Utilizing our Higher Brain in our Thinking: Unconscious Bias

We are more apt to accept someone else’s culture if we are utilizing our higher brain in our thinking. Higher brain thinking reflects attention to rewiring the neural pathways of unconscious bias and negative thinking.

When we are using higher brain function, executive function, our pre-frontal cortex leads the way.  We show up with the ability to process complex conflicting information, have a great sense of self awareness and more likely that choices are more conscious.

Our body can give us clues to whether or not we are using our higher brain state.  We are relaxed and comfortable in our skin.  We are attentive to what is going on around us.  Our thinking is clear.  We feel confident and empowered. 

There are multiple strategies for recognizing and reducing implicit bias. One of the most important practices is to strengthen your metacognition – the ability to think about what you are thinking and feeling.


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.

Your Mother Is White!

Children undergo physical, intellectual, and emotional development as they age and experience the world.  In similar ways, they experience racial development too.  They begin to recognize differences in skin color as early as six months of age.  By the age of five, many children start to not only realize that different groups are treated differently, but also recognize that racial groups can be “ranked.”

At my predominantly black elementary school,  I played on my kindergarten playground.  A boy at my school started taunting and screaming at me, “Your mother is white, your mother is white!”  His loud and angry voice carried across the schoolyard.   My beautiful mother, my favorite person in the world, walked me to school every morning.  Up until that moment, I don’t ever remember registering the color of my mother’s skin; only its warmth and lovely smell. Returning home that day, as I ran into the kitchen, I too began screaming.   While stomping my feet and through tears, I demanded,  “Why didn’t you tell me you were white; why didn’t you tell me?”  Shocked, taken aback and as her eyes also welled up with tears, my mother sat me on her lap. She proceeded to explain to me how black people in the United States could have “white” skin.  That day, on my mother’s lap, with the smell of chicken baking in the oven,  I listened to my first history lesson about the abomination called chattel slavery.  I was five years old.

I suppose that was the first day of my journey to understand issues of race, privilege, and oppression.  We need to begin courageous conversations with our children at a very young age.  It is crucial to start our journey to unlearn some of the prejudices we have picked up along the way.  As we develop a culturally competent mindset, our conversations with our children become more accurate and support their healthy racial development.


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.

Identifying my Superpower

I entertained the idea of quitting medicine after my first night on call during my internship year.  On that night, I felt petrified assigned to the Neonatal Intensive Care Unit (NICU).   Joe, the third-year resident camped out in his call room, gave clear instructions.  He should only be disturbed if an infant deteriorated during the night.  In the competitive culture of the residency program where I trained, the senior doctors, known as the “attendings,” supervised the interns and residents from the comfort of their homes. The unwritten rule stopped residents from consulting them in the middle of the night. 

While I was hunched over a micro-preemie completing a procedure, a nurse asked if I wanted to give antacid to an infant who had acidic undigested formula in his stomach.  Clueless, I breached protocol and interrupted Joe’s football game.  Calmly, he approved of the plan to give the antacid.  I researched the dose and wrote the order in the infant’s medical chart.  The nurse informed me in the wee hours of the morning that the infant with the acid issue improved.

The next day as morning rounds began, I reflected on how all the infants and I had survived the night.  Because of exhaustion, I barely noticed the blinking lights of the breathing machines and the beeping sounds of the IV poles.  Before me in one large room stood twelve tiny babies in their respective incubators with their nurses hustling around them, inserting IVs, changing diapers, and dispensing medications.   I began my discussion of each infant’s events during the night to the senior physician, the two other residents, and several medical students.  The attending physician, Dr. T, asked questions, and I answered moving from one crib to the next.  When we reached the infant I’d written the order for the antacid, Dr. T stared at the crib.  Suddenly, without warning, he grabbed the bottle of antacid sitting prominently on the shelf just above the infant’s bed.  While hurling the bottle towards me, he yelled an expletive and followed with the question that haunted me for many months, “What are you doing, trying to kill this infant?” He followed the outburst with a quote from a research journal about the potentially fatal adverse effects of using antacids in premature infants.  Luckily, my years as an athlete helped me dodge the bottle which settled near my feet.  The room seemed to disappear.  The infant’s incubator crib appeared to leap into my vision inches from my face.  I felt hot all-over and my palms felt wet.  No one said anything to diffuse the situation.  Not one nurse revealed that ordering antacid had been a common practice.  Dr. Joe, the supporting resident, had already left the NICU.  Nothing could have insulated me from the humiliation. I quickly scribbled an order in the patient’s chart to discontinue the antacid and jotted a note on my clipboard to find the research article to read later that day. 

As the morning rounds continued, the bottle of antacid rested in the middle of the floor.  Did anyone, fellow intern or senior resident, or one of the nurses have the courage to support me  that morning? Did anyone else see the hurled bottle as an assault?  Maybe not. After rounds, in the privacy of the bathroom, along with my tears and simmering anger, I reflected on the dynamics that would allow one person to treat a team member with such unfiltered anger and disrespect.  What did the Attending physician possess that the rest of the team lacked?  He could claim seniority.  He possessed seniority in a rigidly hierarchical system. He occupied a position of privilege in relation to everyone else.   In the privacy of the bathroom stall,  I identified a future superpower.  I promised myself that when I had the responsibility of being the senior physician in a teaching hospital, I would never shame an intern or a resident on rounds.  I’d always use my superpower of seniority for good. 

Can you remember an experience that revealed a superpower or encouraged you to develop one? Share below.


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.



Privilege is Your Superpower

The medical team stood around the older woman’s bedside. As one of the students, I prepared to meet my assigned patient. While being assigned to me, Mrs. R. yelled, “I’m not letting that  N*** take care of me!” As the only Black person in the room, her words meant for me hung in the air.  Frozen in place with my heart racing, I fantasized walking out of the room. Without a break in the conversation, my third-year resident, the most senior person on the team, used his superpowers of whiteness, maleness, and seniority to inform Mrs. R. that her bigoted behavior distressed the team. He granted her a choice. She could change her attitude, or we would help her find another hospital. Forty-eight hours later when I arrived at the ward, I learned that she transferred to another hospital in the middle of the night. My third-year resident chose to be my ally. He set a tone for the team and reminded everyone my skin color didn’t allow anyone, including a patient, the right to disrespect and degrade me.  He used his superpowers for good.

There are three prominent aspects of our superpowers.  One,  we all have privileges afforded to us in society. You may be male or tall. You achieved a high level of education or inherited lots of money. You may be socially agile or recognized as being pretty. You may be white. You may be able-bodied or straight. You may have been born in the United States or be a Christian.

The second often frustrating aspect about superpowers is they sometimes allude you.  When you hold a privileged position in society, that privilege offers a buffer to the effects of that social condition.  The advantage becomes the “norm” for you.  One strategy for identifying your privileges is to listen to the stories of those who are at a disadvantage.  Don’t be quick to discount the stories about patients refusing care from the colleague with the foreign accent or sexual harassment continually occurring in the hospital.   Just because it has never happened to you, doesn’t mean it never happens.  These stories are the key to stepping into and owning your privileges and your superpowers!

The third aspect of superpowers is having the discernment for how and when to use your superpower.    The most important thing to realize is when you decide to embark on a courageous act or conversation, you need to understand your role, to act from conviction, not emotion, and to understand the ramifications.

I encourage you to identify your superpower! Imagine you could become the superhero that saves the day on hospital rounds, helps boost team morale, or secures the opportunity to strengthen a special relationship. Remember, everyone has one or more superpowers.   Identify your privileges and commit to using them for good. Advocate for others in situations where their social position, medical condition, race, country of origin, LBGTQ status, disability, size, gender, or rank in a medical setting sets them up for discrimination or harm. I guarantee your life in medicine will be more vibrant with friendships and collegial relationships developing and flourishing for a lifetime. Teams have the opportunity to thrive and do great things for patients and their families. Take some time to reflect on your superpowers, your privileges. Have you used them for good?

5 Day Culturally Competent Mindset Challenge

Starting January 17th, we will begin our 5 Day Culturally Competent Mindset Growth Challenge.  I will be going live for 5 days up to the Martin Luther King, Jr Holiday with a brief activity that will propel you forward in 2019 towards more cultural awareness, capacity for growth, and stronger cross-cultural relationships. Please follow me on my facebook page Culturally Competent Mindset

 

 

cultural competence is a journey not and endpoint

Decisions and Insta-whatevers

I dragged my daughter, a college coed math major and musical theater aficionado to a workshop about creating your ideal life. I had mine- a successful Pediatrician with wonderful colleagues and amazing patients and their families-nearing the end of my career. I had always imagined working into my 80s, older but sprite. But honestly, I recently had joined many of my fellow doctors, dreaming about and counting down to retirement. Let’s face it; the culture of medicine has changed and assembly-line medicine has taken over. It had become harder to “love” the work.

As we sat in the lively workshop, my daughter wrote copious notes on her cellphone. Actually, they were texts and tweets and insta whatevers in rapid fire. I found myself frantically capturing the speakers every word in my journal. This journal would soon become my constant companion. The workshop offered a camp retreat in the Smoky Mountains for relaxation and restoration later in the summer. I turned to my daughter to ask if she’d like to go to camp, she frowned and then declared quite smugly, ” MOM, just go sign up. You know you’re dying to go to camp!” And that was the beginning of this amazing journey that has brought me to this moment. 18 months after the workshop, I am re-creating my ideal life. Instead of picking up a stethoscope and heading into the clinic to work on Christmas Eve ( like several of my professional friends), I am updating my website and listening to a podcast on how to create the ideal funnel.