My last two posts talked about normalizing gender pronouns in healthcare and how to use pronouns appropriately. For day four of Better Speech and Hearing Month (and Star Wars Day… May the Fourth Be With You.), I am talking about identifying and owning internal biases as an SLP. Likely, many of us have gender bias that emerged from society’s emphasis on the gender biases. There are many other types of biases that can relate to race, ethnicity This is important because our biases can cloud even our clinical judgement and decision making. By recognizing and acknowledging them, we will be both a more culturally sensitive and professional SLP that makes the most evidence based and appropriate clinical decisions. When we reduce the impact of our personal biases by understanding when they may interfere in our work, we are more objective and serve our patients even better than before.
What Is Bias?
Oxford Dictionary defines bias as prejudice in favor of or against one thing, person, or group, usually in a way considered to be unfair. Prejudice is a preconceived opinion not based on reason or actual experience. Prejudice is more of an attitude, whereas bias takes that attitude and involves it in decision making and actions, whether consciously or unconsciously.
Source:
Oxford Languages and Google – English | Oxford Languages (oup.com)
Implicit Bias: unconscious attitudes or stereotypes toward a thing, person or group
For example, one example of implicit bias is that we may assume that people who are overweight are lazy and that’s why they are unhealthy, when in reality there are other circumstances that can lead to gaining weight such as a pre-existing condition. Bias can also go in a positive way, but will always favor one group for another. In this instance, a female may take a liking to people that identity as female versus another gender identity. While typing the previous sentence, I referred to the gender binary of female and male, and then caught myself and changed it to be inclusive of all gender identities. That is an example of my implicit gender bias. I did not mean to exclude non-binary gender identities, but I did in that moment. No matter the intention, comments of implicit bias can be harmful to certain groups. However, what we can do is bring own attention to our own bias and try to fix it.
Explicit bias: conscious attitudes or stereotypes toward a thing, person or group
Unlike implicit bias, explicit bias has the intent to be discriminatory, or racist, sexist, xenophobic. A person that uses explicit bias is consciously excluding, degrading or discriminating against a certain identity or group. Overtly racist comments, like ones you may see on your Facebook feed, are examples of explicit bias, no matter what the person making them says.
How Do We Identify Our Internal Biases?
Now that we’ve reviewed what biases are, how do we figure out what biases we have? Some of you reading this may already know some, but implicit biases are implicit, so they happen without our knowledge. It is our job to recognize them.
One way you can do this is the Implicit Association Test. With this test, “you will have the opportunity to assess your unconscious and conscious preferences for over 90 different topics ranging from pets to political issues, ethnic groups to sports teams, and entertainers to styles of music.”
I just took it, and here were some of my results:
Your responses suggested a moderate automatic association of Good with Cold and Bad with Hot.
Your responses suggested a moderate automatic association of Good with Helpers and Bad with Leaders.
Your responses suggested a moderate automatic association of Good with Foreign Places and Bad with American Places.
Your responses suggested a moderate automatic association of Good with Pro-Choice and Bad with Pro-Life.
Your responses suggested a slight automatic association of Good with Emotions and Bad with Reason.
I plan on taking one test a day throughout the month so I can learn more about my biases. I challenge you to take at least one test this month, and you can be entered to win a product from my SLP Survival Shop! My results don’t surprise me too much although I did expect to have a little more of an association with reason over emotions. Since I have more of an automatic association with the other areas, what my bias of these opinions may affect my reaction to patients’ or coworkers views. Medical care involves treating everyone, so it is important for me to work on objectivity in my care.
How Do We Own Our Internal Biases As Healthcare Professionals?
In healthcare specifically, our implicit bias can and likely will impact our interactions with and treatment of patients. Implicit bias can take the form of verbal or non-verbal actions.
You may have a perception that a person of a certain culture is less intelligent, and automatically provide your explanations in simple terms. In reality, this person could be in the medical field or may have experience with the medical problem they are having from previous doctor visits.
This will be discouraging and offensive to the patient that this negative stereotype was put upon them by their healthcare provider. It often results in distrust of providers in general if this happens multiple times with different providers. Even if clinicians say they are committed to diversity, equity and inclusion, implicit bias can always seep in. We can always learn more about how our bias affects our communication with patients.
One way you can avoid the situation I explained above is to ask questions before explaining. One question you could ask is: “What do you know about _____?” The patient will hopefully tell you, and then you can build off their background information to explain more.
This involves them in their own education about their medical problem and does not assume any level of knowledge, because an opposite example is a medical provider assuming a patient knows a lot based on their identity, like assuming a white male has prior knowledge about their medical problem. Both situations involve a false assumption and likely lead to a negative patient-provider interaction, and most impactful, the patient not understanding their own health issues.
To own your biases, you must understand what they are, where they came from, and how to consciously change them.
- An impactful way to do this is with implicit bias training. It may be something your workplace offers. If it isn’t, advocate for it! If you are looking for a person to train you, I recommend Cornell Woodson with Brave Trainings. He trained me when I was college student working as a Diversity Peer Educator. He has two workshops on unconscious bias and how to address it in the workplace.
- Attend CEU courses. If your organization doesn’t, or won’t hold group trainings, take it in your own hands if it’s financially feasible. I linked the bolded test to ASHA’s CEU courses on cultural responsiveness that range from $15-$53 dollars. If these aren’t feasible for you financially, here is a list of sites that offer free CEUs!
- Fill out the ASHA Cultural Competence Checklist. My clinical supervisor had students fill out this checklist before we worked with clients on accent modification (which is a whole other soap box for me about how accent mod if problematic, but that’s for another day). ‘This tool was developed to heighten your awareness of how you view clients/patients from
culturally and linguistically diverse (CLD) populations.
*There is no answer key; however, you should review responses that you rated 5, 4, and even 3.” - Ask more questions, don’t assume. Like the example I gave before, if you are thinking a patient knows or doesn’t know about a topic, or will automatically agree or disagree with certain parts of your treatment plan, ask first! While certain cultures tend to have specific values or ideas on things like end of life care or disability, there will be individual variety, so it is always better to ask. Avoid leading questions such as “Are you feeling well today?” versus “How are you feeling today?”. Based on their answer, you can follow up with a more specific, closed question. Using open-ended questions is generally good practice that was likely taught in your clinical degree, and can be used here. If you feel yourself asking a closed question, try and change it! You will get more information about this individual’s perspective which may align with some common values or viewpoints of their identity, or may not. You won’t know until you ask.
- Learn about cultural beliefs. While there is individual variation, I still recommend learning about different cultures and their views. You will learn a lot. CIRRIE has amazing cultural guides, especially if you are working with a patient from a smaller community in your area that you aren’t familiar with. Pick a guide, and before your start, write down any assumptions you have about that culture or that you have heard others say. See how they compare.
These are five first steps you can take to identify and own your internal biases. This is an ongoing, lifelong process but one that is great to start tackling any time. Let’s get to it!
This is day 4 of Better Speech and Hearing Month. Thanks for reading! If you missed day one, you can check it out here.
Come back tomorrow to learn more about cultural sensitivity as an SLP. For more cultural sensitivity tips, make sure to subscribe to my SLP Survival Newsletter!
