不要无意识的伤害

Do No Unconscious Harm

原载《科学》杂志第379卷第6635期（2023年3月2日）

<Science> Vol 379, Issue 6635 (March 2, 2023)

【节录】在几年前被诊断出患有自身免疫性疾病之前，琳达•查斯汀说她很瘦。 但是西雅图社区组织者针对她病情的救命类固醇治疗使她在1年内体重增加了大约 45 公斤。 然而，她的医生往往未能认识到自身免疫性疾病、她的药物治疗和体重增加之间的关系。 相反，他们经常将超重作为她的主要问题，并建议她计算卡路里。 “让医生根据体重驳回你的很多抱怨或担忧，这是一种非常痛苦的经历，”查斯汀 说。

不幸的是，像查斯汀这样的故事很常见，研究人员说，他们研究了隐性偏见——基于肤色、性别、性偏好或外表的无意识假设——在医疗保健提供者中如何影响患者护理。 查斯汀是黑人和酷儿，她现在正在利用她在医疗机构的麻烦经历来帮助研究隐性偏见并找出应对方法。 她参与了华盛顿大学 (UW) 和加州大学圣地亚哥分校 (UCSD) 各个部门之间为期 5 年的合作，其中一个团队正在开发一种工具，可以在患者接受治疗期间实时向医生提供反馈 访问或访问他们可以做些什么来减轻他们无意识的偏见。

该项目称为 UnBIASED（理解有偏见的患者-提供者互动和支持增强话语），处于对抗医学偏见负面影响的浪潮的前沿。 从创建新的教育和培训模型，到开发准确的测试以客观地测量疼痛，科学家们正在努力为医护人员和机构提供减少偏见和提供公平护理的工具。 虽然现在判断这些干预措施是否成功和持久可能还为时过早，但一些策略似乎很有希望。

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[excerpt] Before being diagnosed with an autoimmune disease several years ago, Linda Chastine says she was skinny. But the lifesaving steroid treatment for her condition made the Seattle community organizer gain roughly 45 kilograms in 1 year. Yet her doctors often fail to recognize the relationship between the autoimmune condition, her medication, and the weight gain. Instead they routinely bring up being overweight as her main problem, she says, and suggest she count calories. “It’s a very traumatic experience to have a doctor dismiss a lot of your complaints or concerns based on weight,” Chastine says.

Stories like Chastine’s are unfortunately common, say researchers who examine how implicit biases—unconscious assumptions based on skin color, gender, sexual preference, or appearance—in health care providers affect patient care. Chastine, who is Black and queer, is now channeling her troubled experience with the medical establishment to aid studies of implicit bias and identify ways to counter it. She is part of a 5-year collaboration between various departments at both the University of Washington (UW) and the University of California, San Diego (UCSD), in which a team is developing a tool to give physicians feedback in real time during patient visits—or shortly after—on what they can do to mitigate their unconscious prejudices.

That project, called UnBIASED (Understanding Biased patient-provider Interaction and Supporting Enhanced Discourse), is at the leading edge of a wave of efforts to counter the negative effects of bias in medicine. From creating new models of education and training, to developing accurate tests to objectively measure pain, scientists are working to provide health care workers—and institutions—with the tools to diminish bias and provide equitable care. Although it might be too early to know whether these interventions are successful and long-lasting, some strategies appear promising.

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原文见：Rodrigo Pérez Ortega (2023). Do No Unconscious Harm. Science, Vol 379, Issue 6635, 870-873.

https://doi.org/10.1126/science.adh3677

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