practice partner
Dr . Jonathan Hellmann
“ As professionals we ’ re servants to the public good . The duty is to not abandon the patient ”
Unconscious bias Value judgments can manifest in ways large and small . Sometimes the patient isn ’ t even aware of how much their care is affected . Consider this scenario . Patient X has substance abuse issues . That ’ s a hot button for his doctor , who has seen three other patients like X already today and finds many of these appointments to be frustrating . Here ’ s the question . “ Are you giving the patient shorter shrift because of an unconscious bias ?” asks Dr . Jonathan Hellmann , a Medical Bioethics Associate at Toronto ’ s Hospital for Sick Children . “ We sometimes label patients . Maybe we don ’ t give them enough time or probe deeper . Or we stereotype – because you do this , you must do that . We may not see them as the complex person they are . It ’ s these subtle things ,” says Dr . Hellmann , a neonatologist and former clinical director of the hospital ’ s NICU . Doctors are encouraged to show empathy notwithstanding the patient ’ s situation or decisions . “ But as humans we ’ re often more empathetic with people who are like us , who strike a chord in our own selves ,” Dr . Hellmann adds . Sally Bean , an ethicist at Sunnybrook Health Sciences ’ Ethics Centre in Toronto , says value judgments can seep into patient files or discussions with colleagues . For instance , referring to someone as “ schizophrenic ” instead of as a person who happens to have schizophrenia , or calling someone simply “ a smoker ”. “ You ’ re defining them by one trait or behaviour ,” says Bean . One danger ? That tag can shape the perceptions of health-care providers , even on a subconscious level .
Mutual understanding When values differ , Dr . Gibson says it ’ s essential to anchor the conversation . “ It ’ s quite possible to sit down with someone who holds views completely different from your own and have a therapeutic relationship . That has more to do with listening to and understanding each other ,” she says . Dr . Hellmann gives the example of a parent who has chosen not to vaccinate his or her children . “ The first concern – how is this affecting their health ? Will there be non-compliance in other forms ? Give them as much information as possible , and also understand their reasoning ,” says Dr . Hellmann . His colleague Dr . Randi Zlotnik Shaul ( PhD ), director of the hospital ’ s Bioethics Department , says “ Sometimes you have pushback from clinicians – ‘ Don ’ t ask me to respect everything a family says because sometimes I don ’ t .’ But speaking in a photo : arash moallemi
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Dialogue Issue 1 , 2017