2024 15th Annual NUBE Conference

Daniel Kahneman’s Nobel prize winning research, on behavioral economics, established how humans often make snap decision that often defy logic. Physicians are no different. Emergency physicians are, in fact, more likely to use “fast thinking” compared to other physicians. This is in part due to needing to make quick decisions based off a triage model on a large volume of patients. However, this can create a bias in how we diagnosis and treat patients.

Bias can occur through implicit bias or subconscious perceptions. These often include unconscious feelings about something one cannot control like race, gender, and weight. Microaggressions are often subconscious buy can also be conscious and often reflect biases in the form of words and gestures. Emergency psychiatry has its own form of microaggressions by using words like “boarder,” “borderline,” and “frequent flyer.” Although these terms might help the physician segment medicine’s harsh realities, it paints the patient in a negative light, leading to poorer quality of care. This presentation will look at things like implicit bias and microaggressions that can occur during an interview by utilizing research from both the diversity, equity, and inclusion (DEI) and psychiatry fields.

However bias is not always subconscious. Chart checking is an invaluable tool that can inform decision making based on past events. When one relies to much on past history rather than current presentation, this can lead to bad outcomes for our patients. Unfortunately, one may never know when a potential negative event occurs in the emergency department since it will occur out of sight and hence a confirmation bias occurs.

The psychiatric interview is a unique skill that goes beyond the traditional subjective, objective, assessment, plan (SOAP) note. During training we teach students, residents, and fellows the art of the psychiatric interview but often do not reassess our own interviewing skills. However, since the interview is highly subjective itself, it leads to more bias compared to other components of medicine. How does one retrain oneself to the level of naivety of first year medical students, while still retaining the knowledge of a season attending?

This presentation will begin by providing a brief overview of the history of bias in medicine with more of a focus on psychiatry and basic DEI principles. Next the speakers will share real life examples of when medicine have failed in emergency psychiatry due to an overreliance on chart checking. The speakers will also discuss their own personal mental health journeys where bias has come into play in their treatment. Finally, it will conclude with how one can look at the art of interviewing and try to remove bias as much as possible by providing real world clinical skills.

Learning Objectives:

Define implicit bias and microaggression.

Understand how mircoagressions and other forms of bias are used in everyday settings including mental health.

Utilize interviewing skills to help eliminate common points of bias during clinical interviews.