Life Changing Moments: Checking Our Biases, Dr. Jonisha Brown

Dec 17, 2023
3 min read

Updated: Feb 4, 2024

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When Dr. Brown was having chest pains, she did what you are supposed to do – Seek help. What she discovered while attempting to get that help changed her career path forever.

Perhaps talking with a coach might help to answer and review your own professional biases.

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Dr. Jonisha Brown is a Family Medicine assistant professor and hospitalist at Atrium Health in Charlotte, NC. She attended Wake Forest University Bowman Gray School of Medicine for medical school and completed her residency at Atrium Health where she specialized in underserved medicine and served as Chief Resident. Most recently, Dr. Brown completed her Master of Public Health Degree from Harvard School of Public Health with a concentration in Health Policy. Her area of expertise includes addressing racism and implicit bias in medicine, ending Black maternal health disparities, and supporting diversity and inclusion in medicine. She is also the founder of BirthRight Inc, a nonprofit in Charlotte North Carolina that addresses the root causes of the Black maternal health crisis through community education, empowerment, and advocacy efforts.

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Access the Show Transcript Here

LCM 33: Checking Our Biases: Dr. Jonisha Brown

Dr. Waxman and Dr. Brown discuss healthcare biases and disparities, advocating for improved care for black women. Take an implicit bias test, prioritize mental health, and seek support from MD Coaches. #HealthcareDisparities #ImplicitBias #Support

2023, Dr. Dael WaxmanLife Changing Moments

Produced by Clawson Solutions Group (www.csolgroup.com)

Generated Shownotes

Chapters

0:00:00 Feeling Powerless: A Life-Changing Experience 0:03:15 A Heart Attack: Dr. Brown’s Life-Changing Moment 0:05:38 Challenging Experience as a Patient in the Emergency Room 0:08:59 Advocacy from a Friend Leads to Urgent Treatment 0:09:36 A Surprising Lack of Awareness and Coherence 0:10:41 Sponsored by Eagle Financial Group: Your Financial Partner 0:12:33 Welcome to Rx for Success with Rhonda Crowe 0:13:35 Introducing Physician Outlook magazine 0:14:45 Helpful Moments in the Emergency Room 0:18:06 The Impact of Implicit Bias in Healthcare 0:23:57 Disparity in healthcare for African American women in the US 0:26:45 Unconscious bias experienced by black women in healthcare settings 0:28:47 Reflecting on personal experiences and unconscious bias in healthcare 0:30:40 Systemic factors contributing to varying healthcare outcomes 0:32:31 Bias and premature closure in emergency room interactions 0:35:02 Tools for Addressing Unconscious Bias 0:37:44 Remaining Curious and Embracing Imperfection 0:40:36 Dr. Brown’s Life-Changing Moment and Career Path 0:42:23 Lessons in Professional Improvement and Self-Care

Long Summary

In this episode of “Life-Changing Moments,” Dr. Dale Waxman explores the topic of navigating challenging experiences and the unique perspective that physicians gain when they become patients themselves. He is joined by Dr. Jonesha Brown, a family physician and hospitalist who has used her own experience as a patient to advocate for improved healthcare.

Dr. Brown shares her personal story of experiencing a heart attack from a condition called spontaneous coronary artery dissection (SCAD) during the postpartum period. She discusses feeling powerless and dependent on others for her care and highlights both helpful and unhelpful interactions with healthcare providers.

Dr. Waxman reflects on the bias and premature closure that occurred in the emergency room during Dr. Brown’s ordeal, attributing it to implicit bias. They both emphasize the importance of addressing biases in healthcare and the disparities in healthcare for black women, particularly in relation to pregnancy. Black women are three times more likely to die during pregnancy, delivery, and the postpartum period compared to other racial demographics.

The conversation delves into the intersection of socioeconomic issues and access to healthcare for black patients. They discuss the lack of representation of black physicians and how it affects access to care for black patients. Dr. Waxman and Dr. Brown highlight the need for conversations and understanding to address healthcare disparities and advocate for prioritizing wellness and seeking care earlier for black women.

To combat biases, Dr. Waxman recommends being aware of unconscious biases and actively countering them in decision-making. They emphasize the importance of continuously learning, growing, and striving for improvement in order to create positive change in the healthcare system.

The episode concludes with reminders to take an implicit bias test, reflect on decisions, practice individualized care, and prioritize mental health. Listeners are encouraged to seek career guidance and support from MD Coaches and to rate and review the podcast to help reach more people.

Brief Summary

In this episode of “Life-Changing Moments,” Dr. Dale Waxman and Dr. Jonesha Brown discuss navigating challenging healthcare experiences, addressing biases in healthcare, and advocating for improved care for black women. They highlight the need for conversations and understanding to address healthcare disparities and emphasize the importance of continuous learning and countering unconscious biases. Listeners are encouraged to take an implicit bias test, reflect on decisions, prioritize mental health, and seek support from MD Coaches.

Transcript

Feeling Powerless: A Life-Changing Experience

[0:00] And going through what I went through that evening really opened my eyes to what it’s like to go through an experience and feel powerless, honestly.There are times in our lives that change the way we see the world.Navigating these challenges can take insight, trusted confidants, or even a coach. Let’s explore those moments.In this companion podcast to Rx for Success, we will discover ways to learn and write our own success stories together.I’m Dr. Dale Waxman, a physician coach with MD Coaches, and this is Life-Changing Moments.

[0:39] Music.

[0:44] At some point, all physicians will be a patient.This role reversal creates a window into what it is like to be one of our patients.With new awareness from being on the other side of the stethoscope, it is well documented that clinicians often become more compassionate and patient-centered after being a patient, especially if they went through a challenging medical ordeal.

[1:12] While this transformation is certainly appreciated by patients, my guest today has taken what she learned from being a patient beyond improving physician-patient interactions to now being involved in raising consciousness, leading advocacy efforts, and researching the issue that she confronted when she became a patient.We’ll hear her story shortly, but first, let me tell you something about her.Dr. Jonesha Brown is a family physician and hospitalist at Atrium Health in Charlotte, North Carolina.She attended Wake Forest University School of Medicine and completed residency also at Atrium Health, where she specialized in underserved medicine and served as chief resident.Most recently, Dr. Brown completed her Master’s of Public Health degree with a concentration in health policy from the Harvard School of Public Health.Her area of expertise includes addressing racism and implicit bias in medicine, ending Black maternal health disparities, and supporting diversity and inclusion in medicine.She is also the founder of Birthright, Inc., a nonprofit in North Carolina that addresses the root causes of the Black maternal health crisis through community education, empowerment, and advocacy.

[2:32] Finally, I have had the distinct honor of working with Dr.Brown, both as her teacher during residency and as a faculty colleague in recent years.Johnesha, welcome to Life-Changing Moments. Thank you so much.Thank you for having me. Well, it’s great to have you.I know I’ve known your story for a little while and it’s good to have you on here to be able to have the rest of the world hear that because I think it’s it’s a compelling and an important story for all of us.And so speaking of that story, I’d like this just to get right into it.I know that listeners are probably like, well, what is it that happened?So tell us what happened. Man, to go back, we actually have to start in 2017.

A Heart Attack: Dr. Brown’s Life-Changing Moment

[3:15] And at that time, I was actually just finishing up residency.I was already a mother to one son, who was about four at the time.And I had just had my second son, Ellis.And I was in the postpartum period, which is obviously the time after you deliver.I’d had a C-section, everything had gone well, I had had a healthy pregnancy and I was sitting at home one evening and all of a sudden just sitting on the couch started having this very strange pressure-like feeling in my chest and there’s a lot that transpired that evening but ultimately I was diagnosed with having a heart attack from something called SCAD which is called spontaneous coronary artery dissection.Right, so which is a compelling enough story and scary enough.

[4:02] And tell us a little bit about what that was like. First of all, what was it like to be a patient?You know, you’re a physician, you know what some symptoms mean.What was that like for you just as you’re experiencing the symptoms and then interacting with the healthcare environment?The whole ordeal was actually really strange and very much the reason why it’s impacted my life so much.You know, up until that point, I had already done a lot of work in working with patients who were underserved and really have tried my best in all professional spaces of my life to really be a champion for people who are on the margins of our society in many different ways, whether it’s in education or in medicine or other areas that I’ve worked in before I went into healthcare.But having that experience as being a patient and going through what I went through that evening really opened my eyes to what it’s like to go through an experience and feel powerless, honestly.

[5:00] To feel like you have to depend on someone else for your care and feeling like you really need them to be on your side to kind of reach where you’re going.Not to say too much, I know we’re going to get into a little bit more, but throughout the evening I had several people who helped me get to where I needed to be, but there were also people during those encounters that definitely made it a little bit more difficult because they, for whatever reasons, couldn’t see that I was going through the issue that I was going through and also wanted to, I guess, attribute it to something else other than what was really going on, which was a major health issue, a heart attack.

Challenging Experience as a Patient in the Emergency Room

[5:38] Yeah, well, so let’s go ahead and talk about that right now.So, there were many who you encountered, and I’m assuming you went to the emergency department.

[5:48] And you’re talking about that vulnerability, sort of that it’s that you really are in this place where you’re dependent on others to be really helpful to you at that time, and that’s already challenging.And it like you noticed that there, even now as you reflect, there were those who were pretty helpful, but there are also some others that didn’t quite feel so helpful to you. Can you say more about that? Absolutely.So just to kind of paint the picture for you, I mean, obviously I’m a physician in the background of all of this, but for your listeners who have studied what a heart attack looks like, by the time I got to the emergency room after realizing that I needed to go, I was sweating profusely, what we call diaphoresis, shortness of breath, really not being able to catch my breath enough to say even a complete sentence.What started out as this kind of vague chest pain or pressure, by the time I got to the emergency room was like full, I don’t know, 10 out of 20 chest pain.Me being a physician was not even a part of the equation. I couldn’t even articulate really.Much more than what I was experiencing, you know, in short, short phrases.

[6:56] So coming into the emergency when my husband was with me, and you know, you kind of go through all these steps where you sign in at the registration desk, you know, I told them what was going on and the symptoms that I was having.At the time, I thought I might have been having a blood clot.That seemed like the most obvious thing to me.And so I told him, you know, 10, 10 days postpartum, you know, I’m having shortness of breath and chest pain, really, you know, struggling to breathe and the lady just calmly told me I need to go ahead and finish my paperwork and you know my husband to complete the paperwork and we sat in the waiting room as I was having all these symptoms and then soon after I went into triage and that honestly was the first moment where I really recognized that I might not be able to get the attention right away that I needed.At the time I was still having all the symptoms and the lady went to go take my blood pressure.And the top number of my blood pressure normally is very low, like low 100s or less.And so by the time I got to the emergency room and got my blood pressure done, I was in the 160s, which was extremely abnormal for me.And I tried to articulate that to the triage nurse.

[8:06] And she kind of just, you know, looked at the number and shrugged her shoulder and said, you know, it’s okay.And you know, I’m like, oh my gosh, you know, like still going through all these symptoms.So, you know, I had the blood pressure, the other vitals done, my heart rate was a little elevated, ended up getting a chest X-ray.From their view, nothing seemed very atypical or urgent. And so I was actually sat back in the emergency room waiting room for quite some time before I got care.What ended up making me get back to a treatment room quicker was that one of my resident colleagues from residency, one of my friends who had known that I had gone to the emergency room that night came to the waiting room of the emergency room to take a look at me to check in with me and he took one look at me.And went back up to the waiting room desk and said, she is a physician here, she needs to go back right now, something is really wrong with her.

Advocacy from a Friend Leads to Urgent Treatment

[8:59] And that’s how I ended up getting back to a treatment room. By the time he got there, I was probably sitting in the waiting room for probably about at least 30 minutes or so going through all these symptoms that I’ve described without anyone doing anything to help me with what I was going through.One thing I’m thinking about right now before we get into more of the story is, You know, one of the things that is common knowledge in our culture, at least here in where we’re both in North Carolina, you know, if you want to go back quickly to the emergency room, just tell them you’re having chest pain.

A Surprising Lack of Awareness and Coherence

[9:36] And interesting, what you’re saying to me is that didn’t happen for you. Yeah, yeah.And obviously, when I’m going through that experience, I’m not thinking coherently. Sure.The words bias or mistreatment were not even in my mind.I’m so focused on Maintaining my body at this point that a lot of the conclusions that I’ve drawn from that night have come after that evening You know, but yeah, like going to the emergency room having chest pain, Sweating profusely having you know vomiting, you know, these are pretty red flag signs You know that something is not right particularly after after just you know, having a surgery related to pregnancy, So yeah, you would think that I wouldn’t have to tell them that I was a physician, which I don’t normally do, because I don’t ever want to make it seem like I should be getting special treatment or anything like that.And it honestly never crossed my mind that I would need to tell somebody that I was a physician that night to get care for red flag symptoms in a timely manner.

Welcome to Rx for Success with Rhonda Crowe

[12:33] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches.Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.I really hope you’re getting a lot of great information.But if you’re looking for an answer to a specific problem, management or administration challenge, or if you’re feeling just a bit burnt out, like maybe you chose the wrong career, well, then there’s a faster way to get the help you need.No, it’s not counseling, it’s coaching.Rx for Success is produced by MD Coaches, a team of physicians who have been where you are.I know you’re used to going it alone, but you don’t have to.Get the support you need today.Visit us at mymdcoaches.com to schedule your complimentary consultation.Again, that’s MyMDCoaches.com, because you’re not in this alone.

Introducing Physician Outlook magazine

[13:35] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about Physician Outlook.If you haven’t discovered this remarkable magazine, please do so very soon.It was created by physicians for physicians to showcase the intersection between clinical and non-clinical interests.Whether it’s writing, painting, cooking, politics, and dozens of other topics, Physician Outlook gives a physician perspective.It’s available online and in print. It’s really unique among physician lifestyle magazines.And like the Prescription for Success podcast, Physician Outlook amplifies the voice of any physician who has something to say.It also engages patients who still believe in physician-led, team-based care.And Prescription for Success listeners can get three months free when you enter our promo code RX4Success and select the monthly option at checkout.That’s a really great deal on this stunning publication.And now let’s get back to today’s interview.

Helpful Moments in the Emergency Room

[14:45] When you were earlier saying there’s some places in that experience that were helpful and others that were not so helpful, can you say more about, let’s go ahead and talk about what was helpful.

[14:56] So we heard some of the non-helpful, but what ended up happening?I was actually talking to my, you know, I’m talking about my friend there, one of my friends from residency.I guess externally people would think we’re very different, but we’re very close friends.He’s a white male. We’re still very close friends now.And he actually had him and his wife and his family had come to simulate earlier that day.And so that was my first little moment of somebody pushing things along for me.Him just coming down to that emergency room after what he was doing that evening and checking on me was so helpful because it definitely got me back sooner than probably what I would have been able to.But after he stimulated that process for me to get back to the treatment room, actually one of the nurses that had been walking past me in the waiting room took one look at me, I guess, and she might have had a different lens at that point.And she was at that time trying to put leads on me to get the reading, what was happening with my heart and everything.And she literally said to my husband, Oh my gosh, I didn’t know that she was this bad.I’m so sorry. I didn’t recognize that she was this bad.So this whole process is going on. The emergency room doctor was not sure what was happening to me.And at one point, he even asked me what I thought was happening.And I told him I was not sure.He ended up saying to me that, okay, well, our initial tests are normal. They’re not alarming.

[16:20] And so maybe you’re having a heartburn, or maybe you’re having a panic attack.So I’m kind of thinking in my mind, of all the things that it could be.I’m telling him, I don’t know if those things are what’s going on or not.I don’t think that’s it because although I’m not having the pain at this point anymore because they had given me treatment for the pain, I still felt my heart kind of flipping in my chest.So he kind of left it there and said, okay, well, we’ll, like they traditionally do, we’ll repeat your tests, your labs again before we discharge you.But if everything’s normal, we’ll go ahead and send you home and you can follow up with your doctor in the morning. And I didn’t know, I couldn’t even think, I was like, okay, well, that’s totally fine.My primary care doctor I knew was somebody that would listen to me.But in the course of that time, the second person that I feel like was so.

[17:08] Instrumental in really helping me that evening was one of the cardiologists who must have been watching everything in the background and looking at my EKG and looking at my troponins, which is a know, a blood level, you know, associated with, you know, cardiac events. And looking at my repeat…Which was essentially was through the roof.He ended up flagging me as having this atypical condition with this heart attack caused by SCAD.And very pivotal in my care, not only because of him noticing it, but then also because he actually, believe it or not, was also a SCAD survivor from a different reason.His happened through physical activity.And so he had been, I guess, in the very primed, I mean, I guess you would say, to be able to see these early signs and know what to look for.So he was also very pivotal in my care. So thank goodness you got the care you needed and some stumbling blocks along the way.

The Impact of Implicit Bias in Healthcare

[18:06] And I know a lot of our listeners are physicians and we’ve all heard very, very similar stories.Some of us have had very similar stories.

[18:15] Medicine is, diagnoses are tough to make and there’s a lot of different moving parts going on. and we’re all aware that everybody’s mostly doing the best they can in the moment, right?

[18:27] And so, you said just a little bit ago that kind of in retrospect, your home, you’re recovering, in retrospect, you kind of look back at this whole experience and something dawned on you. You’ve used the word bias already.Can you say more about that? What dawned on you and how did that sort of emerge for you?Yeah, you know, I think, and I agree with you, there’s being a physician, you understand how incredibly difficult it is.

[18:54] Particularly in the emergency room, right, to take this patient that’s coming in with these symptoms and be able to diagnose them what you think the issue is, to be able to really start their care and start to make them well.So a lot of the things that happened that evening, I don’t actually attribute to bias at all, I attribute it to, you know, how our healthcare system is, how we have to function in the healthcare system because of the ups and downs of being associated with that system.But the thing that really sticks out to me is kind of like this premature closure, you know, that happened, despite me having these red flag symptoms, this premature closure that occurred or almost occurred in that emergency room, where, you know, the physician started saying, you know, maybe you have heartburn, maybe you are having a panic attack, despite me really, you know, trying to convey a lot of the other symptoms that I was having, you and not being able to broaden that diagnosis out to other things that you know might not have presented themselves in that you know the maybe hour and a half that I was in the emergency room.I think that is the thing that I mostly contribute to like what we call implicit bias.So for our listeners who don’t know, what is meant by implicit bias?

[20:03] Yeah, there’s a lot of definitions. You know, I think all of the definitions really include this word unconscious, right?It’s this understanding that there is a way that we think where we have our conscious thoughts, and then we have this area that is more like an unconscious process that’s happening, but we’re using it to interpret what we see in front of us.

[20:25] And so when we have this, what we call implicit bias, we’re using kind of this unconscious way of thinking to make decisions about what we do in our day-to-day lives. And we all do it.Everyone has it, it’s there for all of us, but if not addressed, it can definitely lead to some unfortunate circumstances for patients.And so we’ll get to how how do you address it in a little bit?But what I want to back up and just say this experience led you to The work some of which I’ve already described and can you say more about that?Like what what is it that this prompted you to to invest your energy into?Yeah, so after after that experience, I really was you know, just very My eyes were open to this other side of what happens in the healthcare system for patients that occurs before you diagnose them with a disease, before you give them a prescription.It’s this way that people are interpreting them before any words even come out of their mouth sometimes.And it really set me on this path to understand more about how that affects health outcomes.

[21:38] For me, I am fortunate, but, you know, in America, you know, black women like myself are three times more likely to die, you know, related to pregnancy.So, during the prenatal period, when they are delivering, and in the postpartum period.They are three times more likely to lose their life. And I almost became one of those statistics.And as staggering as that three times is, there’s a lot more women like me, we don’t even know what that statistic is that have had increased morbidity attached to pregnancy, which is a normal process.So black women who come out of the pregnancy period with hypertension.

[22:17] Having episodes of preeclampsia, having the constellation of other things that we hear that can lead to ongoing chronic disease.So it really set me on this path to understand that more, to help end that racial health disparity of black women being three times more likely to die after a normal process of pregnancy, and really seek ways to help learners and faculty members and healthcare providers like myself who want to do well, but most of us don’t go in wanting to hurt people.

[22:53] But for some reason, we’re still having these outcomes, trying to solve that puzzle and figure out how can we turn these racial health disparities around and make more people well.Yeah. So there’s a couple of just sort of scientific questions I have about that, Johnesha.One is my understanding that, first of all, that’s true for African American women regardless of socioeconomic status.Yes. Yes. That’s so true. I am a poster child of that, right?So, physician to income household, access from all levels, in addition to health literacy, and it still happened.And then the other part is, this is the part that I’m a little fuzzy on, the morbidity and mortality of African-American women, maternal health in America has been compared to African-American women in other countries.Is that correct? That is correct. and say more, and I’m going to get this wrong.So tell me what the outcomes of that research is.

Disparity in healthcare for African American women in the US

[23:57] Yeah, so the disparity is still there, and it’s worse in the United States, although there is an existing disparity in other countries.There was actually another study that was done that looked at the immigration of African-American women by generation from Africa, the continent, to the United States.And every generation away from that immigration, you start seeing poorer racial health disparities, particularly in the pregnancy period.So there’s something that’s happening, you know, with the care that Black women are receiving in the United States, unfortunately, that’s definitely causing some of these issues that we’re seeing.But one of the questions is, is it true that for African American women, it’s a higher risk to be pregnant than white women anyway, regardless of, I mean, if there was no implicit bias, no unconscious bias, I know we can’t know that, but do we sort of know that or is that true already?Well, I don’t think there’s anything unique to black women that’s increasing, you know, their health outcomes.And that shows in some of those research studies, right? If they were in other places and they would not have this increased risk.It’s not attributed at all to a genetic predisposition.

[25:18] But definitely there are some things in the system and also, you know, the experience of being in this culture as a black woman that are also linked to differing health outcomes for this racial demographic.So let’s start there. Go ahead and say more about that. And then we’ll talk about how unconscious bias might be contributing to the problem.Yeah, so that’s another thing that I spend a lot of time talking about with my work in Birthright is really this topic of weathering, which we know it as kind of like this term we talk about rocks and minerals and how wind and… other elements, you know, natural elements can kind of chip away at rocks and make different patterns and just change the outer exterior of a rock.That term of weathering that we take from, you know, that geographical kind of perspective or that ecological perspective, you’re applying it to health, right?So the experiences of being a black woman in this culture and the stress that comes along with, you know, different types of microaggressions and experiences that you might have as a child, or honestly, even experiences which we now know, epigenetically, experiences that have happened generations before that are still carried through to, you know, offspring, can definitely predispose someone to having poorer health outcomes.Right. So, the weathering piece is one.

Unconscious bias experienced by black women in healthcare settings

[26:45] That’s the thing that we carry with us, that you carry with you.I’m not an African-American woman. So there’s this African American woman who has the epigenetics, has the weathering, and they enter into the medical environment.And what are some examples of the unconscious bias that African American women are experiencing in the health system?Yeah, well, so now there’s a lot of studies that, you know, are talking about the experience that not just black women, but black and brown people are having, you know, as they enter the healthcare setting, where they’re not being, they feel like their care is different based upon how they appear to their healthcare provider, you know, with the clothes they wear, whether their hair is done a certain way.And they feel like they get differing levels of care because of that.It’s well documented that black women through chart review have had differing pain management during the pregnancy period when they’re admitted for labor and after compared to their white counterparts.

[27:48] And then when you build on top of, obviously this is bigger than a socioeconomic issue, but when you build that on top of patients who might have issues with access or even finding a black doctor who is able to care for them in the prenatal period, because now there’s evidence that shows that black patients, you know, have different outcomes when they’re cared for by black physicians, you know, and knowing that black women are only 2.7% of the physician population, just that decrease in access with someone that you can relate to that you feel like sees you in a different way also leads to kind of this experience of you being further and further away from the type of care that provides you with the opportunity to have the best types of outcomes that you can have.It makes me want to kind of bring it back to you and your experience in the emergency room that night.Are there, are there some things that you’re now thinking of that you haven’t mentioned yet that may have been, again, well-meaning people, you know, unconscious bias is unconscious.

Reflecting on personal experiences and unconscious bias in healthcare

[28:47] And so nobody volitionally tried to ignore anything that you were going through.But what were some of the things as you look back on it, that perhaps because people had, the healthcare system has unconscious bias that you experienced?Well, honestly, the first person that I have to really, really reflect on is myself, honestly.

[29:08] And as I tell this story a lot to, you know, community members that I work with, and like as I’m having these conversations with people and writing about it to like raise awareness, I have to acknowledge, that I definitely was living in that time in a more stressful state than I live in now.I lived in a state where I definitely did a lot of disconnecting from my emotions, a lot of not asking for help, doing a lot of things that probably pregnant women should not be doing during that very pivotal time.Because this whole societal belief about strong women and superheroes and just being a black woman and what you’re, quote unquote, expected to do, you know, definitely didn’t do myself any justice by, you know, increasing the level of stress during that very, you know, pivotal time as my body’s trying to heal.So I actually spent a lot of time talking with black women about not subscribing to these beliefs that we have to do all and be all, and to prioritize our mental health, and prioritize our wellness so that we can help our bodies.

[30:17] Have better health outcomes and actually be able to listen to our bodies when it’s giving us the signals that something’s not right so that we can seek care earlier.That has to be the first place I start because now living in a different space of maturity, I guess, I definitely see how that was the first piece to this puzzle before I even came into the emergency room.

Systemic factors contributing to varying healthcare outcomes

[30:40] And moving from that, I think, to the experience, you know, just to tell your listeners, I grew up abroad.So I grew up outside of the US and I enjoy being around a lot of different cultures.And I just love being around different types of people.I feel like that’s my best environment. And I really like to share that because I think sometimes when we talk about racism, we talk about it and people think it’s a black white issue.And it’s not, you know, everybody has implicit bias. Black physicians have implicit bias.Everybody has it, you know? And then on top of that, there is this history in our society that has occurred.And we still have policies and practices that are rooted in a lot of those decisions that were made years ago that were more overtly to create this hierarchy in society.And so, when you’re thinking about that experience that I had in the emergency room, and as I reflect on it, that’s the biggest thing I see is this systemic way that our society sets up people to get varying outcomes from being patients.

[31:47] So walking into the emergency room and you know being treated you know the way I was treated at the front desk or you know the way that you know the nurses wanted to avoid my stare you know or avoid kind of what was happening in the in the tree you know in the waiting room.These are not things that people want to do but it’s kind of the way that the system is set up you know as opposed to if I came in and I was the CEO of the hospital and they recognized me.

[32:13] Or I came in looking a different way, I might get more faster, delicate care. Those are all societal things.So I think that’s the second thing that I address in those moments.The third part of it definitely is this conversation around that interaction with the emergency room physician.

Bias and premature closure in emergency room interactions

[32:31] That premature closure, sometimes people ask, do you think it was just because you were black.I can’t say that. I don’t know that to be true.It could be because I was a woman. It could be because he thought I looked young.It could be because he thought I was black. It could be because of all three.But what I do know is there was some bias in that moment that maybe if I looked different or maybe reminded him of someone else, that he would have maybe taken a little bit more time with that diagnosis or even admitted me for observation.Some of the outcomes that I’ve seen happen in different settings with less symptoms.And those are conversations we need to have about why does someone like me, when they come into the emergency room, you know, and on paper, if you didn’t know anything about me demographically, you just knew my symptoms.

[33:20] You know, it would seem that I should be the one, you know, that would stay for observation as opposed to others who are admitted for less symptoms or the same, you know.So it’s that difference and less about saying, oh, this person is, you know, has racism or this person, you know, wants to treat me badly.It’s less about that and more of a focus on why are some people treated differently than others?Why are these outcomes different? You know It would be very remiss of us if we did not add race into that with the history of our country But it’s definitely not the end-all be-all.I really appreciate you parsing that out and discussing the nuances and Pointing out that there’s a lot of different things going on And so, for all of us, I think one of the things that you’ve contributed to all of us listeners is for us to begin thinking about, boy, how does this operate in me?

[34:16] Which is unconscious, it’s not my choice, but when I look at somebody that may be in the majority, but I may be treating them differently than I should be treating them as well.And so, thank you for that. That was a great description of what, kind of unconscious bias in reality.So, what is our way out? you know, your work now, in addition to the clinical work you do, you’re doing some great work in advocacy and public health and your nonprofit.

[34:43] How do we address this? I think a huge part of it is not only awareness, but a plan of action.That counteracts or neutralizes, you know, that unconscious process that we have been set up to have, you know, because of the things that we see and the messages that we see in our society.

Tools for Addressing Unconscious Bias

[35:03] So what that looks like is being aware, becoming more aware, making a conscious effort to be aware of our unconscious bias, and then also creating a plan around these spaces like healthcare, where we can have tools in place that check our bias to make sure that it’s not being a part, it’s not becoming a part of decisions that we’re making for patients without true evidence. Do some of those tools already exist?Oh yeah, so there’s a lot of different awareness tools.I think the easiest one that’s most used now is the Harvard Implicit Bias Test, the IAT.Definitely use that. But honestly, in addition to that, one of the things I think is most beneficial of becoming aware of your bias is actually learning more about different types of people.

[35:53] I don’t even think you need that test to do that, although it’s a great test and I’ve taken it multiple times and it’s pretty accurate.

[36:01] I think getting to the space where you can have conversations with people, learning about them, individualizing people so that you’re not unconsciously grouping different types of people into boxes because you don’t know very much about other cultures is a very great way of starting that.Reading books, I mean, we are blessed to be in a country where we have access to education and there’s so many biographies, autobiographies, and documentaries to learn more about people and their experiences and their cultures so that you can start filling in those spaces where implicit bias rests.You actually can start filling them in with conscious education about how people are as opposed to putting them into these different groups.And then taking a moment before you make decisions to say, Hey, is what I’m about to say or what I’m about to do, is it truly because of something that I know about this person or is it because of something else?And if you don’t have that answer, then it becomes like this way of learning how to practice how you ask for more information.That’s a lot of where most physicians are, is like everyone wants to do better.They want to be able to talk to people.They want to be able to learn more about people, but sometimes, you know, we haven’t been given the tools to overcome kind of like those.Moats that are kind of between us and people who you know, we’re not used to being around So.

[37:27] You know finding a space or a person that you feel like you can You know share some of these things with and learn the right way to you know to learn more about people to ask for more information to ask, you know, the questions that you need to know to Get the information that you need to make a good decision.

Remaining Curious and Embracing Imperfection

[37:44] Great. Thank you if I had to sum up what you just said, which is beautiful, was is to always remain curious.You know, to be in that space of curiosity, which is the antidote to premature closure.You know, it’s just to always be out there like, and then examining ourselves, what am I making this decision about? Is it about pattern recognition?Is it about, you know, is it about, you know, what is it? Is it about the clinical evidence in front of me?So that’s great, thank you. So, Jonesha, just as we wind up, is there this whole experience from a person who’s learning family medicine.

[38:21] And now you’re a patient, and then you’re looking at how your experience as a patient has informed a lot of the work that you’re now doing.Anything else that you want to say about this that you haven’t said yet that you wish to impart to our listeners? The only thing that comes to mind for me right now is remembering that no one is perfect and understanding that.Honestly, even being a patient and going through that experience and actively trying to become an advocate in this space and an ally for other spaces that, you know, I don’t fully understand but want to be an ally for, I still make mistakes.And I think it’s important for people to understand that everyone makes mistakes.And if you can get to a space where you can acknowledge missteps and say you want to learn and really, really put the work in, right, like really show demonstration that you are trying to change, there’s so much forgiveness there and there’s so much understanding there.And I feel like that’s the space everyone needs to be in. Not in the space of like trying to get it right all the time or trying not to say something wrong, but more in the space of, I know I’m going to mess up because I’m learning.And kind of having that humility to kind of be open about those missteps and seek out ways to continually be better is the way, as opposed to trying to reach for perfection.

[39:47] Very, very wonderful words of wisdom. I really, really appreciate that.Appreciate your sharing your experience. It’s a vulnerable experience.

[39:58] There’s also things that you’ve learned from it. There’s something about humility in all of this.There’s something about curiosity in all of this. And really appreciate what you have brought to the listeners, what you’re bringing to the community and what you’re gonna be bringing to the larger community of all of us.So, John Asha Brown, thank you once again for being a guest here on Life-Changing Moments.And I wish you well in all the endeavors of educating all of us.Thank you so much. The pleasure is mine and I just really appreciate you giving me the opportunity to share my story. So, thank you.

Dr. Brown’s Life-Changing Moment and Career Path

[40:36] I want to once again thank Dr. Brown for taking the time to have this conversation with me.Her life-changing moment of illness created an additional career trajectory for her that involves education, raising awareness, and advocacy.The lessons that she imparts here are salient while also self-effacing.So here are my takeaways.Number one, making diagnoses is a complex art and our medical system is complex.Sometimes systems issues or familiarity bias can sway our thinking and this can cause premature closure.We’re all at risk for this. Also hidden is unconscious bias, the unconscious process that we use to interpret and make decisions about what is in front of us.We all carry these unconscious biases based on all of the life experiences and influences on our thinking since, well, birth.It is helpful to first acknowledge that these exist in all of us.Then, seek to understand what situations you may automatically drop into unconscious biases to make decisions.

[41:53] One way to do this is to take one or more of the many implicit association tests developed at Harvard which you can find online.Then, create a plan to neutralize those biases.To simplify this last step without having to do all that is just to ask yourself when deciding on a course of action for a patient.Am I doing this because of what I know about this individual person or is it because of something else, like a generalization about an ethnic group or a socioeconomic group?

Lessons in Professional Improvement and Self-Care

[42:23] Number three, recognize that no one is perfect. Everyone makes mistakes.

[42:28] Recognizing our missteps and owning them is the first step towards professional improvement.With respect to unconscious bias, we may seek to get better at what we do by practicing individualized care and remaining curious as Dr. Brown illustrated.Number four, putting aside implicit bias, I really have to reinforce Dr.Brown’s self-reflection about how she may have inadvertently contributed to her illness by ignoring some basic precepts of self-care in order to maintain an identity of strength and resilience.We clinicians are all at risk for this and I’d like to take every opportunity to remind us on this podcast, examine our self-talk.Is our self-talk helpful for our health?Would we suggest that course of action we’ve chosen for ourselves to a patient?Well, there’s so much more to think about and to leave with as a result of this discussion with Dr.Janesha Brown. Thank you for listening.And remember, if you’re at a career crossroads, looking for leadership development or experiencing burnout, consider making an appointment with one of the physician coaches at MD Coaches.We’ve all been there and we’re here to help.You can find us at MyMDCoaches.com. Thank you again, and be well.

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