評論
打印
Let’s start with a basic question: What is implicit bias?
我們先來問一個最基本的問題：什么是隱性偏見？
So implicit bias refers to the unconscious and unintentional mental associations that we make about others, often along lines of personal identity factors like race or religion or gender.
內隱偏見指的是我們對他人無意識或無意的心理聯想，這些聯想通常是基于個人身份因素，如種族、宗教或性別。
But they’re unconscious and unintentional.
但它們是無意識和無意的。
How much does that tend to come up in a clinical setting, and why does it matter?
在臨床環境中，這種情況出現的頻率有多高，為什么它很重要？
It’s more likely to come up when we’re pressed for time; when we’re fatigued; probably when we’re hungry, although that doesn’t exist in the literature, to my knowledge, anyway; when we’re not really knowing the person in front of us very well and we may have incomplete data—honestly kind of every day at work, right, at different times of the day, different time pressures, etcetera.
據我所知，人們趕時間的時候，疲勞的時候，饑餓的時候，更容易出現隱性偏見，雖然并沒有文獻提出這種說法；當我們不太了解面前的人，而且可能掌握的數據不完整時——老實說，這種情況工作中每天都有，對吧，在不同時間，面臨不同壓力的時候都會出現。
And the reason why it matters is because it can actually influence our communication behaviors with patients.
而它之所以重要，是因為它實際上可以影響我們與患者的溝通行為。
And so I wanna be clear that implicit bias isn’t, like, a moral indictment.
所以我想明確的是，隱性偏見并不是一種道德指控。
It’s a coincidence of our lived experiences, how our unconscious mental associations go, but because it can influence our behaviors, we wanna—we work on that in, in our lab.
它只是我們生活經歷的巧合，是我們無意識的心理聯想，但因為它會影響我們的行為，所以我們想——在實驗室里研究它。
What do we know about how implicit bias in a clinical setting can impact patients?
關于臨床環境中的隱性偏見對患者有何影響，我們了解多少？
How do you know when implicit bias has impacted the encounter, right?
隱性偏見影響到見面時，你要怎么知道？
I know it’s because the vibe—I and others—that the vibe has changed, the nonverbals have changed, the patient may get a little more curt in their answers or shorter, you know?
我知道是因為氛圍，我和其他人之間的氛圍已經變了，非語言的東西已經改變了，病人可能在回答問題時很簡短之類的。
And we do this in real life. And I keep getting people who say, “How do we, how do we teach that?”
我們在現實生活中會這樣做。我不斷聽到有人說，“我們如何教授這個？”
And, and I keep consulting other people. I’m like, “How do you teach it? Like, I don’t know.”
我一直在咨詢其他人。問他們，“你是怎么教的？我不知道。”
And so I think we could talk about that as a challenge in case anybody writes in and gives us the answer. I would love it so much.
我們可以把它當作挑戰來討論，萬一有人寫信來告訴我們答案呢。我不勝感激。
Yeah, maybe, maybe there’s, like, a, a body language coach out there ... Yes! An acting or movement coach who thinks about micro facial expressions.
嗯，也許，比如，有個肢體語言教練在收聽……是的！一位思考微表情的表演或動作教練。
Like, somebody’s, somebody’s gotta be able to help with that. Yes—yes, yes, yes and yes.
肯定有人能幫忙解決這個問題的。是的——是的，是的，是的，是的。
If we stay focused on communication behaviors and communication skills, there’s the concept that’s called verbal dominance, meaning that if we have a 15-minute encounter, and if we are gonna center the conversation on racial bias, then if you have higher unconscious—implicit racial bias, more pro-white as a coincidence of your lived experience, then you’re likely to talk more in those 15 minutes when you’re seeing a Black patient compared to a white patient.
如果我們專注于溝通行為和溝通技巧，有一個被稱為語言主導的概念，這意味著如果我們有15分鐘的相遇，如果我們將談話集中在種族偏見上，那么如果你有更高的無意識——隱性種族偏見，根據你的生活經驗，你更親白人一些，那么與白人患者相比，在這15分鐘里，你看到黑人患者時可能會說的更多。
When you’re talking more, that means they’re talking less. Right.
你說得更多，意味著他們說得更少。是的。
That means we’re likely to be asking their opinion less; we’re likely to be doing less shared decision-making, meaning getting their input on what the, what the treatment plan is, is it acceptable to them; asking if they have questions.
這意味著我們可能會更少地詢問他們的意見；更少地進行共同決策，也就是在治療計劃、他們是否可以接受等方面征求他們的意見；詢問他們是否有問題。
Patients perceive less patient-centeredness.
患者感受到的以患者為中心的程度較低。
They perceive, in essence, a colder affect or vibe, if you will, in the encounter.
本質上，在這次相遇中，他們察覺到的是一種更冷淡的情感或氛圍，如果你愿意這么說的話。
And, and we also end up using more words that relay anxiety.
而且，我們最終也會使用更多傳遞焦慮的詞匯。
It’s the way we’re socialized and our unconscious ... Sure. Mental associations. So it’s just humans. Yeah.
這是我們的社交方式和我們的潛意識……當然。心理聯想。這就是人類。是的。
So let’s talk about what you’re doing at your lab.
那我們來談談你正在實驗室里做的事情。
What interventions have you been working on, and what’s been working?
你一直在從事哪些干預措施，哪些措施是有效的？
So we’re interventionalists, right? But instead of needles or devices or pills, we use education.
我們是介入治療專家，對吧？但是，我們使用的是教育，而不是針具、設備或藥片。
So we recognize when implicit bias may have impacted the patient encounter, right?
我們要認識到隱性偏見可能會對醫患接觸產生影響，對吧？
And then we teach people skills to be able to manage that negative influence, negative impact—partner with the patient and then restore rapport, you know, discuss ways of moving forward, etcetera—to be able to have the positive outcomes we wanted in the first place.
然后我們會教給人們一些技能，讓他們能夠應對這種負面影響，與患者合作，恢復融洽關系，討論繼續的方法等等，以便能夠獲得我們最初想要的積極結果。
And so a lot of what we talk about is basic “humaning,” to be quite honest.
老實說，我們談論的很多內容都是基本的“做人”。
And so—but people get nervous when it’s something about race or religion or gender or sexual orientation, and people worry.
所以——但是當涉及到種族、宗教、性別或性取向時，人們會感到緊張，人們會擔心。
So if I can take a step back and explain that the—we were the first to study—we weren’t the first to study patient perceptions of bias and discrimination in their encounters, but to our knowledge in the literature, our lab was actually the first to study it and then stop and say, “Okay, great. Not great that it’s happening, but great that we’re talking about it, that you’re talking about it.”
我先退后一步解釋一下，我們并不是第一個研究患者對接觸中的偏見和歧視的看法的人，但根據我們對文獻的了解，我們實驗室確實是第一個研究它，并提出，“太好了，這種情況并不好，但好在我們正在談論它，大家正在談論它。”
