Samantha Siegel: Implicit Bias in Cancer Care

Samantha Siegel, Physician at the Permanente Medical Group, shared an article on LinkedIn:

”’Patient is a former smoker’: Implicit Bias in Cancer Care.

In the information era, with transparent medical records, I think it’s time to revisit how we use social history to frame the patient narrative.

I recently opened up the chart of a patient with a lung malignancy to read ‘Patient X is a former smoker.’ Mind you, the former smoker label was in regard to a very remote history of tobacco use (over 25 years ago) and the length of use was short (less than 2 pack years).

It had me wondering: what was the implicit message in this communication? Was the author saying that this younger patient deserved their lung cancer because they were a former smoker? Does the very remote history of tobacco use fully explain the current situation? Or is it more about air pollution, their occupational and environmental exposures which were actually omitted from the history? When the patient reads their medical notes, will they internalize blame for their malignancy because they smoked for a couple of years a quarter of a century ago? Will they feel less empowered to seek help or understanding from the medical team because they just should have known better? Did the author know that some lung cancer has nothing to do with smoking?

It had me thinking about other instances where we implicitly judge our patients. Are we nicer and more understanding of a patient with type 2 diabetes and a lower BMI than a patient with type 2 diabetes who has obesity?

What about someone who contracted HIV from a contaminated blood transfusion instead of an occupation as a sex worker?

The smoking history was relatively inconsequential in this case. The information did nothing to change the management. Knowing that, what exactly was the point of sharing this one liner at the top of nearly every note from the recent hospitalization?

Curious how people are changing their practice regarding medical documentation compared to what we were taught in training.”

Source: Samantha Siegel/LinkedIn