Just Read: How to Bias and Debias your readers around LGBTQ patients at the same time

Great and novel study in Jama Dermatology (@JamaDerm) on the association of skin cancer and indoor tanning in sexual minority women and men.

The editorial published along side it is even more important.

I’m bummed out by the image that the journal chose to adorn the web site and email message to advertise it. I was actually taken aback when I saw it in my email box.

Why? I’ve been studying unconscious bias for a little while now and what the data shows is that the way to combat it is to show counter-stereotypic images and positive exemplars when teaching about the issues of people who are minorities.

The editorial attached to the study goes beyond the “what” of the tanning bed/skin cancer association for sexual minorities (there is one, and it has implications for health) and into the “why” – the determinants that might cause this association to exist. And guess what, body image, societal pressure, explicit and implicit bias may play a role. If you don’t address those, the effectiveness of informing people about the dangers is going to be limited.

To double check my concerns about the image, I consulted with a researcher who I know is also doing work in this area. They said:

Not only is the image playing into gender role stereotypes of sexual minority men, but it’s also doing so with the actor displaying pleasant affect, while engaging in the behavior that the authors just spent so much time talking about being so very dangerous!

I agree. I think this choice, probably not intentional (the nature of unconscious bias) is unfortunate if the intent is to reduce bias toward sexual minority men among dermatologists and other readers of the journal.

Recent studies have shown that there’s still measurable explicit bias on the part of medical students with regard to sexual minorities, who, when surveyed feel “less warm” toward humans in this population. It’s just the tip of the effect, though, there’s significant implicit bias as well, measured in our future physicians.

Many physicians do not assess patient sexual orientation as part of routine care; however, when sexual minority patients are informed why this information is important to their care and that it will be kept confidential, many are open to sharing it with their healthcare professionals. Recent data have highlighted significant explicit and implicit negative attitudes toward sexual minorities by physicians and other health care professionals, sug- gesting that additional training in sexual minority issues is needed in medical school curricula. The expression of explicit or implicit bias toward sexual minorities is destructive to a physician-patient relationship and likely a liability to care. (Blashill, et. al)

see: Just Read: Eliminating physician biases against gay and lesbian people, don’t forget the “T” and Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. – PubMed – NCBI

The nature of unconscious bias is that it’s unconscious. At the same time the impact of these choices are important across disciplines – enough for corporations like Facebook to train their employees in it (see: Just Watched: “Managing Unconscious Bias” , for Facebook employees).

I’m posting this because it’s a good example, in 2015, of how far we’ve come, and also of how challenging the issue of bias is and will continue to be for the medical profession.

I suggest the image used be replaced, and more thought put into future advertising of studies that look at health disparities – I’m confident that we all share the same goal, which is to eliminate them altogether – and we can 🙂 .

Ted Eytan, MD