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Seeing Patients: Unconscious Bias in Health Care
If you’re going to have a heart attack, an organ transplant, or a joint replacement, here’s the key to getting the very best medical care: be a white, straight, middle-class male. This book by a pioneering black surgeon takes on one of the few critically important topics that haven’t figured in the heated debate over health care reform―the largely hidden yet massive injustice of bias in medical treatment.
Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. And while race relations have changed dramatically, old ways of thinking die hard. In Seeing Patients White draws upon his experience in startlingly different worlds to make sense of the unconscious bias that riddles medical treatment, and to explore what it means for health care in a diverse twenty-first-century America.
White and coauthor David Chanoff use extensive research and interviews with leading physicians to show how subconscious stereotyping influences doctor–patient interactions, diagnosis, and treatment. Their book brings together insights from the worlds of social psychology, neuroscience, and clinical practice to define the issues clearly and, most importantly, to outline a concrete approach to fixing this fundamental inequity in the delivery of health care.
Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. And while race relations have changed dramatically, old ways of thinking die hard. In Seeing Patients White draws upon his experience in startlingly different worlds to make sense of the unconscious bias that riddles medical treatment, and to explore what it means for health care in a diverse twenty-first-century America.
White and coauthor David Chanoff use extensive research and interviews with leading physicians to show how subconscious stereotyping influences doctor–patient interactions, diagnosis, and treatment. Their book brings together insights from the worlds of social psychology, neuroscience, and clinical practice to define the issues clearly and, most importantly, to outline a concrete approach to fixing this fundamental inequity in the delivery of health care.
352 pages, Hardcover
First published January 15, 2011
About the author
Augustus A. White III
7 books4 followersAugustus A. White III, MD, is Professor of Medical Education and Orthopaedic Surgery at Harvard Medical School and the first African American department chief at Harvard's teaching hospitals.
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Displaying 1 - 16 of 16 reviews
July 7, 2011
Dr. Augustus A. White III, the son of a physician in segregated Memphis, graduate of Brown (undergraduate degree in psychology), Stanford (medical school) and Yale (residency), Vietnam War combat surgeon, renowned orthopaedic surgeon and researcher, first African American to chair a department at Harvard Medical School, and former master of the Oliver Wendell Holmes Society at Harvard, has a most impressive résumé and interesting life story. Fortunately he shares his life with the reader in the first half of this outstanding book, and he is a surprisingly gifted story teller, with a style that I found completely captivating. He encounters racial prejudice along the way to the top, but handles these obstacles with grace and aplomb, in keeping with his upbringing in the African American middle class community of Memphis who nurtured and praised him while stressing him to be humble and grateful for the gifts and opportunities he had been given. He was also taught to be a role model for others, and as he became a respected professor at Yale and Harvard and a fellow of the American Academy of Orthopaedic Surgeons he used his position to advocate for greater representation of racial minorities in medical schools and orthopaedic residency programs, and to address the inequalities in health care and medical outcomes that minorities, the women, elderly and other populations continue to experience in the United States.
In the second half of the book, Dr. White describes some of the findings outlined in the landmark book Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, published in 2001 by the Institute of Medicine, which was influenced by several studies that demonstrated that stark disparities in health care outcomes based on race, ethnicity, gender and age exist for different health conditions, even when factors such as health insurance and socioeconomic status were controlled for. Hispanics and African Americans received adequate pain control far less often than their white counterparts; women with heart attacks characterized by severe blockage of blood flow were nearly twice as likely as men to die afterward, and women with heart disease are far less likely to be accurately diagnosed by their doctors (as their symptoms are more likely to be attributed to stress) and receive standard of care treatment such as angioplasty, bypass surgery, and cholesterol lowering drugs; and elderly people, particularly women, are far less likely to be offered kidney transplants for renal failure, even those who are in good health.
In his work with the Oliver Wendell Holmes Society and his colleagues at Harvard, Dr. White and others advocated for the teaching of culturally competent care to medical students, in an effort to encourage physicians to evaluate and understand their own biases, so that they could provide each patient with the highest standard of care possible. He recognizes that most physicians genuinely care for their patients and want to give their best effort toward them, but cultural biases and personal factors that affect the patient-doctor relationship can impede the task. He injects personal vignettes and stories of others, which made me think about the families that I've taken care of who I haven't liked or communicated well with in the past, and understand that often I did not give them the same level of care that I did to families and children that I closely bonded with, regardless of their race or ethnic background.
The book closes with a section of practical suggestions for patients and physicians to use to better communicate with each other, and a list of national standards to ensure that every patient receives culturally competent health care.
Seeing Patients is a superb biography about an amazing man, a call to arms to ensure that all patients are treated fairly and equally, and a guide to aid health care providers and patients communicative effectively and respectfully to each other. I intend to encourage all of my colleagues, and the residents, medical students and physician assistant students who rotate on our service to buy and read this book, which jumps to the top of my short list of books that every health care provider should read. In addition, I think the lay reader would also enjoy and benefit from this book, as all of us have to encounter a health care provider who may or may not be respectful toward us at some point.
In the second half of the book, Dr. White describes some of the findings outlined in the landmark book Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, published in 2001 by the Institute of Medicine, which was influenced by several studies that demonstrated that stark disparities in health care outcomes based on race, ethnicity, gender and age exist for different health conditions, even when factors such as health insurance and socioeconomic status were controlled for. Hispanics and African Americans received adequate pain control far less often than their white counterparts; women with heart attacks characterized by severe blockage of blood flow were nearly twice as likely as men to die afterward, and women with heart disease are far less likely to be accurately diagnosed by their doctors (as their symptoms are more likely to be attributed to stress) and receive standard of care treatment such as angioplasty, bypass surgery, and cholesterol lowering drugs; and elderly people, particularly women, are far less likely to be offered kidney transplants for renal failure, even those who are in good health.
In his work with the Oliver Wendell Holmes Society and his colleagues at Harvard, Dr. White and others advocated for the teaching of culturally competent care to medical students, in an effort to encourage physicians to evaluate and understand their own biases, so that they could provide each patient with the highest standard of care possible. He recognizes that most physicians genuinely care for their patients and want to give their best effort toward them, but cultural biases and personal factors that affect the patient-doctor relationship can impede the task. He injects personal vignettes and stories of others, which made me think about the families that I've taken care of who I haven't liked or communicated well with in the past, and understand that often I did not give them the same level of care that I did to families and children that I closely bonded with, regardless of their race or ethnic background.
The book closes with a section of practical suggestions for patients and physicians to use to better communicate with each other, and a list of national standards to ensure that every patient receives culturally competent health care.
Seeing Patients is a superb biography about an amazing man, a call to arms to ensure that all patients are treated fairly and equally, and a guide to aid health care providers and patients communicative effectively and respectfully to each other. I intend to encourage all of my colleagues, and the residents, medical students and physician assistant students who rotate on our service to buy and read this book, which jumps to the top of my short list of books that every health care provider should read. In addition, I think the lay reader would also enjoy and benefit from this book, as all of us have to encounter a health care provider who may or may not be respectful toward us at some point.
October 20, 2011
Dr. White writes with great warmth about his experiences as an ice-breaking African American Physician in a Caucasian dominated medical world. His early years are an ephemeral trip down an embarrassing memory lane. The Jim Crow south continues to blemish our contemporary American history. He opened my eyes to the emotional and biologic basis of our social existence and how it plays an important role in medical decision making. Important to me because this is my job but, suggestive of how interactions are influenced in all social interactions. There are many Studies, Books and Articles that document disparities in health care but this one offers suggestions for improvement.
July 3, 2020
The first half of this book traces Dr. White's life narrative as a Black man pursuing medicine at a time when medical schools have strict quotas prohibiting African American students from getting accepted at medical institutions. Through White's description of his work on a medical school admissions board we learn about the institutional barriers that are in place to prevent Black people from becoming doctors. In the latter part of the book White describes his own awakening to health disparities around the time that the groundbreaking study "Unequal Treatment" was published in the early 2000's. White establishes a committee to address health disparities and discusses different groups of individuals (African Americans, Latinx, women, gays/lesbians) that are particularly vulnerable to health disparities. He argues for Culturally Competent Care training as a way to remedy this issue and to make healthcare providers more mindful of the way that stereotyping and biases can impact the quality of care.
What also stood out to me in the book was White's service as a doctor in Vietnam and his constant desire to be a part of the broader social movements occurring in the time. He discusses how he was advised to focus on his studies because building his knowledge foundation and becoming a doctor was also a way to contribute. He expresses that later in life publishing and actively fighting social issues was very gratifying and this was thought-provoking as I believe academics are often caught up in their studies and don't think enough about how to make their work politically relevant and impactful.
Another interesting point that White introduces is Fanon's idea of the "colonialized mentality" where the oppressed group begins to sympathize with their oppressor and internalize the idea that they are "less than" the oppressor.
What also stood out to me in the book was White's service as a doctor in Vietnam and his constant desire to be a part of the broader social movements occurring in the time. He discusses how he was advised to focus on his studies because building his knowledge foundation and becoming a doctor was also a way to contribute. He expresses that later in life publishing and actively fighting social issues was very gratifying and this was thought-provoking as I believe academics are often caught up in their studies and don't think enough about how to make their work politically relevant and impactful.
Another interesting point that White introduces is Fanon's idea of the "colonialized mentality" where the oppressed group begins to sympathize with their oppressor and internalize the idea that they are "less than" the oppressor.
August 14, 2018
I can't even believe I'm typing this, but this is a page-turner. At least it was for me.
I think that partly it was the structure of the book. It's actually mostly a memoir, and in each chapter, White lays out a part of his life, and then what he took away from it, especially relating to the idea of unconscious bias. And it's very compelling. His story is very, very compelling.
As for the stuff about unconscious bias, it's mostly in the last three or so chapters, and though I did learn some things I'd like to explore, it isn't really the focus of the book. (To my surprise and I guess delight?) Anyway. YMMV, but yeah, wow. This snuck up on me.
I think that partly it was the structure of the book. It's actually mostly a memoir, and in each chapter, White lays out a part of his life, and then what he took away from it, especially relating to the idea of unconscious bias. And it's very compelling. His story is very, very compelling.
As for the stuff about unconscious bias, it's mostly in the last three or so chapters, and though I did learn some things I'd like to explore, it isn't really the focus of the book. (To my surprise and I guess delight?) Anyway. YMMV, but yeah, wow. This snuck up on me.
October 24, 2023
This book was not what I expected it to be. I expected a look into research and how that research related to health outcomes manifests itself in the healthcare world. This book was about Dr. White's life work (which to be fair has revolved around diversity). The last two or three chapters were everything I wanted from this book I just wish there was more to them than just a few pages.
November 27, 2019
Required for 4400. Really enjoyed it, the narrative side made it a much easier, more emotional read than blindspot imo. AW is an interesting guy, I liked Dunlevy’s idea that his situation may have been different had he not been lightskin.
August 12, 2020
I enjoyed reading about Dr White’s life and learning about his incredible career. His work presented a clear and straightforward way for me to start understanding racial disparities in healthcare and implicit bias.
January 13, 2023
If it's a topic that interests you, very well done
February 19, 2024
Loved it. Slowly getting underway with all the books about race & medicine, this was a fine addition.
October 4, 2011
I wish that Dr. White had included more of his personal story. He is a gifted story teller and I would have loved to hear more of his story. He puts a face on what to many of us is history, and a history we know very little about.
His discussion on the unconscious bias in health care (and other places as well ) is presented in a thoughful and non accusatory manner. After I had finished the book I continued to think about the issues Dr. White discussed. Being woman I have run into some of the mind set that Dr. White discusses. { It took me five years following a a motor accident to convince the neurologist that "something was not right".}
I have already recommended this book to several friends.
His discussion on the unconscious bias in health care (and other places as well ) is presented in a thoughful and non accusatory manner. After I had finished the book I continued to think about the issues Dr. White discussed. Being woman I have run into some of the mind set that Dr. White discusses. { It took me five years following a a motor accident to convince the neurologist that "something was not right".}
I have already recommended this book to several friends.
January 2, 2014
My MCAT tutee really wanted to read this for our critical reading discussion. I wasn't that enthusiastic about it before but warmed up to it considerably and by the end found myself nodding along with many of the points that the author made. I mean, it's not really anything revolutionary and anyone with a background in being a decent human being or interested in social justice will probably find the conclusions pretty self-evident, but I can see how if you don't think about it often or make a conscious effort to shield yourself against your biases, it might be difficult to maintain impartiality.
November 3, 2016
I know I probably should have realized this before starting the book but I didn't realize the book was written by an African am. Author and the first chapters were a historical perspective of him growing up in the south when serration was still a daily part of life. Though informative this is not what I was looking for.
This entire review has been hidden because of spoilers.
March 8, 2013
Really interesting memoir about race in America by a distinguished doctor. You may learn a lot more about orthopedics and famous orthopedic surgeons than you'd care to know.
December 5, 2014
This was very good, although more autobiographical than philosophical. It can almost be read as a history of African American advancement in healthcare, and one physician's career retrospective.
August 19, 2016
Interesting read, but the author includes too much autobiography. While his story is fascinating, I wish he would have addressed unconscious bias in more depth, as the title suggests.
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March 7, 2019Here is a book I'll refer to again and again.
Displaying 1 - 16 of 16 reviews