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.

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?