Recognizing and Managing Implicit Bias

🚨🚨🚨 New Article Alert🚨🚨🚨 Exploring Obesity Bias in Medical Education 🩺 How do medical students learn about obesity...and what are they actually observing? Our new study, published in Teaching and Learning in Medicine, examines third-year medical students’ firsthand clinical experiences with obesity bias during their clinical training and prior to medical school. Students described moments that were eye-opening, uncomfortable, and deeply formative, from overhearing stigmatizing jokes to watching patients’ concerns dismissed as “just your weight.” Many recognized that bias is not simply about individuals but reflects broader systemic pressures within medical training and care. Importantly, this study does not place blame on clinicians. Providers and trainees enter healthcare with the same cultural and environmental influences that shape bias in all of us. Under conditions of stress, burnout, and limited time, those biases can surface and become normalized through what’s known as the hidden curriculum, the unspoken lessons absorbed through observation. 🔑 The key message: obesity bias is amplified through systems, not intent. And that means we can unlearn it, by creating clinical environments that foster empathy, reflection, and person-centered care. By modeling curiosity, compassion, and respect for every patient, we can equip future clinicians to deliver equitable care and begin to dismantle the hidden curriculum for good. I’m deeply proud of our team of researchers and educators who continue to drive this critical work forward. And shout out to Dr. Robyn Pashby for always being an incredible sounding board and reviewer! Elizabeth Cotter, Ph.D. Ashley Dunford Nicole Farmer Lawrence Deyton  Read the full article here: https://lnkd.in/eSuVu6kD Ted Kyle Patty Nece Dr. Sylvia Gonsahn-Bollie, M.D., DABOM, FOMA Michael G. Knight, MD, MSHP Fatima Cody Stanford Matthew Haemer Stephen Pont, MD, MPH Stephen Cook, MD, MPH Rebecca Puhl Jaclyn Albin, MD, CCMS, DipABLM Thao-Ly Phan, MD, MPH Medscape Jennifer Groos Katie Queen Nimali Fernando, MD, MPH, FAAP Christopher Duggan Michelle Cardel, PhD, MS, RD, FTOS Denise Wilfley Ron Stout MD MPH Alicia Lackro Ryan Kane Dariush Mozaffarian MD DrPH

A patient kept presenting with a 0.3 to 0.4 blood alcohol level and insisting he had not been drinking. For five years, the system decided he was lying.   This is not a story about one stubborn patient. It is a story about what happens when a real diagnosis does not fit the pattern, and how quickly clinical judgment defaults to the most familiar explanation instead of the correct one.   The patient was Joe, husband of nurse researcher Barbara Cordell. The condition was auto-brewery syndrome, where an imbalanced gut microbiome ferments ordinary carbohydrates into endogenous ethanol faster than the body can clear it. Rare, but in Cordell's experience underdiagnosed.   For anyone who leads clinical teams, trains physicians, or builds the protocols that decide which patients get believed, the lessons are worth sitting with.   First, the most dangerous phrase in a workup is "that is not possible." Multiple specialists and an emergency room reached for secret alcoholism because the alternative sounded impossible, and being impossible-sounding is not the same as being wrong.   Second, the diagnosis broke open only when one gastroenterologist did two unglamorous things: he read the existing case literature, and he designed a controlled inpatient carbohydrate challenge so the team could observe the mechanism directly. Curiosity plus a test beat consensus.   Third, the cost of dismissal is not only diagnostic delay. Cordell's blunt reminder is that patients in this position were often disbelieved and even called names, and that the compassion to keep listening erodes under fatigue. A culture that does not protect that compassion will miss the patient who does not fit.   Search "The Podcast by KevinMD" wherever you listen to podcasts   What is one change to your team's workup or review process that would make it easier to take a patient seriously when their story does not match the textbook?   #HealthcareLeadership #PatientSafety #DiagnosticExcellence #PhysicianWellness #ThePodcastbyKevinMD

It was frustrating the first time I heard “I treat all my patients the same” used as a defense when different groups experience different outcomes. How many of us have heard or even said that — only to realize later that good intentions alone don’t immunize us from bias? The recent STAT article about Black patients being dismissed as “hard sticks” during IV placements is a stark reminder: bias in medicine can be subtle. A sigh. A glance. A clinician giving up too soon. These moments seem small — but they erode trust and cause real harm. Training alone won’t suffice. We must pair awareness with system-level change: diverse care teams, standardized protocols that recognize and correct for bias, and institutional commitment to equity for every patient. Well said Jahidah La Roche: "Health care providers — nurses, physicians, and allied health professionals — must actively interrogate their own biases in real-time and ask: Am I giving this patient the same effort I would for someone else? Have I adjusted my technique before blaming the patient’s hydration status? Am I really looking?" #HealthEquity #PrimaryCare #ImplicitBias #IntegratedCare #TeamBasedCare

Your competence at work is judged in seconds. Even when you over-deliver, you can be underestimated. Every day, false assumptions about you are made: — Polite = Weak — Older = Not agile — A foreign accent = Less capable — Introverted =  Not a strong leader — Woman =  Softer voice, less authority It's not just unfair. It's exhausting. So the question is: How do you beat biases without changing who you are? Here’s what I recommend: 𝟭. 𝗖𝗼𝗻𝘁𝗿𝗼𝗹 𝘁𝗵𝗲 𝗻𝗮𝗿𝗿𝗮𝘁𝗶𝘃𝗲 → Speak about impact, not effort. → Articulate your value proposition. →“Here’s the problems I solve. Here's how. Here’s the result."  If no one knows what you bring to the table, they won’t invite you to it. 𝟮. 𝗩𝗶𝘀𝗶𝗯𝗶𝗹𝗶𝘁𝘆 𝗶𝘀 𝗽𝗼𝘄𝗲𝗿 Silent excellence is wasted potential. → Speak up when it feels risky. → Build real not just strategic relationships. → Share insights where people are paying attention. You don’t need to be loud. You need to be seen. 𝟯. 𝗧𝘂𝗿𝗻 𝘆𝗼𝘂𝗿 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝗰𝗲𝘀 𝗶𝗻𝘁𝗼 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁𝗶𝗮𝘁𝗼𝗿𝘀 The traits that trigger assumptions? Those are your edge. → Introverted? That’s deep listening. → Accent? That’s global perspective. Don’t flatten yourself to fit. Distinguish yourself to lead. 𝟰. 𝗢𝘄𝗻 𝘆𝗼𝘂𝗿 𝗽𝗿𝗲𝘀𝗲𝗻𝗰𝗲 → Say “I recommend” not "I think.” → Hold eye contact. Take up space. → Act like your presence belongs (even when others haven’t caught up.) Confidence isn’t volume. It’s grounding. Bias is everywhere. But perception can be changed. Don't let other people's false assumptions define you. Do you agree? ➕ Follow Deena Priest for strategic career insights. 📌Join my newsletter to build a career grounded in progress, peace and pay.

Every few weeks, I see a patient with refractory “diarrhea” who’s had numerous unrevealing tests and failed multiple therapies. Most have seen several gastroenterologists. All are desperate for relief. We discuss their symptoms, I examine them, and usually order just an abdominal X-ray. They’re routinely shocked when I tell them they’re actually suffering from severe constipation. I won’t pretend to be a diagnostic wizard. But after years in practice, I’ve learned to think differently when stories—like this not uncommon one—don’t add up. This thoughtful new JAMA Viewpoint notes that most diagnostic errors involve common diseases clinicians didn’t consider, not rare ones they forgot. These are thinking errors, not knowledge deficits. These thinking errors often arise when we over-rely on “illness scripts”—the type of "mental flash cards" we use to recognize patterns and make quick diagnoses. In this case, a patient referred with diarrhea who has normal tests and hasn’t responded to drug X or Y must have IBS or functional diarrhea, right? Time to try drug Z. This kind of fast, intuitive “System 1” thinking is efficient but prone to biases like premature closure (rushing to a conclusion) and anchoring (overweighting one data point). To avoid these traps, we must sometimes engage slower, more deliberate “System 2” thinking—pausing to ask what else could explain the story. In other words, we must develop the discipline to know when to shift from pattern recognition to critical thinking. That discipline is becoming even more essential. As AI surpasses us at pattern recognition, we must double down on learning not just what to think, but how to think when patterns don’t fit.

🧠 We’ve all been mansplained (unsolicited explanations of things we already know) and he-peated (our idea ignored until a man says it). This happens to interns and SVPs, in finance and philanthropy, in boardrooms and basements. Bias is real. And women help it along. Years of social conditioning taught us to bubble-wrap our point in apologies: "I just want to say... " "Sorry I mean...." "I am not sure, but I think..." "Does that make sense? No one is forcing those words into our mouths anymore. We put them there. If I’m the one pressing my own mute button, I’m also the one who can take my finger off it. Uma and I are often on coaching calls, listening to brilliant women explain a challenge in six scenic paragraphs while we bite our lips thinking, 😅 “How do we say: come to the fucking point.... kindly?” 🪞 I’m not saying “talk like a man.” I’m saying talk like a decision-maker. In the workplace, time is money, perception is reality, and clarity is kindness. You can be warm and still be sharp. You can be collaborative without narrating your inner monologue. Here are 4 verbal moves: ❌ Don’t: “ So quick background… long story short… the market, the vendor, last quarter…” ✅ Do: “Decision: approve X by Friday to hit launch. Two reasons: 1) … 2) …” 👉 Write your headline using Verb + Decision + Deadline (“Approve X by Friday”). Then give two bullets max: “Because 1)… 2)…”. Practice with a 6-second voice note; if you spill over, your headline isn’t a headline. ❌ Don’t: “I’m worried we might be a bit behind and it could become an issue.” ✅ Do: “We’re 3 weeks behind; risk €120k. Option A recovers 2 weeks; Option B recovers 3 with a 10% scope cut.” 👉 Translate feelings to facts with this template: “Status: X; Risk: Y; Options: A/B with trade-offs; My recommendation: R.” Ask “What number proves this?” until you have one. ❌ Don’t: “Sorry, can I just add, (gets interrupted)… yeah, no worries.” ✅ Do: “I’ll finish, then happy to take questions. Building on what I proposed earlier, next step is…” 👉 Memorize one boundary line and say it verbatim. Sit slightly forward, palm down, finish your sentence. If credit drifts, tag it back: “As outlined earlier, I’ll proceed with…” Then move to action. ❌ Don’t: “Maybe someone could own this? Otherwise I’m happy to help if needed.” ✅ Do: “I own A. Priya owns B. We need your yes/no today. If yes, I’ll send the plan by 17:00.” 👉 How to: End every contribution with Who/What/When. Ask for a binary (“yes/no”) to force a decision. Follow up in writing within an hour: subject “Decision + Owners + Deadline,” one paragraph, three bullets. 🧩 Different styles can all be powerful; None of them requires apologizing for existing. You’re not too much. You’ve been practicing small. If you want the reps, grab the replay of our 90-min webinar “Confident Communication.”, 👉 https://lnkd.in/ginRMa4q Because the shortest true sentence wins...

Your best outcome last quarter might have been due to a bad decision… Annie Duke — champion poker player, PhD in cognitive psychology — calls the confusion "resulting": judging a decision by its outcome. Poker exposes the error fast. Players make a reckless call, get lucky, conclude they're geniuses, repeat the call, and get wrecked. Offices make the same error in slow motion. The deal closed, so the rushed diligence was "decisive." The hire worked out, so skipping references was "trusting your gut." Luck gets promoted to skill, and the bad process gets institutionalized. It cuts the other way too: some of your best decisions produced bad outcomes, and they're wrongly filed as mistakes. That's how good judgment gets trained out of teams. The fix, from her book Thinking in Bets: evaluate the process, not the result. Treat beliefs as bets — how confident am I, really? Estimate probabilities instead of assuming certainties. Separate what you controlled from what you didn't. One uncomfortable question for your next win: did we decide well, or did we get lucky?

Designing learning that works for every mind. In preparation for our session at World of Learning in October, Emma Hutchins and I are asking neurodivergent learners to share the 'one thing' above all others that would improve their digital learning experience. Thanks so much to everyone who engaged with and contributed to our last LI post. The list below is what we have so far. But are we missing anything? We'd love to hear from you in the comments if your 'one thing' doesn't appear on our list. Content design and structure - Provide clear and consistent instructions throughout all learning materials. - Ensure a clear and logical content structure so information fits neatly into well-defined categories. - Avoid poor colour contrast and other design issues that contribute to sensory overload. - Avoid locked navigation controls (like 'Continue' buttons) unless it is obvious what needs to be completed to progress. Control over media and sensory input - If possible, avoid linking to external video sites (such as YouTube) unless the learner’s return path is clear and accessible. - Do not include moving or animated content unless learners can pause or stop it. - Allow learners to change the speed of video content (both slower and faster) to suit their processing needs. - Always provide transcripts for video and audio to offer choice in how content is accessed. - Give learners control over narration and audio - allow them to start, stop, or bypass it entirely. - Keep multimedia experiences manageable to avoid overstimulation from multi-sensory overload. Assessment and feedback design - Write unambiguous questions and instructions and test them for clarity. - Provide clear, direct feedback for knowledge checks - explicitly state the correct answer and explain why it is correct. - Avoid double negatives in both questions and feedback, as they slow comprehension and retention. #WOL25 #Neurodiversity #Inclusion #Accessibility  (Five outlined human profiles, each with different colourful brain representations, including connected nodes, flowers, gears, puzzle pieces, and hearts, symbolising diverse thinking styles.)

Smart people are often underestimated. This was the topic of the fascinating podcast I did with Jordan Peterson. As a recovering awkward person myself, I know firsthand how brilliant people can sabotage themselves without realizing it. Why do so many competent individuals get overlooked while less qualified people advance? Why is it hard for smart people to communicate their smart ideas? It's not about intelligence - it's about communication. Here are the 5 most important insights from our discussion: 1. Soft skills are learnable like hard skills: You can study conversation and body language just like chemistry. My professor told me this in college, and it changed everything. Systematic learning removes the anxiety. 2. Warmth + competence formula: 82% of impressions come from these two factors. Competence without warmth creates suspicion. People need to trust you before they'll rely on you. 3. Avoid these credibility killers: Uptalk (ending statements like questions), hunched shoulders, excessive nodding, face-touching. These trigger mistrust, even when unintentional. 4. Precision signals mastery: Clear, concise words + purposeful gestures show you know your material. If you need notes, you don't know it well enough. 5. Reframe salary negotiations: Position yourself as a problem-solver or ally, not a supplicant asking for favors. Show your value, don't just request money. The gap between competence and communicating competence costs careers. But it's fixable. Listen to our full conversation here: https://lnkd.in/gF5ZK8xk

“You’ll never grow your business if it takes you a week to prepare a client presentation.” That’s what my business mentor told me some time ago. “I do it in an hour,” he said. “I just throw the slides together.” I was stunned. Slides?! But that’s just 1% of the work. - I read every piece of research. - I anticipate participants’ objections, needs, and goals. - I double-check every statement with meta-analyses. Every. Single. Time. “You overcomplicate it, Susanna,” he said. So I asked him: “Has anyone ever challenged every statement of yours?” He smiled. “Never.” That’s it, I thought. This isn’t just about working styles. This may be the Prove-It-Again Bias in action. The Prove-It-Again Bias is a well-documented* form of unconscious bias where certain individuals often women, people of color, and those from underrepresented groups are required to continually demonstrate their competence, even after previous successes. Here’s how it shows up: • Their mistakes are remembered longer than those of others. • Their achievements are discounted, attributed to luck or help rather than skill. • Their ideas are scrutinized more closely, needing more evidence to be accepted. • They are asked for more “proof” than peers who are granted trust upfront. Paradoxically, it makes me better, yes. It raises the quality of my work, sharpens my thinking, keeps me rigorous. But it also costs me time, energy, and headspace. It’s an invisible tax many of us pay just to be taken seriously. And more dangerously: it can stop us from sharing bold, original ideas because we know pure judgment won’t be trusted. Only proof. Again and again. Psychological safety I believe is the only antidote to Prove-It-Again Bias because in a truly safe team, no one has to keep re-earning the trust they’ve already earned. * Research reference, of course 😅: 1. Lyness, K. S., & Heilman, M. E. (2006). When fit is fundamental: Performance evaluations and promotions of upper-level female and male managers. Journal of Applied Psychology, 91(4), 777–785. 2. Williams, J. C., Phillips, K. W., & Hall, E. V. (2014). Double Jeopardy? Gender Bias Against Women in Science. Center for WorkLife Law. 3. Eagly, A. H., & Karau, S. J. (2002). Role congruity theory of prejudice toward female leaders. Psychological Review, 109(3), 573–598.