Currents

Strategies to Combat Unconscious Bias

Rene Salazar, MD discussed how unconscious biases can impact patient care in a session at the 2019 American Academy of Dermatology Annual Meeting earlier this year. He shared tips for identifying biases, including a self-assessment test, how these unconscious biases impact relationships with patients, and how to can overcome them.

“There’s been quite a bit of research over the last couple of decades that have shown the impact of unconscious bias as it pertains to patient care,” he says. “The studies have shown over and over again that unconscious provider bias—which essentially is biases that providers may not be aware of—can have a huge impact on how patients are cared for. Examples of that include differences in how patients are treated for pain that’s based on race and ethnicity.”

Dr. Salazar says numerous studies have suggested that physicians can use interventions to address this and potentially minimize the impact of bias as it pertains to patient care. And, he notes, more recently, there has been bias shown toward providers by patients, including bias based on race, ethnicity, sexual orientation, and gender, which also should be addressed as more diversity in healthcare is sought.

He recommends that physicians consider taking an Implicit Association Test (implicit.harvard.edu/implicit/), a test that was designed in 1998 that is administered online to assess an individual’s unconscious biases. Studies have shown that IATs can predict provider behavior, he says.

“Other strategies that one can use to address unconscious bias include things like being more empathetic—having the opportunity to engage with patients and individuals can be quite powerful in terms of understanding their perspectives,” Dr. Salazar says. He also recommends trying to create space to not feel as rushed during patient visits, and possibly even taking a break between patients to reset.

In terms of patient bias toward physicians, he recommends that health enterprises and institutions set policies that inform patients about what behavior is acceptable when dealing with providers.

Get more from Dr. Salazar by visiting our website at PracticalDermatology.com and searching “Unconscious Bias”.

Innovations in Dermatology: Derm Residents Look to Optimize Total Skin Exams

Researchers at the Penn State Health Milton S. Hershey Medical Center are using engineering principles to improve the accuracy and efficiency of total body skin exams.

There is no standardized method for performing a total body skin exam. Dermatologists may develop their own approach, which can potentially result in missed areas and lost time. The research team knew that bioengineering principles had helped Olympic athletes make the most of each motion and started to wonder whether the same principles could be applied in medicine. Their findings appear in the Journal of the American Academy of Dermatology.

“Efficiency and accuracy are important because we do a lot of total body skin exams every day,” says dermatology resident Matthew Helm, MD in a news release. “If it takes us 20 minutes each time, we will never get through our day. However, we do not want to sacrifice accuracy for efficiency.”

The researchers teamed with Penn State engineering students in efforts to find the sweet spot between efficiency and accuracy.

“Part of our students’ capstone program is to work on a real-world problem and deliver results to their sponsor,” says Charles Purdum, assistant teaching professor and director of industry relations in the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering. “This project was attractive to me because it was a unique application of engineering principles in the health care field.”

A mix of biomedical and industrial engineering students formed the team that consulted with Jeffrey Miller, MD, chair of the Department of Dermatology at Penn State College of Medicine, on the project. They met on a weekly basis and gave proposals, timelines, updates and a final report.

“We treat it like an engineer’s first project out of college,” Mr. Purdum says. “It’s a great model to show students what industry is like.”

The engineering students watched video recordings of five dermatology faculty and five residents conducting total body skin exams on both a male and a female patient. They assessed the exam time, physician and subject movements, sequence of body parts evaluated and whether any body parts were missed. Using statistics, the students calculated the variability between the evaluations performed by each provider. The engineering students observed that the underside of the neck and armpits were frequently missed areas and considered that when designing the optimal order of the procedure.

After watching the videos a second time, the students proposed a more efficient and accurate technique to Dr. Miller and the dermatology residents.

“The proposed method was different from how I had been doing the exam,” says Dr. Helm. “Now I use the optimized way, and I feel like it has helped me to be a better clinician.”

Dr. Miller hopes to help prevent errors by teaching faculty, residents, and medical students the new technique. The next phase of the research will measure if that educational objective is successful.

“If we can save one life from skin cancer because we are doing the exam consistently well, then we’ve succeeded,” adds Dr. Miller.

L’Oréal Rewards Social Initiatives Led By Dermatologists at WCD

In partnership with the International League of Dermatological Societies (ILDS) and the 24th World Congress of Dermatology (WCD), L’Oréal announced the laureates of the third International Awards for Social Responsibility in Dermatology: “Caring to Inspire Skin Confidence.”

The program aims to reward social initiatives led by dermatologists, improving patients’ physical and psychological well-being, self-esteem, social integration, and skin health, and enabling patients to re-engage socially.

Brigitte Liberman, President of L’Oréal’s Active Cosmetics Division, says, “Social responsibility is a priority for L’Oréal and we are proud to partner with the ILDS and the WCD to reward iconic dermatologists having positive actions on people’s lives.”

Professor Harvey Lui, President of the ILDS, adds, “Beyond the day-to-day activities of dermatologists in managing patients with skin issues, there is a vital social role, which is exemplified through our partnership for these awards and lies at the heart of the ILDS philosophy to promote skin health for the world.”

WATCH NOW

On-line reviews can be one-sided, as dermatologists may be limited in their abilities to respond due to HIPAA regulations. However, the best defense is a good offense, says Neal Bhatia, MD. He recommends partnering with patients and creating positive experiences that limit sub-prime experiences.

A total of 123 projects across the world were evaluated by a panel of experts. Dermatological projects fulfilling at least one of the following three categories were accepted for assessment: Prevention and education on skin health; Improved quality of life and self-esteem for people facing skin issues; and Access to care, coverage and surgery.

• For Africa & Middle East: Prof. Dalia Gamal Aly & Dr. Ragia Hany Weshahy from Egypt: For a Better Life after Burns
• For Asia: Dr. Sabina Bhattarai from Nepal - Dermatology Patient Care in Rural Nepal: Reaching the Unreached
• For Europe: Prof. Kathrin Giehl from Germany - Besonderhaut: Initiative for Children with Rare and Genetic Skin Diseases
• For North America: Dr. Mark Holzberg from the United States: Volunteer Dermatologist Dermatology Clinic for Atlanta’s Homeless at the Mercy Care Clinic at the Gateway Center
• For South & Central America: Dr. Carolina Reato Marçon from Brazil - Pró-Albino Program: Prevention, Diagnosis and Treatment of Actinic Skin Damage, Emotional Support and Social Inclusion in Albinism.

For videos of the 2019 awarded projects, visit inspireskinconfidence.com.