I lost my patience when the food-delivery driver called me and said she could not find her way to our house. Our home is newly constructed and does not appear in some GPS systems. Sometimes it guides people to a wrong location near where we live. Unfortunately, this malfunction includes the GPS system used by delivery drivers who work for a certain online food ordering company.
Although the driver was lost, she was in my neighborhood -- I could tell because I recognized the names of the streets she was reading aloud as she drove past them. The driver's English was limited, which was somewhat unnerving. I was able to guide her to our home, but my tone was gruff, perhaps because she interrupted my viewing of the nightly news, or because I was "hangry" -- our dinnertime meal was 25 minutes late. My anger also stemmed from the fact that I had quite a bit of difficulty communicating with her.
I met the driver at the curb, waving her down as she approached our house, in fear she might overshoot it. She stepped out of her compact car -- a car that had obviously seen better days -- and handed over the meal. I composed myself and thanked her.
"Where do you come from," I asked?
"Ukraine," she replied.
My heart sank. I was suddenly ashamed of the way I had treated her over the phone. The nightly news that she interrupted? Lester Holt was giving an update on casualties in Ukraine from extensive bombing that day.
"You know there's a problem with the GPS system you are using," I said in a conciliatory tone. "Here, let me show you a better app for directions," as I introduced her to "Waze" on my iPhone.
Now collected, I was less bothered by her meager English as she explained that online orders through the delivery app are automatically linked to their GPS system. However, she took note of the "Waze" application as a back-up and said she would use it in the future, if necessary.
I took our dinner inside, but I had lost my appetite. I couldn't come to terms with my initial unfriendliness. It was uncharacteristic of me. In my mind, there were inciting factors for the way I behaved, yet they were clearly based on prejudice and couldn't justify my disrespect of the driver or undo the interaction.
I became engulfed by my thoughts: was I guilty of microaggressions with patients before I retired from practice? How many patients may I have offended or incensed due to biased thinking? Surely, I saw many patients who spoke English as a second language. Was I negatively predisposed to all of them?
I flashed back to my years spent in training and clinical practice in Philadelphia. The diversity of people living there enriched my education. English as a second language -- or no English spoken -- was never a problem. We had interpreters on staff. On one occasion (before HIPAA) I enlisted the corner hot dog vendor to help me translate for a patient who only spoke Greek.
I was outraged when Joseph ("Joey") Vento, the owner of a local eatery and shrine -- Geno's Steaks -- slapped in the window declaring that only English-speaking customers would be served. It read: "This is AMERICA. When ordering, speak English." The sign attracted national attention, and legal attempts to remove it were unsuccessful. The sign was voluntarily removed in 2016, a decade after it was posted. I protested by ordering from rival "Pat's King of Steaks" across the street.
My thoughts also reverted to the 1970s and the era of Frank Rizzo -- the former Philadelphia police commissioner turned mayor turned radio talk-show host. Rizzo was known widely for his racist and anti-gay views, leaving a legacy of unchecked police brutality.
The aggression exhibited by Vento and Rizzo was at the "macro" level. On the other hand, my emotional response to the driver delivering my food was more subtle -- a microaggression. are flash-in-the-pan behaviors that stem from implicit biases toward people unlike ourselves.
are unconscious stereotypes, assumptions, and beliefs held about an individual's identity. They affect our understanding, actions, and decisions, and . The important point is that implicit biases influence even in the absence of a physician's intent or awareness, because ingrained biases are never truly extinguished -- they leave a "mental residue."
Learning how to identify and overcome implicit biases is essential to improving the delivery of healthcare to diverse populations. The first step is to look for stereotyped descriptors in the electronic health record. A recent study found that, compared with white patients, Black patients were two and a half times more likely to be described in negative terms -- for example, "non-compliant," "agitated," and "refused." The authors concluded that providers may not be able to change their belief systems without self-awareness and/or training on potential biases.
Such training may take the form of a to cross-cultural care, , and other types of education aimed at recognizing stereotypical thinking. The key is to learn how to replace biases and assumptions with accurate representations of patients free of racial and ethnic context, and increase opportunities for positive contact with geographically and socioeconomically disadvantaged patients.
Loretta J. Ross, associate professor at Smith College, adds that when microaggressions occur, shaming people is a natural impulse but not necessarily the correct option. It is better to , she says. Calling in is similar to calling out, but it's done privately and with respect. Calling in involves conversation, compassion, and context. Ross , "...take comfort in the fact that you offered a new perspective of information and you did so with love and respect, and then you walk away..." The calling-in practice entails reserving a seat at the table for transgressors if, at first, they are not receptive to your kind gesture but later decide to join the conversation.
So, to all my former patients -- and any other individuals I may have transgressed against -- I humbly seek your forgiveness and ask that you call me in rather than call me out.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board, a 2021-2022 Doximity Luminary Fellow, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.