Bias In Medicine: Last Week Tonight with John Oliver (HBO)

doctors rated number one by reasons there's a finger in your ass magazine doctors have held a position of high esteem in our society for generations as you can see in the 1930s film men of Medicine in every US city and town there is one house that everybody knows the doctors available here are the services of the man who by law is privileged to practice the most respected of all professions yes only doctors have the privilege of shoving a stick into a child's mouth and diagnosing addition that we in the 1930s know as gross throat the cure for it is drowning but but what medicine may be the most respected of all professions it is important to know that not everyone has the same experience when they visit a doctor I think I would have been treated completely differently if I had been male you'll hear doctors and nurses like oh they're just exaggerating you know and not really listening to them because it's a black person but it's just like a white person it's just like oh my god like this is serious it's true if you are a woman and or a person of color in the US you may well have a very different relationship to our healthcare system than a white man so frankly who better to talk at you for 20 minutes about this than me the fright of white men I'll get a sunburn watching the Travel Channel I'm a walking cider doughnuts pail filled with cake and found at every farmer's market in the Northeast but this is a discussion that we need to have because what the vast majority of doctors are doing hard work with sometimes limited resources bias in medicine is a serious issue and while it's not the only factor in determining health outcomes it can have a massive effect so tonight let's talk about bias in medicine in two specific areas first sex and then race and in the words of every therapist I've ever had let's start with sex historically women's bodies have always been fought with judgments and misconceptions no it's not a good idea the first two or three days of your period you might get children test cold Oh try Peggy of course I can't go swimming you know I've got the curse she's got the curse she can't swim she'll sink it's true in the 50's women refer to their period as the curse but that's not all breasts were the haunted mountains butts worth the valley of doom pregnancy was the happening and giving birth was called the babadook it was a very very scary time to be a woman and look things have clearly improved since then but women can still face an uphill battle to get quality health care there are many many studies showing this for instance they found that women were less likely to be referred for knee replacements than men if they're over 50 and critically ill they were less likely to receive life-saving interventions and when going to the ER with urgent abdominal pain women were less likely to receive any pain medicine just listen to one doctor sum up how too many in her profession treat female patients I think that a lot of times women's symptoms especially pain are attributed to emotional imbalance or you know women being hysterical or crying wolf about their pain and that's absolutely wrong yeah of course it is the only time it's understandable for a doctor not to hear a woman's complaints about pain is if she's calling into the office and she's got a TMT because the course keep dropping out boom business I'm airing my dirty diapers in public again oh boy maintenance we look well some of this may have to do with implicit bias on doctors parts there was also a systemic problem here where doctors may literally know less about women's bodies because historically medicine has studied men's bodies which here means those assigned male at birth as a proxy for all bodies and as one researcher who study this will tell you the reason for that was incredibly dumb there's this assumption that you are me with pesky hormones oh it's pesky hormones the idea is that the fundamental things that are similar between you and me so that ironically the best way to study you is to study me because when you don't have pesky farmers right we're studying all the fundamental things in you without this sort of nuisance stuff yeah women are full of nuisance stuff which is why medicine has long chosen to believe that women are just hormonal men or so children are tiny men dogs are furry men trees a big hard still men but and then who can fly fish a men who can glub and volcanoes a man who for some reason ejaculate larvae and this idea that women are just men with pesky hormones has led to some woman shaped blind spots in medicine for decades women were basically excluded from medical research trials in part because of a concern that their menstrual cycles would complicate the results which you would think would be all the more reason to include them in tests because women are half the population and can respond to treatment or drugs very differently and in some cases their exclusion was utterly ridiculous as this news report from the 90s shows in 1990 the Journal of the National Cancer Institute published this report which looked at the impact of diet on estrogen metabolism and it's links to cancer of the breast and uterus all of the subjects were men it's true they studied a way to prevent cancer of the uterus on people who did not have one that's ridiculously unhelpful it's like studying healthy conflict resolution and only surveying the Real Housewives of New York they resolved no conflicts LuAnn still pissed off about two rindas fishroom remoteness turned up uninvited at Barbara's clambake and Tinsley's furious because they all laughed at the fact that she froze her dead dog the group's dynamic is still a mess and the shows all the better for it and and when you have the male body as the defaults reference and doctors who might not take women's pain seriously the consequences can be deadly take heart attacks you're conditioned to think of them looking like they do on TV all the time you know people grabbing their chest and then falling over but for many women that is not what they look like instead their heart attacks present with subtler symptoms like pain in the back or jaw nausea and unusual fatigue and lots of doctors miss that just look what happened to Katherine Leon who went to the ER with serious heart problems and was told this the young doctor came in very condescending thought I was just a drama queen and he said it's not my job to tell you what's wrong with you it's my job to tell you what it's not and it's not your heart and that was it I was like well what do I do next and he's like you go home Wow that doctor managed to find literally the only time that telling someone to go home is bad advice because having a bad day at work just go home and a party stuck next to a girl who wants to talk about Bitcoin go home you're on second and your body grounds a single into left field the outfielder picks it up and throws to first is around third but you realize he's overthrown go home go home go home now but Kathryn Leon was having a heart attack she should not have been sent home when she's by no means alone one study found that women who came to the hospital with heart attack symptoms were seven times more likely than men to be misdiagnosed and sent home from the hospital which is terrible the only thing a woman should be seven times more likely to do is recognize those Real Housewives references from earlier and you know what even that is not remotely okay that show is both a nuanced and searing portrayal of wealth power and loneliness in Manhattan or universal themes that should transcend whatever superficial boxes in which is currently confined it it's our much ado about nothing an Andy Cohen is our Shakespeare but that's not the point it's a very good point in fact it's an excellent point but it's not the point we're making here which is sex and gender bias can clearly distort medical outcomes but they are not the only forms of bias that can do that and now if I may quote the inside of Donald Trump's head when energy at one of this rally seems to be flagging let's get to the racism stuff because there is a huge disparity in life expectancy between black and white Americans particularly for black men in fact when one study tried to quantify what is called the mortality gap they found some shocking numbers which this documentary chose to illustrate in the most jarring possible way we found over 83,000 excess deaths per year in the african-american community alone 83,000 excess deaths each year that's the equivalent of a major airliner filled with black passengers falling out of the sky every single day every year okay that's such a weirdly specific way to put that you don't need to take a number that's already a disaster and put it in terms of another disaster 83,000 excess deaths is like four double-decker buses driving into each other every six hours it's 32 hot air balloons exploding every minute for a week it's the death of Princess Diana eighty-three thousand times okay I get it it's pretty bad I get it now know clearly clearly there are systemic factors contributing to that number but even just when it comes to contact with the health care system there can be appalling disparities there are again many studies showing african-americans have a lower likelihood of receiving recommended care for everything from pneumonia to hip fractures to multiple cancers and what there's no one cause for these disparities it certainly doesn't help that as a study of med students and doctors found just three years ago misinformation about african-american patients is rampant the study found some doctors believed there are biological differences between the two races for example 25 percent of doctor residents thought blacks have thicker skin holy ships you do not expect to hear that at a medical school you barely expect to hear it yelled across a table by a racist grandfather at Thanksgiving what are you talking about grandpa his skin isn't thicker than yours and even if it were that is not why you didn't vote for him that is not the only insane belief that that study found 14 percent of second-year med students agreed that black people's nerve endings are less sensitive than whites which they obviously aren't and 70 percent believe that black people's blood coagulates more quickly than whites which it obviously doesn't and at that point I wouldn't be surprised to learn 86 percent of them believe that Irish juice is green on holidays not not even just some Patrick's Day all holidays even Yom Kippur that's the worst time to ejaculate now now it is impossible to say exactly where they came by those beliefs but medical textbooks are not immune from bias this nursing textbook was available until just two years ago when it was pulled after it emerged that it featured statements like and I quote Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter Heaven African Americans believe suffering and pain are inevitable and Native Americans may pick a sacred number when asked to write pain on a numerical pain scale and you expect that a textbook might have typos or outdated information you do not expect it to basically say Hispanics think God is kinky and Native Americans will tell you wizard numbers and misconceptions like those can have tangible effects on treatment just think about it if a quarter of all medical residents think that black people have thicker skin and nurses have been told that they think suffering is inevitable that might lead to black patients pain being treated differently which happens and I actually think that Wanda Sykes some days are best because of racism black people we don't even get our hands on opioids they don't even give them to us white people get open yours like they did tax it amazes me how many open yours you have a double mastectomy you know what they said my blood is always frozen okay okay first from now on advil should absolutely call itself I hope you protein that is non-negotiable gut has to happen the second that's by no means unusual one recent analysis found that black patients were 34 percent less likely to be prescribed opioids for pain than white patients with similar conditions and while there are a lot of good reasons to prescribe fewer opioids my patients are black is just not one of them and the danger is if you consistently have bad experiences with healthcare you might be less inclined to seek help that you need in the future just listen to this woman who was diagnosed with lupus described how she was impacted by the response from doctors when she sought pain treatment it was just this belief that I was making things up that what I was saying wasn't real that I must be seeking drugs or selling the drugs or some such thing is that really what people would that's that's what you were getting absolutely absolutely and so what happens is you start to develop a ton of fear around going to the doctor yeah of course she'd be frightened to come to the doctor if you thought they treat you like a drug dealer I'm terrified of them and the worst thing doctors ever say to me is mr. Oliver you're 42 and you should no longer need to be bribed with a lollipop to get a flu shot but I want one I wonder what we pop I've been very brave give me a war we pack no I'm not that all doctors are racist or sexist because they obviously aren't but people have biases and doctors are people and they may have come up in a system that intentionally or not as often discounted the experiences of a major portion of the population and their biases explicit or implicit have life or death consequences and there's perhaps no stark expression of where sex and race can negatively impact healthcare outcomes than maternal mortality currently the United States has the highest rate of maternal mortality in the developed world which is already terrible but it gets even worse for black women you're a woman of color in this country especially if you're black your odds of dying in childbirth are three to four times higher on average in our country why cuz you're not talking about access to health care you're not talking about money or education no and this is gonna be hard to hear we believe black women less when they express concerns about the symptoms they're having particularly around pain yeah and that is hard to hear but it is worth really underscoring what he just said there these racial disparities exist even when you control for socio-economic factors like education or insurance status we are literally disbelieving black women to death and that is appalling enough in theory but it's heartbreaking in practice take Kyra Johnson who gave birth to a son only for things to go horribly wrong her husband said that she waited hours for a CT scan and by the time doctors took the situation seriously it was too late she died in surgery and to this day her husband wonders what he could have done differently I said oh wait at nights thinking man like maybe I should have grabbed somebody by their collar right maybe I should have turned the table over right would that have made a difference I definitely thought about the whole issue of I didn't want to be seen not only as angry but angry black man right I'm not the smallest guy in the world and what that would mean and how we would be perceived and how he would be treated as a result of that perception when this first happened I would get the question a lot what do you think it was because she was black you think would be different if cura was white it was different color and the way I answer that question is the simple fact that you have to ask that question is a problem yes it's a huge problem because that's absolutely devastating a woman no one would listen to and a man who feared that if he spoke up he'd be judged for the color of his skin look I don't think anyone in their right mind would be comfortable with the idea of someone getting worse medical care because of their race or sex so given that we all agree off that what can be done here well ideally no we'd simply figure out a way for no one to ever get sick again thus making trips to the doctor an embarrassment of the past you know like VCRs or MTV giving out something called the Michael Jackson video Vanguard Award hold on 2019 they're still doing that is that a difference Michael Jackson it must be right why track missing Elliot into this but but but there are also concrete measures that the medical community can take here standardizing care is a good first step since 2006 California has cut its rate of women dying in childbirth by more than half in part by instituting protocols for maternal care some hospitals there now do things like quantifying blood loss after birth by gathering the sponges and pads and weighing them on a scale that way the doctors potential biases are removed from the equation because if a patient is bleeding too much the scale will say so but that is just one example to address one very specific problem clearly we need to think much bigger here and I know I am just not the best vehicle for this message what we really need is someone who can speak with authority from real experiencing here and luckily I know just the person please welcome Wanda Sykes Wanda wrong one day I'm so glad I'm so I'm so so glad that you're here bet you are yeah it's just cuz I was a bit worried that I might be a bit too white to give advice on this subject well that's because you are oh yeah your real wife yeah I bet you clap on the one and the three don't you I obviously wouldn't know how else to do it yeah so you just gonna have me stay in here Oh would you rather oh yeah I would oh okay should I should I just [Applause] hello and welcome to last sad tonight with spectacles Nick door key okay look if you're a woman or a person of color going to the doctor can be rough been there done that got the eye blue profile but there's some things we can do first doctors and med students should get bias training I know that doesn't sound like fun but it's one of those things that's not fun but you should do it anyway like reading with your kids trust me trust me you don't want to hear that your child has a reading problem and it's you second we need more diversity in the medical field we need more non-white doctors in actual hospitals not just the was made up by Shonda Rhimes and finally until we do those first two things you've got to advocate for yourself and if that doesn't work don't worry I've got a back-up plan it's called bring a white man basically if your doctors ignoring you just bring the white man to repeat everything you said and if you're thinking Wanda where the am I gonna get fine one of those don't worry I've got a white friend who loves complaining to doctors and he's recorded some messages you can use so let's say you're having a heart attack and they're not listening just take out your phone and show your doctor this hey you know what but it's not like no it's a it's a it's a lady heart attack giving him an EKG an MRI and a BLT if he asked for it look and it's not just heart attacks I got Larry to record messages for every occasion my elbow hurts when I when I do this I got like a whipping motion my knee I can't bend it I cannot squat my uterus is killing me I've got some pesky hormones today shouldn't have to say this but skin thickness is pretty much the same as everybody else's talk to me to explain what's going on with my ass but I'm gonna tell you something it hurts okay side to side and the crack and it's like I don't know if it's coming from the crack and that's why the sides heard or if it's coming from the sides and that's why the crack hurts oh no I can't go swimming I've got the curse you can find all of those and more at what's Larry's problem calm oh that is so that's so great wonder but let me just let me just ask quickly what if a doctor still ignores you oh don't worry I got Larry to record the white person seven word mating call check it out I'd like to speak to your supervisor thank you so much

Channel: LastWeekTonight

Views: 8,205,239

Keywords:

Id: TATSAHJKRd8

Length: 22min 37sec (1357 seconds)

Published: Sun Aug 18 2019

Reddit Comments

[u/jimmy_talent]

I actually have a story to support Wanda's "bring a white man strategy", I'm a white man but my sister is Hawaiian and while I was out of town she told me she had been having severe abdominal pain and vomiting one night so I told her she should go to the ER. She wasn't even seen by a doctor because while in the waiting room several of the nurses threatened to call the police if she didn't leave, this same ER has treated me for pancreatitis (basically the same symptoms my sister was having) many times even when they made clear they thought I was just an addict, so when I got home I took her to the ER and they found that she had heavy metal poisoning and would have died without treatment.

I know it's bullshit but minorities really should think about trying to make friends with a white dude, it makes systemic racism easier to deal with.

[u/BoogsterSU2]

WhatsLarrysProblem.com

[u/Malakay_sun]

A topic that is not widely reported on, has some depth and is of importance: that is the foundation of a great episode of Last Week Tonight. As much as I enjoy John Oliver going on about a topic from the current news cycle, I think that the format of his show is much better suited to dive into a topic that is outside of it.

[u/thesillyobserver]

https://tubeunblock.com/watch?v=TATSAHJKRd8

[u/MbakKoKom]

Is there any update on the Guiness thing?

[u/id10t_you]

Wanda Sykes is awesome. I Bu Fuckin Profin!!

[u/0LowLight0]

I am a disabled veteran who was left in the waiting room at Dignity Health (formerly Mercy Medical) for over 8 hours screaming in pain. Every time I asked anybody what was wrong with me, the only answer was "I don't know". Nobody examined or diagnosed anything. Instead of treating me, the resident police officer threatened to tase me if I didn't leave. I arrived in an ambulance and was forced to leave under my own power, in the middle of the night, with no vehicle of friend to call. A post script to this is that the ambulance ride was supposed to be covered by the VA. There was a "clerical error" in the filing, which caused an avalanche of departments all saying to me "that's not our department". The ambulance company, AMR, doesn't communicate with customers, so while I was navigating the VA's labyrinth of beurocracy, the $2,500 bill went to collection. As I started receiving incessant phone calls from the bill collector from Sri Lanka or wherever, the VA sent a claim letter to me describing that there was a clerical error.

So, I was untreated for my emergency and turned away. I was not compensated for the ambulance bill and was turned away. I tried to communicate to the ambulance company, and was turned away. The only company not turning me away is the phantom bill collector, as of this posting still trying to collect a non-bill. 2-3 times a day.

[u/redhawkwill]

Great piece, but I think they left out two groups that there is significant medical bias, transgender and obese.

I'm a morbidly obese white male pharmacist and can communicate with medical providers. I have had an issue with my gallbladder that flares up every few years. I went to an emergency room twice with similar symptoms within a week with nausea and vomiting and stomach/chest pain. I told the providers during the first visit that I thought it was my gallbladder. They dismissed it as chest wall pain due to being obese and gave me nothing to help. A week later, I went back to the same ED and, thankfully, the next provider listened and got me the appropriate treatment. I did not have to have my gallbladder removed yet, but it scares me that a provider would make a judgment based on being obese and deny me the appropriate treatment.

Medicine is still messing up with transgender people. They misgender routinely due to current EMR limitations on top of biases that people still have about transgender people. Add in sex and race biases and it makes it even worse.

[u/cplforlife]

Mirror for Canadians who refuse to support bell media?