias (weight, race, gender, etc.), but regardless of the reason, there is no good reason to harass anyone.
When it comes to healthcare bias, research shows that healthcare providers carry similar implicit bias as non-healthcare providers. Implicit bias is a type of bias in which a person is unaware of their unconscious bias about a certain person or group of people. Explicit bias, on the other hand, is bias in which a person is completely aware of their evaluation of a group of people, and feels that their evaluation is accurate.
A 2020 study shows that 21-percent of people who took a survey had an experience of bias in the health care system. And surprisingly, about 72-percent of those people had more than one experience of bias. Bias in healthcare can come in the form of gender bias, weight bias, and racial bias, to name a few. A study of weight bias reveals that some healthcare providers felt that overweight patients were "annoying" and they had less desire to help them versus thinner patients.
Stories of health bias
Over the past two or three years, I have been trying to find a diagnosis and cause for the masses on my pancreas and thyroid. And during that time, I have come to understand bias in the health sector personally and know how demeaning it can be. Before my symptoms started in the fall of 2017, I was what society would call a "healthy" young woman who had a thin, fit build and took vacations wherever there was a recreational running race I could compete in.
My doctors' appointments were uneventful and quick, and when the overweight patients in my job as a dietitian would tell me how fearful they were about going to see a doctor, I didn't understand.
As my symptoms progressed over 2018, and I gained nearly 30 pounds over a year and a half, I was soon in the body mass index "overweight" category. I counted calories fervently and took 2–3-mile walks during my lunch break. I didn't know why I was gaining weight and wanted to know what was going on with my body.
By the summer of 2018, I had a diagnosis of multinodular thyroid goiter, but the first endocrinologist I went to told me that my thyroid levels were normal and that the thyroid has nothing to do with weight gain. I would later find out from another doctor that the thyroid could most certainly impact weight.
Fast forward to the spring of 2019, I received a diagnosis of a mass on my pancreas. What would be a scary moment in anyone's life would turn out to trigger a series of events that would cause more pain mentally than I could imagine.
For one thing, the pancreas mass was misdiagnosed by my pancreas team and cancer center as an accessory spleen or tissue from the spleen that mimics a tumor. During that year and a half of misdiagnosis, I went to doctors to ask for labs to help figure out why I had chronic fatigue, muscle weakness, insomnia, and multiple gut health issues. They would look at my records and say things along the lines of:
"Well, the mass on your pancreas is no big deal, so that's not causing any symptoms."
"I have this colleague who is a functional medicine doctor that helps people like you."
(aka weight loss doctor)
"Take this prescription for a diet pill."
"Some of my patients have felt better after cutting out dairy."
"I can put together a calorie count for you."
(says the doctor to the dietitian who calculates nutrient needs for a living)
If this wasn't bad enough, after six or seven consultations with oncologists and endocrinologists, I had a gynecologist ask me, while I was in straddles, "What is your go-to food." As if this was even remotely relevant to the annual visit I was there for.
And to put the icing on the cake of my 2019-2020 experiences, I requested medical summaries from all my doctors up to that point. One of my appointments after the mass diagnosis, at an oncology center, involved one doctor telling me he would order a specialized imaging test that my doctor requested. But after meeting with me for about two minutes, he said that since his colleague was positive the mass was an accessory spleen, he wouldn’t order the test.
Instead, as I started tearing up from frustration, the doctor told me that I should see a functional medicine friend of his. Then his colleague proceeds to tell me I should be happy I wasn't "riddled with cancer" and that he could prescribe thyroid medicine, but since that wasn't his specialty, he couldn't guarantee it would help me.
Needless to say, I was visibly upset during this appointment due to utter humiliation and since I was frustrated that yet another doctor didn't want to help me figure out what was going on. When I read the note from this appointment after the fact, I saw that the doctor said that I was "overemotional" and “became upset when told she didn't have cancer,” which was not even close to how I was feeling. I was a patient with a history of disordered eating and body image issues who has a tumor on her pancreas but was just told to go see a weight loss doctor and I would feel better. I was furious.
I tried twice to get the note revised, but the doctor refused to admit wrongdoing and wouldn't change it. Unfortunately, before I had my primary care doctor remove that note from my medical history forms, two endocrinologists I had a consult with read that note. So, immediately after reading it, they pretty much left me with little more than diet advice and an offer to prescribe a diet pill if I wanted it.
From these experiences, I now develop physical symptoms like nausea, increased heart rate, and abdominal distress whenever I am waiting to go in for a doctor's appointment. The therapist I started going to upon diagnosis of my pancreas mass told me that this series of short-term traumas has led to a long-term trauma response similar to PTSD (post-traumatic stress disorder). I now understand what my overweight patients were saying when they said they were fearful of going to the doctor.
Five things you can do to help prevent or reduce health bias
Health bias can not only harm the mind but can also harm the body when someone delays care to avoid bias encounters. Bias in the healthcare system and in the health and wellness world is not something that is going to go away overnight or easily for that matter. However, read the tips below to find out how you can start changing the way you think so you can teach others how to reduce health bias in their mind.
Avoid stereotyping people: Not everyone is the same, even if they look similar. But sometimes one can develop stereotypes about certain groups of people based on certain traits. Such stereotypes may include that overweight people are lazy or unmotivated, or that women are dramatic or emotional, for example. To limit such stereotypes from creating bias, it's important to see each person as just that, a person, just like you and me. By seeing someone as an individual instead of as a trait, then you can learn to understand them better.
Follow facts, not opinions: If you start seeing others with similar opinions as yours enough, you start to think they are facts. However, these opinions are not always true depictions of people or situations. It's vital to make sure that you have all the facts before you try to provide advice or "helpful" hints to another person.
Listen to others’ stories to find out about them and their experiences: One way to avoid bias is to learn more about a person's story. Start to see someone as a person instead of just a number on the scale or a skin color, for example. Learn about their journey, and then you can hopefully start to realize that most humans are alike in the way that we just want to experience love and acceptance in this world and want to feel heard.
Put yourself in someone else's shoes: If you try to imagine how you would feel if you had to live in someone else's experiences, then perhaps you can start to realize how unhelpful superficial advice and judgments are. For example, telling someone who is overweight to just "move more" or "eat less" is assuming that you know the habits of this person. In my experience, my patients who were larger were already doing these things but had hormonal imbalances that were preventing them from losing weight. Since there are so many possible causes of obesity, it's ridiculous to think that such generic advice applies to everyone who is overweight. Not to mention how hurtful it is to hear such advice.
Try not to follow instinct, and instead try to have sympathy: Sometimes bias is so ingrained in your brain that you work on instinct when making judgments or giving advice to people you think need it. To reduce bias, work hard to not do what you would normally do. Work against instinct and try to see each person as an individual person. If that person is struggling, listen instead of assuming, and try to have sympathy instead of letting your bias cloud your perspective. For example, if you meet an overweight person as a healthcare provider or trainer, instead of automatically providing advice on eating less, instead ask the person about what their daily eating and moving routine looks like. Then provide advice as needed based on what you hear. Not all people will be completely honest, but it's even worse to assume the person doesn't know how to be healthy.
How to move forward with health bias
Health bias is more common than one would like to believe. We want to believe that everyone is treated fairly, especially at the doctor's office. But from personal and professional experience, I know this is not true. And there are multiple upon multiple studies and stories to confirm this is not true. You may not be able to change others' biases, but you can change yours and in turn teach others how to overcome theirs. Let’s work together to normalize unbiased behavior.
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