PDF(Pubmed)
Abstract：
Implicit (i.e., unconscious) bias frequently differs from one\'s explicit or conscious convictions. As humans, we rely on information and experiences that are repeatedly reinforced until they become reflexive, shaping our perceptions of reality. Specialty bias, a form of implicit bias specific to an individual\'s medical specialty, is a form of this bias. These cognitive processes of making assumptions aid efficient decision-making and likely confers an evolutionary advantage. However, automatic thinking can contribute to stereotyping, prejudice, and discrimination at both explicit and implicit levels. Despite a person\'s explicit beliefs evolving, the lasting implicit bias significantly impacts their behavioral interactions with individuals from stereotyped groups. We present a case of an 83-year-old non-English speaking gentleman with a reported past medical history of an ischemic stroke who presented with acute encephalopathy and fever without jaundice and Aspartate transaminase/ Alanine transaminase (AST/ALT) of 64 and 34, respectively. He was initially treated for acute meningoencephalitis in the Neurologic Intensive Care Unit. With no clinical improvement in symptoms, his care was transferred to the Internal Medicine service later that week, and it was noted that he had features consistent with liver disease. Further history-taking revealed that the patient was intermittently confused with episodes of constipation. On examination, he had palmar erythema and asterixis, and additional labs showed elevated liver enzymes and ammonia levels. Computerized Tomography of the abdomen was suggestive of cirrhosis. He was treated for hepatic encephalopathy with lactulose and rifampin, with improvement in his mental status. We believe our patient\'s clinical diagnosis was compromised by incomplete information related to a language barrier, and anchoring biases prevented a thorough history taking from the patient family and later on from the patient. Physician\'s anchoring bias, a form of implicit bias, can negatively impact outcomes in patients, especially those with limited language proficiency, due to communication barriers leading to misunderstanding of the patient\'s clinical presentation and overreliance on clinical heuristics.
摘要：
隐式(即，无意识)偏见经常不同于一个人的明确或有意识的信念。作为人类,我们依赖于信息和经验，这些信息和经验被反复强化，直到它们变得反身，塑造我们对现实的看法。专业偏见，一种特定于个人医学专业的内隐偏见，是这种偏见的一种形式。这些做出假设的认知过程有助于有效的决策，并可能赋予进化优势。然而,自动思维会导致刻板印象，偏见,以及显性和隐性层面的歧视。尽管一个人明确的信念在进化，持久的内隐偏见显著影响他们与刻板印象群体个体的行为互动。我们介绍了一例83岁的非英语绅士，有缺血性中风的既往病史，表现为急性脑病和无黄疸发热，天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）分别为64和34。他最初在神经重症监护病房接受急性脑膜脑炎治疗。症状没有临床改善，那周晚些时候他的护理被转移到内科服务，据指出，他的特征与肝脏疾病一致。进一步的病史记录显示，患者间歇性地与便秘发作混淆。在检查中，他有手掌红斑和星号,其他实验室显示肝酶和氨水平升高。腹部计算机断层扫描提示肝硬化。他因肝性脑病接受乳果糖和利福平治疗,随着他精神状态的改善.我们相信我们的病人的临床诊断是由不完整的信息相关的语言障碍，和锚定偏见阻止了彻底的病史从病人的家庭和后来从病人。医生的锚定偏见，一种隐性偏见，会对患者的预后产生负面影响，尤其是那些语言能力有限的人，由于沟通障碍导致对患者临床表现的误解和对临床启发式的过度依赖。
