Understanding Provider Bias
- Prior to Keltie Knight’s blood disorder diagnosis of microcytic anemia, her doctor’s made her feel she was “crazy” when they dismissed her symptoms as due to stress from work or her eating habits. Now she’s urging other women to push for answers when it comes to their bodies.
- It’s important to understand that while your doctor has undergone years of training and practice, she or he is ultimately still human and may come with their own set of biases that can impact how they treat patients.
- To combat these biases, known as provider biases, and really get the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear.
- When it comes to your health, it’s okay to be a little pushy. You know your body better than anyone else. When you see a doctor for a problem, don’t hesitate to make sure that your question is fully answered and that you are comfortable with the plan moving forward. Keep seeking multiple opinions until you feel you are being heard.
Before E! News correspondent
Keltie Knight , 42, was diagnosed with a type of blood disorder called microcytic anemia, her doctor's made her feel the symptoms she was experiencing were her "fault," she recently recounted. Now she's determined to inspire other women to be their own advocates and push for answers when it comes to their health. Speaking on the "Tamron Hall" Show this week, the three-time Emmy Award-winning Canadian TV personality admitted she felt "crazy" after her doctor suggested the issues she was having were due to lack of meditation, eating poorly, or stress. Knight, who first opened up about her blood disorder diagnosis two months ago, a time when she also announced she was having a hysterectomy (removal of part or all of the uterus), said on Wednesday's episode, "Every time I went to the doctor, Tamron, I knew that I couldn't see the teleprompter at work. I was memorizing my scripts before I went out there. "And every time I went to the doctor, I would get the same thoughts. ‘Well, are you eating enough vegetables?’ ‘Well, are you drinking enough water?’ ‘Oh well, you know you just work too hard. Maybe if you meditate more, you will feel better.'" https://twitter.com/TamronHallShow/status/1795846724256231763 She explained further, "I was like, 'Oh well, this is my fault because you're right. I had a latte this morning instead of green juice. So obviously, this rash I have over 75% of my body is something I did to myself.' "And then I felt shame that, ‘Oh my god, I'm so bad at being a woman that I'm hurting myself.' And I tried so hard to fix these things that they were saying ... I was drinking water, I was drinking the green juice. Nothing helped. So I felt crazy."
RELATED: Tools To Navigate Grief And Shame: Dr. Marianna Strongin Addresses These Topics In Her New Column 'Strong In Cancer' Knight didn't understand what was wrong with her body her friend referred her to a doctor. The podcast and New York Times bestselling author, who said she went to 15 doctors prior to getting the referral, said, "I went, and the bloodwork panel was like 60 pages. I've never seen something so thorough before. "And when I went for my follow-up, he looked me in the eye and he said, ‘You were very unwell. I will make you well. It's going to take a year.’ And I just started bawling." She added, "It was the first time a doctor had looked me in the eye and said, 'You are valid in feeling this way.' And that is when we started the process of doing the work, getting to the bottom of this."
As for why she's speaking out about her blood disorder diagnosis, Knight said, "I think it's people like you [Tamron] who empower women to tell their stories even when they are hard. ... Knowing that I have learnt so much over the past 10 years and wanting all women to understand that they are not crazy, that they are not liars, and that their symptoms are real. "And they have to keep fighting for their health until they find help. That is my mission."
Expert Support Resources
Knight previously opened up about her diagnosis in a tell-all video shared via Instagram, where she admitted she'd been "
suffering in silence for so long behind the scenes," dealing with blurry vision and extreme fatigue, She explained how she's living microcytic anemia, a type of blood disorder. According to the
New England Journal of Medicine , this type of disorder is “characterized by smaller-than-normal red cells due to decreased production of hemoglobin.” Knight added, "I have smaller and less blood cells than a normal person, which means my body carries less oxygen to my tissues and it messes up everything." Additional research published in Medical Clinics of North America adds that “the vast majority of patients respond effectively to inexpensive and usually well-tolerated oral iron preparations.” “It doesn’t matter what you do to me, nothing – nutrition, infusions, hormones, anything – my blood cells are just smaller, and there’s less of them, and so, I’m feeling awful constantly,” Knight said.
Getting a second opinion is extremely common and encouraged after a cancer diagnosis, colorectal cancer surgeon Dr. Heather Yeo explains. As for her busy work schedule and job-related responsibilities, Knight added, "I felt replaceable, so I never really advocated for myself because I knew if I was out sick, they would find someone younger, sparlier and healthier. Living with a chronic disease silently takes over your entire life. There is the guilt of not being a good wife or a good friend, and the shame of never getting better leads to deep depression." “As women, we stop feeling like we need to pretend everything is OK when it’s not," she insisted, noting, "“I’m having a hysterectomy! I’ve been silently suffering for most of the last decade." A
hysterectomy is a procedure that removes part or all of the uterus (or womb), often along with the cervix, according to the National Cancer Institute. Women who receive a diagnosis of uterine, ovarian, and cervical cancer may have their cancer treated with a hysterectomy. Women may need a hysterectomy for a variety of reasons she and her doctor carefully review. Some examples may include endometrial cancer, ovarian cancer, endometriosis, chronic pelvic pain or vaginal bleeding, and uterine fibroids.
Provider Bias in Healthcare
It’s important to understand that
while your doctor has undergone years of training and practice, she or he is ultimately still human and may come with their own set of biases that can impact how they treat patients. In Knight's case, she felt shamed when here doctor suggested her health issues stemmed from her lifestyle. For other women, it's not unusual to be ignored at the doctor. And the same goes for many groups of people, including Black people, older people, the LGBTIQA+ community, and anybody who is lacking on education and money.
RELATED: “Too Embarrassed To Talk About Cancer,” Former MTV Host Ananda Lewis, 50, Says She Had to ‘Power Through Shame’ To Share Breast Cancer Diagnosis With Her Family To
combat these biases , known as provider biases, and really get the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear. To better understand how you should approach
conversations with your doctor , SurvivorNet previously spoke to
Dr. Dana Chase , gynecologic oncologist at Arizona Oncology. According to Dr. Chase, physicians, like many of us, can be a bit biased when seeing patients. Dr. Chase makes clear that these biases are rarely sinister, but rather unconscious and more subtle.
Avoiding Provider Bias – Is Your Doctor Understanding You? Dr. Chase says, “We have certain beliefs that we don’t know about. We might look, for example, at an older woman, and just by the way she looks we might make certain assumptions, and we might not even know that we’re making these assumptions.” Sometimes, these assumptions can lead to differences in the care that doctors provide. That is the point at which you, the woman, should advocate for yourself and clear up any misconceptions the doctor may have, says Dr. Chase. “Say things to your doctor like, ‘I may not seem healthy because I’m 92, but I want you to know that I play tennis three times a day,’ ” she explains. This type of discourse can be really helpful when building a relationship with your physicians and even more important when it comes to creating a treatment plan. To sum things up, Dr. Chase says, “In order to avoid situations where potentially the doctor is making assumptions about you that you don’t even really know about, reminding yourself to tell the doctor who you are, to explain your life situation, I think is really important.” Clearing up misconceptions is important, but so is understanding what your doctor is telling you, says Dr. Chase. In order to do so, she advises women to speak up and ask questions when they don’t understand something. “It’s never a bad thing to ask for something to be repeated, or to ask the doctors to explain it in different terms.” So next time you go to your physician, we think you should feel empowered to speak up, both so she or he understand you and you understand them.
Being Your Own Advocate
It’s important to practice, something many SurvivorNet experts often recommend, being your own biggest advocate. “Every appointment you leave as a patient, there should be a plan for what the doc is going to do for you, and if that doesn’t work, what the next plan is,”
Dr. Zuri Murrell , director of the Cedars-Sinai Colorectal Cancer Center, told SurvivorNet in a previous interview. “And I think that that’s totally fair. And me as a health professional that’s what I do for all of my patients."
WATCH: Why advocating for your health is important. Getting a second opinion is another way to advocate for your health. Doctors do not always agree on whether your symptoms might warrant further testing. It’s during moments like these that having a second or third medical professional’s opinion might be able to catch something before it worsens.
Dr. Steven Rosenberg , chief of surgery at the National Cancer Institute supports patients getting
multiple opinions. “If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care, because finding a doctor who is up to the latest information is important,” Rosenberg previously told SurvivorNet. "And it’s always important to get other opinions so that you can make the best decisions for yourself in consultation with your care providers."
WATCH: Cancer Research Legend Urges Patients to Get Multiple Opinions. Combatting Shame
Knight noted living with a chronic disease made her feel shame and
affected her mental health. Psychiatrist
Dr. Samantha Boardman suggests that people working on their mental health practice positive psychology. Positive psychology focuses on encouraging patients to feel positive and finding what brings a sense of vitality to their lives.
WATCH: Managing your mental health amid a health challenge. Dr. Boardman explains them as “pathways to embrace your everyday resilience.” In other words, these are tools people who may be struggling with mental health issues can embrace to help maintain a certain sense of positivity. And those positive feelings can go a long way when people are facing a health challenge like a cancer diagnosis. According to Dr. Boardman, these three wellsprings of vitality are:
- Connecting. This involves how you’re connecting with others and having meaningful interactions. It involves being a good listener and being engaged with the people around you who you care about.
- Contribution. How are you adding value to the people around you? Are you helping them in ways that feel meaningful to them? This entails contributing/engaging with others in a meaningful way.
- Feeling challenged. Being “positively challenged” could involve learning something new (perhaps by taking a new class or reading an interesting book) and expanding your mind in some way. “Those are the cores of vitality and the core pathways to enhance your everyday resilience,” Dr. Boardman said.
Questions to Ask Your Doctor
If you find yourself struggling with a diagnosis or helping a loved one cope with their emotions, consider asking your doctor the following questions:
- How can I go about improving my outlook/mental health?
- Are there any activities I can do to encourage positive feelings?
- When should I seek other interventions if I’m still struggling?
- How can seeking these connections help me in my day-to-day life?
Contributing: SurvivorNet Staff 
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