Explicit Bias: how prejudice leads to death

Today the world watched as a killer walked into a New Zealand mosque and shot people indiscriminately while streaming the massacre on Facebook Live.  A simultaneous attack was carried out at another mosque, in total killing 49 innocent worshipers from children to elderly and injuring many more. The perpetrators were fueled by the hatred, white supremacy, and extremism, rampant in our society.

This attack shook me and numerous others.  My mind immediately returned to the community trauma of the Chapel Hill murders in 2015, which to me is the pinnacle of the cross-section of implicit and explicit bias.

As mentioned in my post on implicit bias, it refers to unconscious attitudes we have about certain types of people.  The Chapel Hill victims were extraordinary people in every way, none of that protected them from their fate.  Because although some of their accomplishments and activism may have affected the implicit biases of people they interacted with, they could not change the explicit bias of their killer.  

Explicit bias is what stokes extremist groups, hate speech, and the subsequent violence.  Traditionally, people control, suppress, or hide their biases if not socially acceptable.  But in our modern era, we have seen a public shift towards the outward expression of prejudice against specific groups of people, based on ideology, religion, ethnicity, race, or other factors. 

Bias manifests at many levels.  One of the most common of which is in microaggressions; which can be the result of either implicit or explicit bias.  As implied by the name, these are small actions, that could almost go unnoticed, or seem like an innocent mistake.  They are intentional or unintentional slights towards someone of a marginalized group.  Such as misspelling a south Asian person’s name by one letter so that it says something possibly offensive.  Or moving away when a black man enters the elevator.  Or speaking slowly to a woman in hijab, as if she won’t understand. 

I have been told many times that I “speak English so well” even after explaining that I was born and raised in America.  I have had my last name spelled as Diablo countless times, which means devil in Spanish.  I have been seated in hidden away tables at restaurants.  I am often stared at in public places.  I have been mistaken for a nurse or a nun, while clearly presenting myself as the physician.  I have been cat-called walking down the street in broad daylight dressed completely modestly.  I have been told that women aren’t as good as men at math, even if they try, it’s just harder for them to catch on.  And the list goes on. 

Each time, I have responded differently; sometimes ignoring, sometimes explaining or educating, sometimes with humor or sarcasm.  Each time, I feel more exhausted than the previous. 

But I carry on.  Because behind every microaggression, there is the risk of a macro-aggression if those pervasive attitudes are not called out and corrected.  Even then, I often feel helpless because the voices of hatred are loud and ubiquitous.  When allowed to fester and spread, those rampant ideologies lead to tragedy. 

Immediately, the Tree of Life Synagogue shootings in Pittsburgh in 2018 come to mind.  And before that, the shootings at Emanuel African Methodist Episcopal Church in Charleston, South Carolina in 2015.  When the power of hate takes root, the result is often devastating violence.

Yet, today, I am discouraged.  Today I want to retreat.  I work hard everyday, as a human on this earth, to love others and show them the compassion and concern I want shown to me. I take risks and put myself out there to break stereotypes, push back against bias, and combat hatred. Events like the four I’ve mentioned above push us so far back.  

I am processing and wondering.  What must one do to establish their humanity, their right to live, to remain alive, to not be shot, murdered, slaughtered in cold blood?  Do my daily words and actions contribute at all to making this world a more loving, safer, united, and connected place for all people to live?  How do we process, heal, and move on?

As I realized in my post on Overnight Hearts, perhaps I need to sleep on this.  Tomorrow, maybe I will be filled with hope.  Tomorrow, maybe I will feel renewed to push on, to persist.  Tomorrow, maybe I will sit with others, connect, share, and rejuvenate.  We must do those things.  We must carry on spreading the messages of justice and peace.  We must continue to recognize and address bias in all forms.  We must continue to combat hate.  We must believe victims of micro and macroaggressions and hear their stories.  

A heartfelt thank you to all those that reached out with messages of love and peace.  It is every one of you, every one of your words, every one of your hearts, that will make the difference.  I hope to join hands with you and walk that path again tomorrow.

Click here to learn about the above image of the New Zealand fern.

Implicit Bias: open your eyes

I look like a doctor

In a previous post, I talked about how I manage bias in the professional setting as a physician who is both a woman and a Muslim in hijab.  But the issue of bias has many more far-reaching implications than that.

There are two aspects of bias that we need to consider.  Firstly, implicit bias, which refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.  Implicit bias is activated involuntarily, without our awareness or intentional control.  

By contrast, explicit bias refers to the attitudes and beliefs we have about a person or group on a conscious level.  Expressions of explicit of bias (e.g. discrimination, hate speech) occur as the result of deliberate thought and can be consciously regulated.

Both biases are harmful in many ways, but the latter is the one more likely to lead to death and destruction.  I deal with both, often at the same time, on a regular basis. 

In this post, I would like to examine implicit bias, its effects, and how to change it.  I discuss explicit bias in a separate piece. 

A story of implicit bias:

A fellow female physician parked in the designated parking spot for her speciality in the hospital lot.  When she returned to her car, she found a parking ticket.  She went to the parking office to inquire and the attendant told her: “I didn’t know you were a doctor.  You don’t look like a doctor.”

This leads to the obvious question: what does a doctor look like?  And the inherent answer: male.

The women physicians she shared the story with had varying responses. Many shared similar stories and expressed frustration.  Some said, take it as a compliment, you are a young and beautiful woman.  However, if we don’t address implicit bias, people will not become aware of it and not be able to change it. Implicit biases can be changed if people realize them in their own minds.  If they come to recognize that they have a bias about people of a certain skin color, gender, or religion, they can work to correct that.  But if they are in denial about it, it will never change and continue to lead to negative consequences to the people on the receiving end of the their bias-directed actions. 

Implicit bias can be addressed in many ways, politely, creatively, even with wit. It probably won’t be effective to attack someone with angry words.  For example, before performing surgery on a patient, he said to me, I can’t believe you’re the surgeon, you look like you’re 16 years old.  I shrugged, smirked, and responded firmly:  well i’ve been doing this for 16 years so there’s something wrong with the math.  I went on to perform a successful surgery, and the patient was thrilled with the outcome.  During the ensuing post-operative visits, he continued to refer back to his remark and say things like:  “I didn’t mean anything offensive by it, I was just surprised by how young you look.  Clearly you are very good at what you do. You are a professional. You did a great job.”  Although I never brought it up to him again, he recognized his own implicit bias and felt the need to redress it.  

I probably have a similar story for almost every day I’ve worked as a doctor.  That was a simple example of a more complex issue.  So you may be thinking, implicit bias seems harmless.  Well actually, no it is not.  In fact, it is detrimental. 

Let’s start with just two examples:

  • A 2012 study gave pediatricians identical case vignettes to examine how their implicit racial attitudes affect treatment recommendations for four common pediatric conditions.  Results indicated that as pediatricians’ pro-white implicit biases increased, they were more likely to prescribe painkillers for simulated patients who were white as opposed to black.  This is just one example of how implicit bias leads to differential health care treatment, even for children.
  • Academic scientists who evaluated identical resumes belonging either to a fake “John” or “Jennifer” perceived Jennifer as less competent. They were less likely to offer to mentor Jennifer and were more likely to say they would hire John to be a lab manager. Furthermore, scientists proposed a starting salary that was $4,000 (13 percent) higher for John than for Jennifer, based on identical resumes.  One can easily infer how implicit bias leads to significant gender disparities in the workplace that increase exponentially over time.

Research shows that most Americans have positive attitudes associated with white people and negative attitudes with African Americans, leading to myriad unfavorable and harmful outcomes for black Americans.  Extensive research has documented the pernicious effects of implicit racial biases in various settings, like classrooms, courtrooms, and hospitals.

In medicine specifically, implicit biases about gender have led, amongst other things, to a pay gap, where female physicians make 80 cents on the dollar compared with males.  Over a 30-year career, that translates to women being paid millions of dollars less than men for the same work. 

The silver lining is that implicit bias can be modified.  Studies suggest that we can reduce bias in our minds and in our workplaces by becoming aware of it, discussing it, and implementing anti-bias education.  As GI Joe always said:  knowing is half the battle.  Awareness of the unconscious associations and connections we hold is the first step toward correcting our biases.

Many have taken to social media to break down these biases with campaigns like:  #ILookLikeADoctor (to combat the myth of what a doctor looks like), #BeEthical (to end gender disparity), and #HeForShe (men advocating for gender equity).

When you see implicit bias, don’t stay silent.  Look for it in your own thoughts and fight it.  Find polite and appropriate ways to address it with others.  By definition, people are completely unaware of their own implicit bias.  

I work hard in my life to combat bias and stereotypes; and honestly, it can be exhausting.  There are days when I want to give up.  But what kind of world would I leave behind for my offspring if I did that!

Would love to hear your thoughts and experiences on this very important topic.

Check out my article on explicit bias.

To LASIK or not to LASIK?

I was very happy to be invited for an interview on the GetHealthy360 Podcast with Dr. Kris Ferguson.

Many people ask me if LASIK is a good option for them.  In this episode, I discuss laser vision correction and vision correction with lens exchange or cataract surgery.  Take a listen to get a better understanding about the pros and cons of these different treatments that can allow you to see well without glasses or contact lenses; and an explanation of how age affects our recommendation of one treatment over the other.


Is Your Environment Promoting Growth Or Prolonging Stagnation?

I was given a plant as a gift two years ago.  At that time, it was full of pink blossoms.  Over the course of a month or so, those flowers gradually died.  For the next 22 months, it sat on my kitchen counter, under two large skylights, watered weekly, and it grew.  The gangling green branches sprawled, increasing in length continuously.  However, it never blossomed again.  Eventually, I grew tired of it, sitting on my counter, taking up space, not producing any flowers.  Knowing little about plants, I wondered if I should’ve planted it outdoors, moved it to a larger pot, or if it had just run its course and I should toss it.  I decided on the latter, but as an after-thought, I moved it to another room on a table by a large set of windows, next to another plant.  

Now that my plant was in the living room, I no longer saw it everyday, only for weekly watering.  A few weeks passed, and one day I had a big surprise — it had blossomed again!  The same plant that just weeks earlier, I had decided to throw out.  Just a small change in environment, perhaps the south-facing sun or the proximity to other plants,  had given it what it needed to bloom.

This got me thinking about myself and people in general.  How many times do we find ourselves in frustrating situations, where we want to give up?  How many things in life have we let go of that could’ve thrived with some small change?  Are we placing ourselves in an environment that promotes growth in the right areas?  Or are we allowing ourselves to stagnate because we can’t, don’t know how, or simply don’t want to change something that is holding us back?  Are we staying in a situation that is harming our well-being because changing it seems too hard and we don’t know where to start?  

Often times the changes aren’t as hard as we think, and we just have to take that first step.   For example, we are more likely to complete the tasks which help us reach our goals by minimizing distractions.  Want to read a book, move it from the shelf to your nightstand.  Place work you need to do on your desk rather than in a distant location.  Turn off notifications on your phone for a period of time when you want to focus.  To eat healthier, surround yourself with better food options.  A study discovered that a shift from 12–inch plates to 10–inch plates resulted in a 22% decrease in calories.  Smaller plates cause us to eat less due to an optical illusion — we think things are smaller when we compare them to things that are larger, so a large plate makes the food look less and we consume more.

Although the questions I’ve posed above are not easy ones, optimizing our environment to make better choices can impact our actions.  This is a task to which I am challenging myself.  Choose a sore spot in my life, an area of weakness or pain, something in which I feel stagnant and wish to progress, and really ponder on what change I can make to put me on a path to success or improve my well-being.

In a previous post, I talked about how our success is in who we surround ourselves with.  Today’s thoughts encompass that and more.  What element in my environment needs to be changed and do I have the wherewithal or courage to do it?  I’m going to move over here into the sun and sit with that for a while. 

(Speaking of which, studies suggest that a daily dose of sunshine can elevate mood, increase sleep quality, and even aid weight loss ?.)

The Power of No

As a parent of 19 consecutive years – and  36 cumulative years – I’ve learned a lot . I’ve developed some of my own parenting philosophies and strategies, which change with the years and situation. 

As we are in a society of plenty, at least here in the bubble in which I live (and sadly not so for much of the world, as I saw first hand when I volunteered in the refugee camps), I have found utility in saying no. 

There are lots of self-help articles about saying no when people request things of you, just to save your sanity and help you prioritize. This isn’t about that. This is about things like randomly saying no to my kids when they ask for something they don’t need and how that applies to my notion of self-discipline. 

For example, if we make a quick stop in Walgreens and my son asks if he can buy candy, I will sometimes agree, and I will sometimes say no.  Not because he has done something wrong and I am withholding. Not because I don’t have the extra $1. Not because candy is unhealthy and bad for your teeth (even though it is).  And not really to enforce my authority as a parent. But just to let him experience “no” and all that it entails. I have to acknowledge that this specific example reflects how truly blessed we are in having our external needs met; and that we are spoiled in that we have extra for unnecessary things as well. However, I believe the broader concept applies to our humanity in all walks of life.

In this world of YOLO and you-do-you, many of us have lost sight of the value of self-discipline. Restricting and limiting one’s self is an ancient skill that is often the first step to enlightenment. Many of us want to find our best selves, reach higher states, and perhaps have spiritual experiences. It’s popular to quote Rumi and talk about being zen. But we often don’t know how or don’t want to do the hard work required to walk that path. 

It’s not huge, and I don’t give a lecture with it, but one small contribution to my children’s development of self-control is requiring them to accept my “no” and experience the effect of not fulfilling that desire in themselves. 

In actuality, this is a lesson foremost for myself. I need to tell myself no more often.  I believe in self-care, but I think we are drowning in self-indulgence and that’s different. I don’t think giving ourselves everything we desire has made us happier. A look around at our society demonstrates that and there are studies to prove it. What this means for me practically is occasionally withholding things from myself that in other situations may be considered beneficial.  A perfect example is fasting, abstaining from food in order to achieve a higher state of self, which is part of many religious and spiritual traditions. Similarly, abstaining from things that feel good in the moment but don’t bring us closer to our long-term goals (such as binging on food or shows), and avoiding excessive leisure or comforts can build strength of character.  For some, like myself, controlling our tongue (or our fast-typing fingers) can be an important exercise in reflection.  We face urges and desires in all aspects of life, and while not all lead to dangerous territory, practicing self-restraint may build our willpower for the times we need it most.

How does the power of no apply in your life?  How can restricting yourself in some situations make you stronger in others?  These are questions I continue to ponder while looking for practical applications on the path to finding my best self.

Doing it all

Overwhelmed by a mountain of mail!

Many times over the years, people have asked me how I “do it all.”  I don’t and I can’t. Can any one person do it all? Of course not. We shouldn’t expect that of ourselves or others, as it sets us up for disappointment and feelings of inadequacy.  

I know that in reality what people mean when they ask me that is: how do you balance your many responsibilities and activities, as a mother, physician, and community volunteer?  The answer to that is: prioritize!  We have to actively consider our priorities and make that the basis of how we allocate our time and energy.  We must also realize that priorities shift and sometimes change in different phases of life, we must be willing to change accordingly.

Time never exists in a vacuum  – something will always fill it!  If we are not actively choosing what that is, we will find ourselves spending time on things that don’t promote our long-term (or even short-term) goals and don’t match our priorities.  This will in turn lead to lack of fulfillment and maybe burn-out.  When I find myself spending a lot of time on something, I need to periodically assess how it is affecting me in 3 key ways: spiritually, emotionally, and physically.  That is in addition to making sure it’s not negatively affecting my top priorities at that time.  

The challenge is often how to handle the obligatory (and often unpleasant) things that fill our lives.  For me, those are things like cleaning bathrooms, laundry, grocery shopping, cooking and MAIL.  I’m sure each person has their own unique list.  For these things I try to:  outsource, delegate, and develop efficient systems.  

For example, with mail, I try not to bring it inside until I’ve gone through it once.  My garbage and recycling bins are outside, so I can stop there and drop off the junk mail before coming in.  I also don’t empty my mailbox at times when I don’t have the energy to address what’s inside it. One challenge is determining what needs to be saved and how to save it. I have a desk drawer with hanging file folders and file away paper under certain subject headings. Sometimes I take pictures of documents and save them in a “reference” album in my phone.  You can try different methods and see what works best for you.  When we develop systems (that we modify and tweak with time), chores will take less of our precious time.  This is more effective than just resigning to doing it the arduous way and hating every minute. 

When I say, I don’t do it all, I really don’t.  For instance, I’ve delegated laundry to someone who comes to help me clean the house.  She gets it washed and folded and the kids have to put it away.  That has saved me a lot of time every week, and I’m careful what I do with that time, so it doesn’t just get sucked up elsewhere or wasted.  I’ve chosen to put that extra time towards fitness.  Less laundry, more exercise, increases my physical and emotional well-being.

We must always be actively evaluating the way we use one of our most precious commodities – our time.  It is, after all, a finite resource.  We can’t rewind it, multiply it, or reuse it.  It behooves us to develop a process to evaluate where our time goes each day, each week, and make sure it’s filled with things that match our current priorities, promote our goals, and improve our spiritual, physical, and emotional well-being. 

There’s no need to do it all – but choose well. 

“Take advantage of five before five: your youth before old age, your health before illness, your wealth before poverty, your free time before work, and your life before death.”  —Prophet Muhammad ﷺ

Suggested read:  168 Hours by Laura Vanderkam