Doctor Reacts to John Oliver | Last Week Tonight: Bias in Medicine


– Hey, guys! Welcome to another episode
of the “Wednesday Checkup”. John Oliver just did a
hard-hitting piece on medical bias and you asked me to talk
about it, so let’s get to it. (smooth hiphop music) I actually like getting these
subjects out in the open ’cause I feel like if we can discuss them honestly, openly, and fairly, we’re gonna make the best impact on the healthcare community, starting right here on
this YouTube channel. So when I heard John Oliver
did a piece on medical bias, I knew I had to watch it. But because he talked
about a lot of studies and used a lot of references, I felt like it was in your best interest and my best interest to first
watch the piece on my own, do the research, check out
the studies he referenced, and then watch it again
with you right now. – Men of medicine. – [Announcer] In every US city and town, there is one house that
everybody knows, the doctor. Available here are the services
of the man who, by law, is privileged to practice the most respected of all professions. – In my family medicine
residency training program, we had 21 residents, 18 were
female, three were male. We actually had a little camaraderie that we were the only
three guys in the program. We made running jokes about it. That type of diversity is
really good for medicine. You could even check out my
“Diversity in Medicine” video which I’ll link down
below in the description. – Not everyone has the same experience when they visit a doctor. – I think I would’ve been
treated completely differently if I had been male. – You’ll hear doctors and nurses like, oh, they’re just exaggerating. – Dramatic. – And not really listening to them because it’s a black person,
but if it’s a white person, it’s just like, oh my
god, this is serious. – It’s true. If you are a woman and/or a
person of color in the US, you may well have a very
different relationship to a healthcare system than a white man. – This is difficult for
me to watch as a doctor. Watching patients talk about
getting poor quality of care from my colleagues hurts
because what I wanna do, what I hope all doctors wanna do, is give each and every patient
the best quality of care without distinguishing
between what race they are or what sex they are, what
country they come from, what language they speak. Medicine is not run by robots, it’s run by doctors who are humans and humans have biases and
they have other issues, they have stressors. I’m not making excuses for doctors. I just want you to be aware of all the things we’re
gonna be talking about throughout this video when it comes to gender discrimination, racial discrimination, the
disparities that exist, why that can happen, and really,
the steps that we’re taking as a medical profession to improve that. – Better to talk at you for
20 minutes about this than me, the whitest of white men. (audience laughs) Look, I get a sunburn
watching the Travel Channel. – John Oliver does a really
good job diffusing the situation by using humor here. Oftentimes, I’ll tell my students if they have the ability to
insert humor into a situation, respectfully, of course,
and not distastefully, they should do it because
patients love that. I’ve been on the cancer ward so many times in so
many different hospitals where the second a moment of
lightheartedness comes in, you can see the patient’s smile light up, especially in the pediatric population. We love to laugh, we
love to have a good time with our patients and they love it too. – Let’s talk about bias in
medicine in two specific areas. First, sex, and then race. And in the words of every
therapist I’ve ever had, let’s start with sex. (audience laughs) Historically, women’s bodies
have always been fraught with judgment and misconceptions. – Mom, can I go swimming with
Peggy tomorrow after school? – No, it’s not a good idea the first two or three
days of your period. You might get chills and catch cold. – Oh, that’s right. (audience giggling) Peggy, of course, I can’t go swimming. You know I’ve got the curse. – Yeah, Peggy! – On one hand, we can look
back at it and laugh and say, oh my god, look at the
things we used to say, how politically incorrect
or how inaccurate is this, but I look back at this and I wanna celebrate the
fact that we’ve come so far, that we’ve made strides in medicine. I feel like if I fast forward
100 years into the future and look back at the things I’m doing now, it would be barbaric. It’s gonna feel like we’re cave people working with rudimentary tools. – Women can still face an uphill battle to get quality healthcare. There are many, many studies showing this. For instance, they found
that women were less likely to be referred for knee
replacements than men. – He’s accurate here. There are really good
quality studies that show there are disparities
for women in healthcare. When a disparity occurs, it means something’s
happening on unequal terms. Essentially that’s a correlation, that we see these two events
happening on unequal terms, but we don’t have a causation, meaning we don’t have a
reason why that happens. For that knee replacement
study that he talks about where women are less
likely to get a referral to get a joint replacement, that’s true. This study does exist, it
was was published in 2011 in a good orthopedic journal. They do such a fantastic job analyzing each part of the system. When the patient
recognizes their symptoms, how long it takes them
to go to the doctor. Once they go see their
primary care doctor, what’s the discussion like? How likely are they to get a referral? At what point do they
actually need the referral in terms of the damage that needs to be done to their joints? Once they see the orthopedic surgeon, how likely are there to actually
go for joint replacement? Now, in almost all these cases, they found women were
getting less care than men. I’m gonna quote the study here: “One factor may be the way
patients describe their symptoms. “Women tend to speak more openly “and personally about their symptoms “and describe them in a narrative style, “when compared to men who
typically present their symptoms “in a business-like or factual manner “and are more reserved in their comments. “Women’s narrative presentation
style reportedly contributed “to physicians making
more diagnostic errors.” And this study gives so many factors, both from the patient’s
side, the doctor’s side, the system’s side, all of
these things can be addressed. – If they’re over 50 and critically ill, they were less likely to receive
lifesaving interventions. – The study itself actually
gave some really good points on what we should be doing to correct this because, again, it didn’t specify that this is solely a result of bias. The study talks about the need
for sex or gender analysis after conditions happen, after mortality. We talk about the need for more research to figure out if biases exist and what types of biases exist. And finally, looking at sex disparities that occur between certain conditions. How often do females versus
males have pneumonia? How often do they have
complications of pneumonia? “There may be also plausible
biological explanations “for the differences in mortality “we found between critically
ill older men and women. “Sex has been found “to influence the expression, progression, “and outcome of many
common medical conditions “and can influence pharmacokinetics, “which is how medicine is absorbed, “how it functions, and
responds to therapy.” Now, it may seem that I’m trying to find other reasons than
bias as to why this happens. That’s true to a degree. I wanna make sure that
we’re not missing anything and just jumping to the
conclusion of discrimination because we can then
miss some systemic flaws and biological differences
that had we addressed them, we can do better by our patients. – When going to the ER
with urgent abdominal pain, women were less likely to
receive any pain medicine. – This pain study is actually real. Women were less likely
to get opioid medications than their male counterparts and on average took them longer
to get these medications. But again, the study that
Jon Oliver mentions here, I took a deep dive into it. They do not have a causal
reason for why this happens. They postulate seven reasons. One is maybe doctors are
unaware of women’s biology. They’re worried about masking specific types of abdominal pain that if they treat the
pain, the patient leaves and then something bad
happens to the patient, they’re gonna be doing
the patient a disservice. I think one of the very interesting
points within this study that I like to figure
out an explanation for is that while there
was a gender difference in the prescription of opioid medications for pain between men and women, there was no gender
difference in the receipt of nonopioid analgesia for men and women. If we’re postulating that we
have a gender discrimination occurring here between males and females, why isn’t it hold true
for nonopioid medications? I don’t have the answer to that. That’s why I like that
we’re talking about this and creating avenues for further research. What I want you to know,
this is for the bright side of this conversation that
Jon Oliver doesn’t focus on, ’cause that’s not what
his segment is about, but it’s that we are aware
of these disparities now. Because of this great research that has been done 10, 15 years ago, we are now talking about this. We have bias education in our classrooms, we have different ways we screen female patients
versus male patients because of their atypical presentations. That’s actually one of the next points he’s about to get into. – A lot of times, women’s
symptoms, especially pain, are attributed to emotional imbalance or women being hysterical or
crying wolf about their pain and that’s absolutely wrong. – It’s wrong, flat-out wrong. That’s not the way we’re
trained to practice medicine. I feel like it’s almost an archaic way of practicing medicine. And I think this newer
generation of doctors that’s been trained
within the last 10 years, I hope, and I am optimistic
that the future studies that are gonna be done on
this will show an improvement. – There was also a systemic problem here where doctors may literally
know less about women’s bodies because historically, medicine
has studied men’s bodies which here means those
assigned male at birth as a proxy for all bodies. – He is so right in this case. These studies that have
been done 20, 30 years ago on specific ailments have
been so poorly designed when it comes to the patient population that it’s just not applicable to everyone. Taking care of a female patient is different than taking
care of a male patient. They way they present is different, the way they talk about
their symptoms is different, their biology is different,
their anatomy is different, their hormones are different, and the way they experience
pain is different. This is not a bad thing, it’s just something we need to be aware of and structure our
research around properly. – Take heart attacks. You’re conditioned to think of them looking like they do on TV all the time. People grabbing their chest
and then falling over. But for many women, that
is not what they look like. – The reality is we’ve
studied heart disease as a disease of men. It’s not the case. Women have high rates of heart
disease just as much as men, if not more in some cases because it’s missed and undertreated. – If you are suffering a heart attack, will you always get a shooting pain down your left arm first?
– It’s not always. And in fact, the tricky part about this is men and women feel
heart attacks differently. – Wow!
– The classic symptoms that we see in men is that pressure, the elephant sitting on your chest. They don’t often happen to women. They have more substernal
pain, maybe a discomfort, sometimes radiating to the
jaw instead of the arm. – Your jaw? – Yes. – So you could be thinking
it’s a toothache– – Exactly!
– And you’re literally having a heart attack?
– Yes. – But here’s the good part. Right now in medical school, and even when I trained in
medical school and residency, we’re aware of this because of the quality of research he talks about. We’re so aware of it that now when a patient
comes into my office, a female patient, and has
some of these symptoms, right away, I recommend to the patient, let’s check out your heart and make sure that it’s not your heart. Now, this doesn’t apply to
the entire medical field because there is doctors
that are practicing that are 67 years old
that weren’t taught this. So as time goes on, I think
we’re gonna continually improve our identification of
women’s heart disease, the way we do research. – The young doctor came
in, very condescending, thought I was just a
drama queen, and he said, “It’s not my job to tell
you what’s wrong with you, “it’s my job to tell you what it’s not. “And it’s not your heart.” – That’s obviously an
egregious medical error and horrible treatment of a patient. If you’re going into medicine and you’re gonna be talking
about patients that way, it’s just a failure on
all sides of the equation. Because the goal of a doctor
is to treat the person that’s sitting directly or
laying directly in front of them and to come in and say something
like that, it’s horrible. And I’m sorry that this
patient had to go through that. I don’t wanna poison the
doctor-patient relationship thinking that this is the norm. This is not the norm. – One study found that women who came to the hospital
with heart attack symptoms was seven times more likely
than men to be misdiagnosed and sent home from the
hospital which is terrible. – The tricky part about
recognizing heart attack symptoms in female patients is
that they are often masked and they all often present atypically. Now, we should be on the lookout for this and I do think that if we
repeat these same studies 20 years from now, we’re gonna
have much better outcomes because we’re learning about this. Actually, the American Heart Association has put forth a ton of effort and money into educating the public
about women’s heart health. I actually participated with the American Heart Association Go Red for Women events all the time because we need to not
only educate doctors about keeping their eyes open and being really attuned
to the possibility of these atypical symptoms, but also educate patients themselves. In fact, a Wall Street Journal article that Jon Oliver quotes says this: “Women do bear some of the responsibility “for delays in care themselves. “Women think, ‘Yes we’ll call the doctor “after we pick up the kids
and finish that report “and put the casserole in the oven.’ “But she urges others
to pay more attention “to their bodies and their instincts. “‘You know when something is not right. “‘That’s what I didn’t pay
attention to.’ says Ms. Thomas. “The acid test, if somebody that you love “is experiencing these
symptoms, what would you do?” This is great advice. The thing that I tell my patients is to be alert but not anxious. You don’t wanna be anxious
about your conditions because that can exacerbate
symptoms, make things worse. But if you’re alert and you’re attuned to what’s normal for you, you can then go and talk to your doctor and have a good quality conversation about whether you need to
activate the triage system and go to the ER or you can take the time and go to the urgent care center or your family medicine doctor
appointment a few days later. – We found over 83, 000
excess deaths per year in the African-American community alone. – [Narrator] 83,000
excess deaths each year. That’s the equivalent of a major airliner filled with black passengers
falling out of the sky every single day every year. – Okay, that’s such a weirdly
specific way to put that. – Jon Oliver’s a funny guy. This is interesting. That interview from the
documentary happened in 2008 and it’s amazing how much
socioeconomic factors decide whether or not you’re gonna have good health outcomes. In fact, it’s been said that
social determinants of health, basically your zip code, decides more about your health outcomes, how long you’re gonna live, what quality care you’re gonna receive, moreso than your actual genetic makeup or your medical history. And that’s crazy to think that just because of where you were born, you’re gonna have worse health outcomes. But it’s true. In 2008, that study was
done and that was the case. I will say, in 2017, which is nine years after
that documentary was done, the CDC released a statement saying that the racial mortality gap is closing. Fast forward to 2019, The
Economist releases an article that states Black men in America are living almost as long as white men. Now, that’s a weird headline to hear but it shows that this
racial mortality gap is closing further. Now, we need to keep monitoring this because that can change really quickly depending on the financial
status of the US, how medical care is distributed, insurance status, and all of that, but progress is being made and I think that is the one piece that’s missing out of Jon
Oliver’s segment here, which, I guess, it’s not his
job to give you all of that but it’s that we are making progress. – Even just when it comes to contact with the healthcare system, there can be appalling disparities. There are, again, many studies
showing African-Americans have a lower likelihood of receiving recommended
care for everything from pneumonia to hip
fractures to multiple cancers. – This is one of the things I hate hearing about our healthcare system, that just because you
live in a specific area that has a high amount
of African-Americans or even other minorities, you’re gonna have worse outcomes in care when it comes to pneumonia,
trauma, all of these issues. We’re failing, right? We’re failing as a healthcare system, we’re failing as a nation. And I actually dove into this article that he’s talking about here. “Despite the overall
improvement in outcomes, “the gap in quality of care “between black and white
trauma patients in Pennsylvania “has not narrowed over the last 10 years.” This was a study that was done in 2013. “Racial disparities in trauma “are due to the fact that black patients “are more likely to be treated
in lower quality hospitals “compared with whites.” Just because of the
lower quality hospital, African-American patients are
suffering more complications, having worse outcomes,
receiving worse care? That’s horrible. Is it because these
hospitals are understaffed? Is it because they have
too much patient volume? Meaning too many patients are
coming in at the same time? Is it because they’re not
following the standard protocols? Unless we take a hard, firm stance and look at this data that may
be uncomfortable to look at, we won’t be able to deliver quality care to all types of patients,
irrespective of where they live. – As a study of med
students and doctors found just three years ago, misinformation about
African-American patients is rampant. – [Reporter] The study
found some doctors believed there are biological differences
between the two races. – The way that this newscaster is presenting the information, it’s almost as if she’s
saying doctors are wrong to believe that there are
biological differences between the races. There are biological differences and it’s actually really
important for healthcare providers to be aware of these differences to deliver better healthcare. – [Reporter] 25% of doctor residents thought blacks have thicker skin. – Holy (bleeps)! You do not expect to hear
that at a medical school. You barely expect to hear
it yelled across a table by a racist grandfather at Thanksgiving! – Again, we have to bring
this back into perspective. This study actually presents 15 points, some of which are true
biological differences between black and white patients and it asked medical
students and residents to rate how true those questions were. It wasn’t a yes-or-no question. In taking a test like this,
you’re bound to make mistakes. I would have made mistakes on this test. Actually, if we pull up the exam here, some of these questions
can be quite tricky. Question number nine: Blacks, on average, have denser,
stronger bones than whites. Most laypeople and even some
doctors may have trouble. It’s true. That is a biological
difference between the races. It changes the rates of certain conditions that can affect our bones
moving forward later in life. The question listed as
number eight in the study says black people’s skin has
more collagen, in parentheses, i.e. it’s thicker, than
white people’s skin. So it didn’t just say thicker, it talked about a specific
makeup of the skin, of collagen. It’s not crazy to believe that there’s differences between collagen. It’s just a mistake or
a lapse in knowledge. I don’t like that he’s
trying to draw a parallel as if it’s a racist person
making this assumption. – That is not the only insane
belief that that study found. 14% of second-year med students agreed that black people’s nerve endings are less sensitive than whites
which they obviously aren’t, and 17% believe that black people’s blood coagulates more quickly than whites, which it obviously doesn’t! – I don’t know how he says
it obvious that there aren’t. There are biological differences, and second-year medical students, 10% of them are allowed to
make a mistake on an exam. To point us out and say it’s
obvious that they aren’t, I would like to see John Oliver,
especially as a layperson, hear the point that blacks have more dense bones than whites, I’m curious to see it’s
obvious that’s not true. He’ll be making a mistake. – Black people, we don’t even
get our hands on opioids! (audience laughing) They don’t even give ’em to us. White people get opioids
like they Tic Tacs. – First of all, I love Wanda Sykes. I think she’s absolutely hilarious. What she’s saying is true. The opioid epidemic has
disproportionately affected the white community way more
than it has the black community which is a result of the overprescription of opioids to the white community. – One recent analysis
found that black patients were 34% less likely to be
prescribed opioids for pain than white patients
with similar conditions. And while there are a lot of good reasons to prescribe fewer opioids, my patients are black
is just not one of them! – We have to figure
out how that bias forms and where these patients are
more likely to be treated. As I mentioned earlier
in some of the segments, that unfortunately, the African community attends lower quality hospitals. In lower quality hospitals, doctors are generally
faced with more patients, less resources, and
they’re facing patients that may be facing homelessness, they may have substance abuse issues at a higher rate than the white community, so they may be more reluctant to prescribe opioid medications. I think we need to do a better job at formulating our research to not only find out
that, A, this happens, but to try and figure
out where this happens. Is it happening in isolated centers? And then we can focus on these centers and figure out what’s going on, why these biases are occurring or these disparities are occurring. – If you consistently have bad
experiences with healthcare, you might be less inclined to seek help that you need in the future. – This is important to
note in both directions, that if you consistently have
bad experiences with doctors, you’re less likely to trust them and less likely to seek help. John Oliver’s absolutely right. That’s the human condition. Now, I also wanna bring forward a topic that’s not as much discussed in that doctors, throughout their day, are constantly seeing
drug-seeking patients, are seeing patients who are
selling their medications, are seeing patients who are not compliant and the doctors may be genuinely worried about the abuse of these medications. That can not only trigger doctors to prescribe less of those medications but also have a genuine concern
as to if they prescribe it, are they doing a disservice. I’m not excusing the fact that doctors are
prescribing 34% less opiates to black patients than
they are to white patients. I’m just merely saying that we should really take a look at this and figure out why this disparity occurs. I’d like to speak up for
the medical community because I know doctors, in some of these low
socioeconomic communities, are dealing with less resources,
less time per patient, dealing with very difficult patients, and patients that maybe
have incomplete insurance or poor health coverage and the only thing they can prescribe and that the patients
can afford is ibuprofen and that’s horrible to say! In talking about all this, it may seem that I’m ignoring the bias or discrimination that can occur. This absolutely occurs. And I’ve heard anecdotally
from some of my patients where this has happened and it sickens me and we need to talk about
that, put that in the open, but now put an over focus on that where we miss systemic flaws
like socioeconomic factors, quality of hospitals, the quality of insurance
that patients have, because unless we address all of these things simultaneously, we’re gonna make progress in
one area but fail in another. I wanna help patients as much as I can and not get short-sighted and focus on only the
most inflammatory factor. – It was just this belief
that I was making things up, that what I was saying wasn’t real, that I must be seeking
drugs or selling the drugs or some such thing. – That’s what you were getting
in the doctor’s office? – Oh yeah, absolutely! – See, this is horrible. But what I will say is now
we’re establishing guidelines that will allow us to avoid
these awkward interactions. For example, we’re creating pain contracts where if we’re establishing with a patient that we’re gonna be giving
them controlled substances, we create a contract. This is how it’s gonna work. We’re gonna give you X number of pills. If you lose your pills,
this is the plan of action. If you are traveling, you have to take your
medications with you. And there’s all these
guidelines that are set so that the patient knows what to expect, the doctor knows what to expect, and there’s no surprises and
no feelings of discrimination. – And there’s perhaps no stocky expression of where sex and race can negatively impact healthcare outcomes than maternal mortality. Currently, The United
States has the highest rate of maternal mortality
in the developed world. – This statistic receives
a lot of publicity and there’s a few interesting
theories that people have. First of all, the maternal
age in The United States who are having babies later in life, we’re the most obese we’ve ever been, which obviously lends to
a lot of complications when it comes to pregnancy
and post-pregnancy, but then I found a really
interesting article that suggested this theory. Scientific American showed the statistic that the maternal mortality
rate from 1999 to 2002 was about 9.8 per 100,000 live births. And then if we fast forward 10
years later to 2010 to 2013, it jumped to 20.8 per 100,000 live births. What they say here is really
the most interesting part. The numbers in the latter
period may have been affected by a small change in the forms that are filled out when a person dies. Until relatively recently, most states relied on a
death certificate form that was created in 1989. A newer version of the
form released in 2003 added a dedicated question asking whether the person who died was currently or recently pregnant, effectively creating a flag for capturing maternal mortality. The addition of this question means that the apparent increase in
maternal mortality in The US is quote, “‘Almost certainly
not a real increase. “‘It’s better detection
from new certificates.’ “says Robert Anderson, “chief of the Mortality Statistics Branch “of the CDC’s National Center
for Health Statistics.” The CDC is saying we’re
not actually seeing more maternal mortality in our country. What we’re actually seeing is better representation
of that mortality. – If you’re a woman of
color in this country, especially if you’re black, your odds of dying in childbirth are three to four times higher
on average in our country. – Why? ‘Cause you’re not talking
about access to healthcare. You’re not talking about
money or education. – No, and this is gonna be hard to hear. We believe black women less when they express concerns about the symptoms they’re having, particularly around pain. – These racial disparities
exist even when you control for socioeconomic factors like education or insurance status. We are literally disbelieving
black women to death and that is appalling and often– – That is appalling! There’s no doubt that this happens and it needs to be addressed
on a systemic level. I don’t wanna get caught up and believe that’s the
only thing that’s happening because researchers have found
other contributing factors like the researchers in New York who found that up to
half of this disparity can be as a result of black patients attending lower quality hospitals, but then even then, we need to figure out why those lower quality hospitals are contributing to this
increase in maternal mortality. Is it genetic? Is it because they’re
predisposed to illness? Is it because there’s lack
of preventive care options? And until we have this
difficult discussion, we’re never gonna figure
out how to close that gap. I wanna come in from the
optimistic side again and let you know that there’s
actually millions of dollars that are being dedicated to looking at all of these gender issues, race issues, maternal
mortality issues from Congress to figure out what’s happening,
to conduct proper research, to improve our screening methods. And again, I wanna hammer this point home that a lot of these studies
were done 10, 20 years ago and that already we’re seeing improvements in the way that we treat female patients, in the way that we identify our bias, in the way that we understand that we need more diversity in medicine, that we’re trying to create
funnels from different cultures to come into the field of medicine through scholarship
programs and all of that. In fact, I work with the STFM, the Society of Teachers
of Family Medicine, who have scholarship for minorities that I’ve actually donated
to and partnered with through my foundation Limitless Tomorrow. And the more we can do that, the more we can get onboard
with this type of diversity and bias training and acknowledgement that our system is failing
certain minority groups, we can all do better. We’ll all improve as a result. This is obviously quite
a controversial topic. Uncomfortable for me to watch, uncomfortable for my colleagues to watch, but I think it stimulated some really good conversation among us. If you have any outstanding
comments or questions or even experiences
that you care to share, drop ’em down below in the comments. I’m all about stimulating
happy and healthy conversation, especially if it means we’re gonna improve the healthcare field. And definitely click on this video. And as always, stay happy and healthy. (smooth hiphop music)

100 Replies to “Doctor Reacts to John Oliver | Last Week Tonight: Bias in Medicine”

  1. 19:00 I had a biology teacher tell me that black people are less adapted to cold climates than white people. Their brains don't cycle the blood as many times as whites and they end up getting frostbite more quickly. That isn't racist, it's different. I think black people are great. But they ARE different in some ways than white people.

  2. What "hurts" is getting crap care due to bias.
    Also, your surprise at John Oliver being correct is at best silly. You are surprised they did their homework?
    As for "non-opiod medications" that is because these are over the counter like Ibuprofen, Tylenol or Aleve. Fine for minor short term aches, pains or fevers but useless when given for anything more serious than minor aches and pains or the occasional fever. Most people have these meds at home. There is no difference in access because there is no difference in the ability to walk across the street from the hospital to Walgreens and picking them up. This is the modern version of "Take two aspirin and call me in the morning."
    As for biological differences.. to hear a doctor use the word "races" is worrying. There are no "races" in any physical way.
    People may have individual differences but there is only one human race left on this planet, and we are all it.
    As for why do people in poorer clinics and hospitals have worse outcomes: because they aren't taken as seriously as they might in better facilities. My husband has memory issues, and got laughed at by a nurse while in the hospital. In a hospital that tends to better off people she would have been fired, maybe sued.
    Full stop.

  3. Oh by far my favorite is how easy it is for men to be able to get the…ahem…wires cut, but if I go an ask my doctor about getting something done to my own personal reproductive organs; you’d think I was dooming the human race to extinction.

  4. you keep bringing up "quality of hospitals", but what about the quality of education?? seeing how you attended a school that isn't even ranked among forbes' top 650 "quality" institutions in america… so does this mean that your perspective is of low quality? if there's high & low quality hospitals then there are certainly high & low quality schools right?

    the bottom line is this, the concept of high & low quality hospitals is just as bs as someone trying to discredit your medical degree arguing that your school is inadequate. bc you ALL are SUPPOSED to be taught the SAME exact information & abide by the SAME exact laws no matter what school, zip code, city, or any other bs defense you're proposing.

  5. Worked pretty damn hard to avoid confirming any bias…basically found any reason he could to excuse it.
    I appreciate a good debate but damn…the white male doctor reacts to a segment addressing female and race-based bias…. works very hard to try reason with it…

    Damn people…this 'doctor' also chooses to react to HOUSE and Scrubs like….wtf

  6. I don't know how to feel about this video or John Oliver's Medical Bias show–and I just started watching your videos. For someone who used to collect tons of data (working in HC quality), there is a reason why some research are addressed behind closed doors and filtered when shared in public. A lot of hospital administration do address these things to make policies unless the hospital is in a situation where they can't, which you have mentioned already. However, claiming things from research without sharing the rest of the information without an expert weighing on things at a widely-watched public talk show feels almost misleading. Who among the million viewers would look up those research papers that were mentioned? Who has the time and willing to discuss these things? Oh, yes…Dr. Mike. Unfortunately, John Oliver doesn't mention follow-ups nor those research, right? Is the show supposed to be informative, entertaining or just calling for awareness?

    A lot of patients don't know what goes behind Hospital administration. Maybe it's good to share some insight on that, as well.

  7. While you where trying "not to make excuses", you totally forgot the fact, that we use the medical knowledge we have now, based on studies which do not at all reflect both sexes. Of course it's discrimination.
    Female bodies aren't as well "tested" as male bodies. No one says, it's the doctors fault, but this system doesn't work for a big part of our population and everybody should acknowledge that.

    One example, I experienced myself: if you do not describe symptoms in a factual short summary manner, but with more explanation and emotion, male doctors tend to get impatient and stop listening. Me, as a nurse, I than always tried to give them a short summary, they could understand – that's pitiful.

  8. I told my dentist I wanted a tooth removed because I couldn't afford a root canal. No insurance… The doctor refused to do that, and said I was too young to have a tooth removed. I was 23.. He was an old, old white man. I told him I couldn't afford it, he didn't listen and said they couldn't do a root canal, but he was going to start it. I never was able to afford to see a dentist again before it shattered in my mouth. I refuse to see male doctors because they never listen to me.
    As for the mortality rate of women in childbirth… I don't know why you brought up the increase that may not have been an increase… John Oliver said that the rate of death in the US was the highest in the DEVELOPED WORLD, not that it increased recently… So the better stat just shows how much farther behind we have always been to other countries.

  9. I really enjoy watching your take on the matter, since medicine is your area of expertise, I find your analysis to be much more accurate. Thing is with John Oliver is that he frames certain subjects in a way that is somewhat misleading, he implies racism and sexism are the causes of these discrepancies, however correlation does not equal causation. Yes, racism and sexism are indeed factors, but not the only ones. Watching Dr. Mike and his method of framing is much better, and doesn’t determine the cause of these things.

  10. I wish my doctor was like doctor Mike. Instead, my therapist or doctor dont respond to my emails for at least 2-3 weeks, I cant make an appointment for almost just as long, and my therapist refused to let me off of one medication because I hadn't seen him enough times. I told him the medication made me irritable and worse, and he said I haven't seen you in a couple weeks so I'm not changing your meds. I've been seeing him for almost a year. I haven't filled a new prescription for my mental issues because I feel uncomfortable seeing him in almost 7 months. I cant ever talk to him directly because I feel like he's judging me. I cant talk to him because it feels uncomfortable for me to sit in his office. I told him about hearing voices and often times seeing things that are t there and hes like oh dont worry about that. It's just stress and it's like I'm not even stressed. I bake cakes for a living. Why are you ignoring me and the things I say? Do I need to scream it at you for you to listen? I dont want to be ignorant and shouty but you're leaving me no option. It's either I sit unmedicated for years and slowly get worse or I see a man who makes me feel like I'm less than a human, and sorry to say sir, but no thanks. I'd rather stay at home in the comfort of my own home than be made to feel like I'm less than human

  11. When people of color go to neighborhood ERS they are more likely to spoken rudely. Some ER doctors in these areas are tired and their bias makes them assume you are drug seeking.

  12. I think it is great that a Jester can provoke a response like this and it is also great that a Doctor responds like this. Let's hope something changes.

  13. Thank you for actually doing research and being open-minded to all causes of medical inequality. Just yelling “racism” and “sexism” at everything is useless.

  14. I had my doctor send me to the ER with a BPM of around 170 the doctor came in the room the next day and said that I just had "white coat syndrome" referring to my heart rate goes up because I'm scared of doctors… he was a dickhead, he didn't even bother running any tests

  15. Maya Dusenbery, "Doing Harm." There are implicit biases, ones that you don't think you hold – but you do. This is where the problems happen. The doctors don't think they are causing harm to women, but they do think that they might be a bit "emotional" about their problems, and this implicit bias means they take the complaint less seriously. This extends to people who drink, smoke, have "risky sex," or are fat. The doctor's implicit bias is that they are causing the problems that they complain about. This is more common than not. Hopefully the new crop of doctors coming up will see fewer biases in treatment, and we will learn and grow. But read "Doing Harm," it is essential reading for every doctor.

  16. They are so aware of these stuff that a lot of it still happens? It seems to me just a white guy trying to justify all of the problems mentioned and saying that it needs to change in the future while people are dying now.

  17. Ref: poorer neighborhoods and poorer hospitals – this could be helped by a single payer medicare system. The for profit system will **always** give poorer care to those less able to pay. My best friend is a doctor – and when she was your age, we argued over "socialised medicine" – I said it was better, and she said she had this expensive school, and wanted the capability of profit without the government intervening in her wages or standard of care. However, as her career unfolded, insurance companies intervened in her standard of care. Her corporate bosses told her how much time she could spend with a patient, or how many or what kinds of tests that were "standard of care." She could not, under the profit system, provide the care she wanted to provide for her patients. She left and works as a type of government doctor (providing health care for State University students), totally disgusted with how the profit system of medical care was working.

  18. The guidelines of pain contracts are humiliating and discriminatory by nature. The patient is contractually guilty until proven innocent, and you can't prove a negative. I don't know anyone who has chronic pain who is satisfied with their pain contracts. Look to be seeing increased suicides over this issue.

  19. Maternal mortality rates. People cannot afford hospitals. Also – there has been a huge increase in antidepressant prescription rates, and there are no studies which show that antidepressants are safe in pregnancy. There are, however, studies which show that there is a correlation between antidepressants in pregnancy and autism (for example), and that it is a danger to the baby to take antidepressants. Of course, they are extremely hard to get off of, and if your pregnancy "just happened," you may not be able to get off of them in time. I thought it interesting that the first time period (99 to 02) and the second time period (10-13) – there was an exponential increase in antidepressant prescriptions. Just sayin'.

  20. Doctor Mike, how can women’s symptoms be ‘atypical’? unless of course you are unaware of your own bias in treating men’s symptoms as ‘typical, and women as some kind of aberration. WTF? This whole segment reeks of smug, self-satisfied, ‘trust us we’re the experts’ bullshit. Typical!

  21. So this brings up another question or concern that's majorly overlooked, with transgender patients our anatomy is different, and our hormones are different, considering that there have been recorded cases of transgender people dying in the hospital because doctors don't know what to do. Dr.Mike I was wondering if you could touch on this subject with "ex-transgenders" approaching the white house, and many people claim we're "overexemplfying a mental illness" I was wondering what a medical professional would think about this. so two questions, what would be your opinion on transgender healthcare? and what would be your response on gender-affirming surgery on a patient under 16 years old?

  22. I'm sorry this is just liberal bullshit …percieved slights aren't actual slights….but we treat them as be all end all …I cant finish watching this because its just stroking liberal ego's…stand up for your profession man dont pile on to appease the masses

  23. Abdominal pain in women. I wonder what would cause that…
    There's a reason they don't prescribe opioid medication for ABDOMINAL pain in females. A lot of the time abdominal pain for females is related to reproductive organs and pregnancy. Duh!

  24. I get links to articles like these through my subscription to the American Optometric Association newsletter. One of them I read included an article stating women perceive pain more intensely than men. The article also reported women are more likely to be prescribed opioids than men. I think the conflict in the statement with the study mentioned by John Oliver was the study in your video was limited to opioid prescription solely for abdominal pain. Feel free to take a look. https://www.npr.org/sections/health-shots/2019/08/26/741926952/women-may-be-more-adept-than-men-at-discerning-pain

  25. Dr mike you know that it is almost impossible to determine causality in these cases- you can’t use this as a catch all response to these studies

  26. Thank you for making this video. As an African American Woman, I’ve experienced medical bias more than once. One time I went to the ER with these symptoms: Pain right sided, radiating in my back, really really fatigue, and loss of appetite. The doctor came in checked me and only ordered a urine screen. I waited for a few hours and a nurse came in with discharge papers. The doctor never came back. They said I had a UTI, prescribed antibiotics and sent me home.

    I started feeling worse and went into same ER the next day. This time I had a different doctor. Right away, he ordered blood cultures, urine, a CT, and treated the pain. It came back that I had a very serious Kidney Infection and I had to go on IV antibiotics and was admitted for 4 days.

  27. My sister went in for chest pain thinking that she'd better make sure it wasn't serious and the doctor laughed at her and treated her like an idiot. Thankfully the nurse told her she did the right thing. I hope these more progressive doctors replace quacks like that quicker.
    Also, my best friend was in the hospital because his lungs were filling with fluid, and the doctor flat out told him and his wife, "Sorry you're going to die." It took that doctor's supervisor stepping in finally to save his life. I don't know if it was cause they're poor, or just the doctor was just that jaded… Sometimes you have to wonder though how someone who goes into this field ends up with that outlook.

    Edit: As an added note, great bit about maternity mortality and just capturing the accurate amount of mortality with a form, however that doesn't change the fact remotely it's still the highest. It just means we've sucked about it longer than we've realized.

  28. I have PCOS. I went to the college OBGYN and told her that i am having pain to the side and slightly lower than my navel. I suggested that I should get an ultrasound because that pain was familiar from the last time I had an ovarian cyst. The doctor looked me in the eyes and laughed and said "do you even know where your ovaries are?" and didn't give me an ultrasound. I had a very very painful cyst burst a couple of months later.

    I am studying nursing, and I have come to find out… that the dermatome pain for the ovaries are exactly where I was having pain.
    https://rislyonline.wordpress.com/2017/06/12/dermatomes-myotomes-referred-pain/

    a different obgyn told me that passing out during a period is normal. it isn't.

  29. can we have a video talking about the rate of false positive mammograms? i have a friend very passionate on the subject devoting her life to studying better ways of cancer screening tests

  30. you keep saying "they do not have a causation for why this happens" but at some point if multiple different studies are finding the same problems with only one major factor then maybe that's the issue

  31. This was a balanced review. I liked your willingness to point out where these studies are being twisted, as well as where these issues are being presented fairly.

  32. You should have played the Wanda Sykes part a little longer, where she says that she had a double mastectomy and they gave her ibuprofen. That would have invalidated what you said next about people of color going to lower cost hospitals and patients not being able to afford the meds. Because, obviously, Wanda Sykes is a wealthy woman of color and would be going to a higher quality hospital and could afford the meds, even without insurance.

  33. Also, I do have a story about getting lower quality care because of a bias towards heavy people. My ex-husband was air force and so I saw my Drs at the VA. She absolutely HATED fat people. I used to be over 350lbs and I went in there with an ear infection and she told me if I lost weight, this wouldn't be happening to me. My blood pressure, cholesterol, and blood sugar have always been perfect, but she sent me for blood work every 4 weeks because she just knew she was going to find something (yet, somehow missed why I had gained so much weight). I guess I wasn't the only person she did it to because she was fired less than a year after she started. So, the male Dr who replaced her said that my blood pressure and cholesterol were better than his (and he still missed my diagnosis). It wasn't until I started seeing a Dr (my OB/GYN) outside of the VA system, that I was finally properly diagnosed. My 1st appointment was at 8am, he took blood and urine and all the standard tests and calls me at noon, I knew immediately something was wrong. He called me with a panic in his voice and told me "you need to call your primary and get on medication NOW". My TSH reading was 57 at this point (normal being between 0.4 and 4). He told me he has never seen a patient alive and functioning with that high of a number. I told him I wasn't really functioning and he said "patients with that high of a number are usually comatose or dead". So, I called my primary and told him what my gyno said. His response was "well, let's wait and see what happens". He put in a slip for me to get blood work 2 1/2 weeks later. My TSH shot up to 175 in the meantime. I got on meds and actually ended up losing a lot of weight and got down to 195 at one point. Then I yo-yoed for years. After I had my son, my weight shot back up and I couldn't get below 250. When I started seeing the endocrinologist (shortly after the blood work), they diagnosed it as Hashimoto's Thyroiditis. That combined with severe PCOS made it impossible to lose weight. Since then, my son is now almost 8 and I am 15 months out from gastric sleeve. I was around 280 lbs when I had my surgery 15 months ago and am now about 120. The point of my rambling is that there is also an inherent bias against heavy people and there are Drs who do believe that everything is because you're fat and the only possible reason for you being fat is that you're lazy and only eat junk food. That caused the Dr to not look for an underlying cause and could have killed me. And there's nothing anyone could have done about it because you can't sue the government.

  34. Or if ur more open to the science fiction, try “ghost in the shell” there isn’t much about medicine but it’s a movie about the body or shell in relation to the soul or ghost

  35. 4:00 that reminds me of a passage from Star Trek were Dr. McCoy is in the past and disguised as a doctor in a hospital and he sees a patient on dialysis and he's like "what is this? the Dark Ages? Take this pill, call me if you have any problem" and latter the patient is like "The Doctor gave me a thing and I grew a new kidney!"

  36. You are right, there are some diffrences between races. For example sickle cell disease, where I live we see this rarely, but it's genetic protection from malaria.

  37. The biggest problem, in my opinion, is that people can't stop equating race with sub-species. There is absolutely no such thing, and people haven't been on the planet long enough to be sorted into them. Humans all stem from the same common ancestors, race isn't a biological concept, and although we have developed some internal and external differences due to migration, exposure to the sun, environmental, seasonal, DNA mixing, diet choices, etc, there are more similarities to people of different 'color' than those who have the same. We need to think of a more efficient way of categorizing people if need be, rather than using the flawed system of race.

  38. Sorry Dr. Mike but your comments about the reasons for the disparities in rates of maternal death are way off the mark and fuel the 'mother blame' culture. I'd recommend you read the most recent data from the CDC which confirms that black women have a much higher risk of maternal mortality than white women, even when stratified by education. https://www.cdc.gov/reproductivehealth/maternal-mortality/preventing-pregnancy-related-deaths.html You also fail to draw attention to the fact that the US has the worst (ie highest rate) of maternal death among ALL well-resourced countries. See the 2016 Lancet article describing national rates (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31470-2/fulltext). This is by far a more damning statistic than discussion about why rates of maternal death have increased due to possible underreporting. If this is all due to underreporting, then the rate has therefore been high for a longer period than we originally believed. Lastly, reducing maternal death and morbidity and the disparities related to both is a major research agenda for the NICHD. https://www.nichd.nih.gov/about/org/od/directors_corner/prev_updates/040419-maternal-mortality Instead of speculating on the reasons for disparities, i would encourage you to focus on the urgent need for research to better understand these causes for these disparities which are likely more to do with structural racism than patient-level factors. This has been attracting considerable attention from major news media outlets e.g. ny times. https://www.nytimes.com/2019/05/07/health/pregnancy-deaths-.html The Jon Oliver piece draws attention to this issue. I would encourage you to do the same and downplay your speculative comments as to why until we have more data. The Maternal Mortality Review Committees will help us better understand the medical reasons for these deaths, but it is unclear whether they will unearth the impact of structural/hospital-level contributory factors.

  39. Its definitely not bias…at least bias is just a small part of it…it must really be the low quality hospitals! Yeah right!

  40. I’m not quite sure about the study about trauma patients in Pennsylvania. I live in a rural area of PA and it is so hard for anyone to get to a quality hospital. They just aren’t around. The closest MI and CVA receiving hospital to me is about an hour away, and the closest level 1 trauma center is about an hour and 45 minutes away. So while I’m sure there is bias towards different races, I just don’t see how they can determine African Americans have any harder of a time getting to quality hospitals than whites in this state.

  41. What about bias against patients with mental health diagnoses? I have an anxiety diagnosis and have gone to doctors with severe migraines to the point of not being able to speak clearly, and their advice was to “calm down” and two days later, with the same recurrent migraine one gave me a prescription for Xanax. My anxiety has already been well controlled, I’m looking for help with migraines. Basically the medical community is saying “Your pain does not matter because you have anxiety.” It’s enough to want to give up on the medical world altogether.

  42. Thank you for presenting this conversation to us watchers.

    From the angle of John Oliver’s segments, he’a talking to the laymen who have different degrees of isolation from health professionals, and the majority of the practitioners in general are those older practitioners who are preferential to their old (read: outdated) information from their training. However, this generation is getting doctors with better training, and the system is increasing its standards in patient care

    For the racial differences, it seems that one of the problems is that the more racially charged would take the true differences to their logical extremes, such as equating the force needed to pierce a patient’s skin for an IV to the force needed to pierce the skin of an elephant (or along that lines). Or, in the case of thicker bones, ignoring that that there are patients that are completely normal in appearance and day-to-day function but are on the spectrum of bone density to where it takes less force to break their bones. It’s the kind of idea where the true difference versus the biased difference are most distinguishable when they are plotted on a graph. And this is the point that is “obvious” to John Oliver (or his script writer/editor).

    To sum up my comment, both your points and Last Week Tonight’s points are important to bring to light. The most important thing to be aware of is what the base reference is for the different audiences.

    Sincerely, a pharmacy student.

  43. Theres the DISC system. Men are D type…very bottom line. Women are S type and we need and love details about what's going on with our bodies.

  44. How about a video discussing the type of care people are getting here in Las Vegas. Worst medical care in the US. Not only is the care already bad, but if you have state Medicaid or Medicare forget about it. My diabetic mother living on social security and Medicare hasn’t physically seen a doctor in over a year.

  45. Ok so maybe I am a little late to the game, but I was wondering something. Has anyone done any side by side comparison of recent valid studies done on opioid prescription and addiction? Is there any comparison for not only who gets prescribed more and who is more likely to develop an addiction? Not saying everyone needs opioids, and I'm not saying they shouldn't be prescribed because of a statistic (I'm far from a medical noivce let alone expert), but, if there is some sort of bias at play in the world of prescriptions… Maybe some linkage?
    Side note(s): My husband can go to a MD for any pain and almost always gets some form of opioid even though he refuses to take them. I however am advised (not that I want opioids at all) to just take OTC pain killers?
    I have also had to stop seeing an MD who was helping in diagnosing and prescribing medications for mental health because he asked, in front of my 7 year old daughter, "Do you get b*tchy around… 'that' time of the month? "

  46. Try treating the obese as real people, not just as a failed diet who doesn't deserve surgery, knee or hip replacement, or any other procedures.

  47. One bias that wasn't addressed here is overweight/obese patients, especially women. I have a host of minor medical issues, and while my weight might worsen a couple of them, it is certainly not the cause of any of them. In fact, I'm overall very healthy – vitals and blood work all normal. But I feel that all providers see is my weight. And it is frustrating. It took YEARS for anyone to believe me or get proper diagnosis/treatment for many of my issues. I have yet to find a PCP who I feel actually listens. Any diagnosis I've received has come from specialists or urgent care providers.

  48. And let's not forget how clinics love to run pregnancy and STD testing on patients without their permission, even when the patient says those things aren't possible! Because most women don't understand how pregnancy and STDs happen.

  49. The best biases I have had to deal with as a female were dermatagraphism and PCOS. When I was searching for a diagnosis with several different doctors as a small child. Was told by one male I was being "imaginative" and " attention seeking" despite having very real physical symptoms that, for days at a time for years, kept me up at night and led me to scratching myself raw and bleeding many nights. Literally took an open minded doctor and a pen to diagnose. what for years I was told was in my head or I was faking.

    With my pcos I have been told that my borderline hemorrhaging, months long(longest being 7 months and some change long), painful periods that have put me in the ER for severe anemia where my body was shutting down, was "just my genetics". "Woman problems". I have had cysts tear my ovaries but hysterectomy isnt an option because "your future husband might want kids" something said to me by SEVERAL OB's.
    I would like to not have internal bleeding in the future. I FINALLY have a OB that isnt just throwing me on birth control and leaving me to figure things out. We have several things we are trying beforehand but he does say that if these things dont work he will refer me to someone to go forward with a hysterectomy. I dont want one if I dont need it but if NOTHING else works I am willing. It's more just a relief just to have someone in my corner that genuinely wants to help that has taken so much stress out of things.

  50. Example of unconscious bias: Keep describing normal women's experiences of heart attacks as "atypical symptoms" over and over. They are not atypical, I'm guessing, just not typical for males.

  51. A bit of a dramatic story but I was once told that the cure to my mental illness and MI-induced pain was to "Find myself a nice husband and have a few children" because that would "Sort out my hormonal issues". I'm a non-passing trans man. I went in to get a refill on medication that I've been using for years, not to be dismissed and told that my problems are all "womanly issues".
    Passing off bias in medicine as "needs more research" or "We're not taught about this" leads to these kinds of things happening. These and all the other stories in the comments. It's a systemic social issue that actually affects people in real life, not just in studies. The experiences of these people needs to be listened to and understood instead of being passed off. It's nice to be hopeful and look to the future, but willfully dismissing or smoothing over evidence of actual bias is in and of itself a bias.
    I also noticed that the death of the black woman and the comment of "women are just men with pesky hormones" was left out of the video and not commented on. That says a lot.

  52. 3 years ago I developed severe abdominal pain, at a point I couldn't even walk, first two times to A&E nothing happened I was just given antibiotics after a NEGATIVE urine sample. Third time I went I was offered pain meds while in the waiting room, I told the nurse that I had just taken an hour ago 1000mg paracetamol, 400mg ibuprofen and 60mg codeine and if they give me any again right then it would be an overdose, she said if don't take it they won't take me seriously and probably just send me home so I HAD to accept it and take them. After 5 hours of waiting still in agonising pain (pain meds did nothing at all) I was kept in overnight, they run a blood test but nothing else. Not a SINGLE examination, not even a simple physical,let alone Gyno. 3 years fast forward with this pain I was finally referred by my family doctor to a specialist clinic. I have severe, deep infiltrating endometriosis… That I need surgery for within the next year and than hopefully it won't affect my fertility at least for a while.
    In my experience most doctors don't take abdominal pain seriously in women, not even when you have this much paid meds and you can only curl up as a ball and cry and not move at all…

  53. I think this can also apply to age. When I was a teenage girl I got really sick and was told that it was anxiety because I’m a teen. A year later I’m unable to stand or walk because I have a genetic conditions and bunches of chronic illnesses.

  54. The gender issues mentioned in the video can also be seen in the UK. In a very very obvious way. I understand that Dr M. wants people to look at other reasons why these biases may be happening, he talks about socio-economic issues and hospitals in lower socioeconomic areas. Patients who cant afford the same care etc. But these issues wouldn't necessarily convert to the UK. The NHS is the same throughout the country and hospitals are run the same. People don't have to pay for medication or treatments so there wouldn't be a disparity between what the doctors can or can't offer.

    So why are we still seeing the same bias against gender?

    My Mum and Dad for example…A 53 year old woman spent 5 years going in and out of Drs for knee pain before being diagnosed. A 52 year old man going to exactly the same Dr got diagnosed within a year for the same condition. Says a lot.

  55. I live in the Scotland, in the UK, and I would be interested to know if there is any research being done in these areas which spans across different countries, particularly between the US and countries like the UK who have free health care. The reason I mention this Dr Mike is that this may allow researchers to begin to work out how much socioeconomic factors are actually effecting these statistics. Although it wouldn't be exact because there are still cultural and lifestyle differences to account for, I personally think that more cooperation between countries when it comes to this research could uncover some really useful information. I think this would particularly be good to see between the US and UK because of the extreme differences between health care systems even though both countries are developed and have similar levels of knowledge and access to equipment ect. In the UK your income is only really a factor if you go down the private health care route. Although there are geographical differences in quality of health care in Scotland, most of this relates to specialists, not day to day care. It would be interesting to see if there were the same levels of difference in quality of care related to gender or race. I think this could also really help medical researchers to discover some of the biological differences that can directly be attributed to race, gender or geographical factors.
    I hope my idea is clear, I know that I rambled a bit.

  56. The knee replacement one got to me. It’s so bloody true. I was told the only way to fix my knee would be with a full knee replacement. I’m in extreme pain, and at one point couldn’t walk without a cane for 3+ months. but because I was 30 when I found that out, they refused and sent me home. Apparently it doesn’t matter that some days I can barely walk. Also. My son had a hard time breathing while eating right after birth. His pediatrician at the time told me it was normal, he was just eating too quickly, and as a first time mother I’m just overreacting. I took a long trip with him when he was a month and a half, and brought him to the ER. Turns out he has tracheomalacia, and almost died that night after he choked from laying on his back, and his windpipe collapsing. When I went back and told him I made sure to mention that it was a good thing my son hadn’t died. His face went pale, and I never went back to that dr again.

  57. The reason women are prescribed fewer opioids than men, but there is little difference in non-opioid analgesics prescriptions, is because doctors will use the excuse that we are 'drug seekers'. Nobody is using a non-opioid analgesic to get high. This is discussed frequently in many women's health groups and many women are fearful of going to the hospital because they will be labelled as a drug seeker.

    Personally, I also feel that there isn't enough training in general medicine for women's health issues and bedside manner. I often get mistreated by older male doctors who look at me as a 'crying woman' and don't know what to do with me. I even had a doctor stop a physical exam in the ER for pain because he thought I was "Too hysterical" and refused to continue. Oh, and that was after he tried to diagnose me with a stomach ailment without even touching me. The next day I tried a different hospital and was given an abdominal ultrasound for pelvic pain.
    Fast forward nearly a year and I got in with a pelvic pain specialist, who diagnosed me with Chronic Pain Syndrome (stating that I've literally developed more pain because I've been in so much pain for so long), IC, and a laundry list of other stuff that I can barely remember. Yeah.. sure… I'm totally faking it for drugs Mr ER doc.

  58. Wow I never knew the symptoms could be different from a man and woman with a heart attack(I feel like I need to send this to my mom, she has hypertension most likely from raising 3 girls lol)

  59. TLDR: Normal young girl with medical conundrum who refuses pain medication. Is told she is too young to have issues, is lazy, making things up, and she is seeking drugs.

    Can we address the AGE bias in 2019 I am 20 years old and have been dealing with a still mostly undiagnosed condition leading to the chronic pain diagnosis I legit found when I googled my symptoms Fibromyalgia. I now as a 20-year-old having to figure out a way to work and deal with my symptoms because since I have no diagnosis I do not qualify for any financial help or job leave when I am rendered incapacitated and these symptoms started gradually at the age of 14. I never want pain medication because of the addiction risk and family history, you would think as a white female from a middle-class family with good insurance I would be treated well right (not to say I am privileged but to say I am not a direct recipient of most biases) Dr.s seem to think that a normally healthy girl who is as typical as they come would seem out of place claiming to be in pain and dealing with chronic symptoms NOPE I get you're not in pain you are too young. You just are lazy, you just don't want to be in school, you are making this up, you just want pills. Young infants dealing with cancer are too young obviously age doesn't matter to disease and illness. If I was lazy would I be doing all of this I mean even now I see my health professionals more than I do my best friends. I switched to an intense independent study program to continue school while dealing with my health, I had to complete a semesters worth of work for a single subject in 3 weeks. (a friend of mine tried it and lasted 2 months I did this for 2 years up until I had my dominant hand in a half arm cast and fell behind due to me not being able to write legibly) Why would I make up things that limit my quality of life and stand in the way of my dream career? also when health professionals asked that it made the people around me treat me worse due to them subconsciously thinking I was faking it. Its real guys my own mother told me last week she doesn't know how much of my health issues are actually real. Yeah, I love not being able to drive anymore and having trouble paying my bills its a party. SARCASM PILLS oh the pills doesn't everyone know that a patient who refuses pain medication is actually using reverse psychology to get Dr.s to give them pills that they won't even fill. I got my wisdom teeth removed a couple years ago and my mom picked up the meds and accidentally filled the Norco prescription it sat fully sealed in the cabinet for 6 months before I found a way to properly dispose of it. I had a lot of pain because they had to drill into my jaw to get the teeth completely out but you will never guess what helped sooo much ready for my secret. FROZEN PEAS AND MOTRIN also Hulu helped the Motrin was a larger dose that was prescribed however this was to limit the number of pills I had to take not because it was such a large dose that I couldn't have taken normal Motrin.

    TLDR: Normal young girl with medical conundrum who refuses pain medication. Is told she is too young to have issues, is lazy, making things up, and she is seeking drugs.

  60. This person downplays racism immensely and makes frequent excuses for why people of color don't have the same quality of healthcare as white Americans. To me the answer is over arching racism. It is so apparent, Stevie Wonder could see it. That's where he should start then work outward from there.

  61. when i was getting my cast cut off my leg i was so nervous and after my doctor cut it off (obviously it had been on for a couple weeks) he goes "sheesh you could have at least shaved your leg" lmfaoooo i love when doctors use humor to diffuse an uncomfortable situation

  62. I've definitely experienced a little bit of bias from my doctor, but not in the ways that have been discussed here. Like, from a young age (12-13 ish) my doctor was telling me to lose weight, even though she also was telling me I was perfectly healthy. I was just barely "overweight". But a lot of people who are overweight or obese have genuine medical concerns scoffed at by medical professionals and told "just lose weight and it'll go away".
    when I was 17-18 that same doctor was showing a bias because she was assuming a generalization she held applied to me. I had come in because I was having pain in/around my stomach that was so severe I was kicked out of my history class because my crying was disturbing other students. By the time of my appointment a couple hours later, the pain had stopped, but I was still concerned so I was trying my best to communicate what I had experienced to her, and she was so stuck on "well when girls your age come in with these symptoms, we usually run a pregnancy test." which I refused, repeatedly, because I was not/had never been sexually active, so I knew it would be a waste of time. But she kept bringing it up, thinking I was lying to her, that I was afraid of my dad finding out, etc. In the end, she didn't know what had happened to me, but had a few possibilities in mind (other than pregnancy), and I didn't really mind the mystery because the pain had already passed, and a few of her suggestions had seemed pretty plausible. You wanna know what other advice she gave me though? To lose weight.

  63. He's talking about all of his female colleagues, but the clip about the doctors in the beginning is from the 1940s or 1950s. He's far too young to remember old paternalistic male doctors telling women our pain wasn't "that bad" or we were "imagining it." But this is still rampant. From Bergl et al., 2019: "More women than men experienced a diagnostic error [in unplanned ICU admissions]. On multivariable logistic regression analysis, female sex remained independently associated with risk of diagnostic error both at admission and at 24 hours." And in Bullock-Palmer et al., 2019: "There is a void with regards to awareness of cardiovascular disease in women." Most research is done on male animals. I really wonder about a doctor who doesn't know this is a problem. Brush up on your research, doc, or better yet, ask a woman, particularly a woman of color. For health issues, I'd rather be treated by John Oliver.

  64. I know you have watched "The Resident" before, but I think the episode "If Not Now, When?" addresses exactly what you are talking about.

  65. I think part of the problem is how hospitals run. For example my father went to the hospital and on his itemized bill the hospital charged $10 for two Tylenol pills. I could have gone to the drug store and gotten a whole bottle for that price. I think that the whole system needs an overhaul. You have insurance company's dictating what drugs patients can get to hospitals more concerned with their bottom line than the patient.

  66. I have had many NHS doctors, now I pay unecessarily for private health care because I am a young woman that suddenly presented with sudden, intense pain (was an athlete at the time, no injuries) who didn't even go in for antibiotics before this was scared something was wrong, knew something was wrong and didn't get diagnosis for 4 years. Then didn't get treatment, drugs nor physical therapies. I want a life, so I pay for a doctor who is motivated to maintain my health

  67. I'd love to see you dive into the potential bias the medical profession has against fat people. It doesn't matter what I walk into the doctor's office for, weight loss is always mentioned. And here's the thing: I can lose weight today! All I have to do is become a meth addict. When I say this to my doctor, he says, "Well, obviously that's not what I meant." "Then what do you mean?" I ask. And then he talks about eating and exercise. But how does he measure any "progress"? By weighing me. Yeah. I know thin people who do nothing but smoke cigarettes and eat junk food while they sit on the couch. And I know fat people who eat 4-to-5 servings of fruits/veggies a day and run marathons. So can we please! talk about health and not weight!_. I've been on or between diets since I was 12 (54 years now), and the only thing it's done is drain my body of muscle and help my metabolism be so efficient that for one 7-day period when I was on a protein-fasting liquid diet, I lost 2 ounces. In a week. Eating ~500 calories a day. Yeah. There is a lot I can do. But why bother, really, when all the doctor does is look at the number on the scale and frown if it's higher than it was last week, or smile and congratulate me when it's lower. I told him never to celebrate weight loss. So what did he do? "I'm sorry you lost weight." ~sigh~ I said, "No, don't do that either." And I'm sympathetic. He's been my doctor for 7 or 8 years. My weight has fluctuated, mostly up. Why should he put that much effort into caring for me, when it appears I care so little. I don't know the answer. If I did, I wouldn't be sitting here. But I believe that _you believe that you can make a difference, and I sure the eff would love for you to make a difference in this. And if you haven't seen this, do: https://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes

  68. Biological Anthro here. There are no biological differences between “races” as there’s is no conclusive evidence that distinguishes population phenotypes into races. Purely a social construct based on supremacist beliefs… sigh

  69. I have to point out that you're calling how a woman presents with a heart attack "atypical" but if it's how half the population presents, how on earth can medicine continue to call it atypical?????

  70. All women's heart attacks are atypical. Honey. Maybe atypical isn't the right word maybe we find men as the base for what's normal way too much. It's complete crap. And you're an apologist.

  71. Hey doctor mike! Your bias is showing! Check your own biases! You can’t talk about medical bias without seeing the connection to societal biases that you clearly have. Thank you for giving me another reason to thank and cherish my black woman doctor!

  72. I'm a white woman and very calm and logical. I've encountered so many dismissive doctors who don't even make an effort to find out what is actually wrong with you. You have to be your own advocate and very calmly insist on what you need and be precise on your symptoms. I'm only alive today because I did that. Sadly, all Drs. are not like Dr. Mike here. Finding a truly good one is not an easy thing.

  73. I've been ridiculed by doctors since I was 5 months in my mom's stomach. They wanted my mom to abort me because I had a gaping hole in my heart, all the while she had my autistic brother to take care of and basically told her, "You have too much on your hands with your son."

    4 months later, out I came and in I went undergo open-heart surgery. 3 open-heart surgeries with PVC and staples to hold my heart together.

    I despise going to a doctor because of how they see my symptoms and think "she's probably just wanting attention" like, I have a lot of issues and no one likes to take the time to listen to their patients and look into the symptoms.

  74. i love your openness and honesty. but when discussing topics like this it’s important to be mindful of the “optimistic” approach bc you run the risk of undermining the complaints/concerns of those being affected. as a white man, it is much easier for you to take the optimist approach bc you (personally) aren’t being negatively impacted by these biases. that said, it makes me really happy to see you bring this to light, and using your platform/privilege for the betterment of society.

  75. We know women do a better job going to the doctor. Increased osteoporosis means women are obviously treated differently. The study is just covering its bum, be real, this happens. The fact that you say “actually” before each explanation is disheartening. The link is gender, giving the most generic medications instead of opioids is screaming at you.

  76. 20:00 opioids are typically NOT expensive! Stop defending this nonsense! No it’s not only happening at isolated centers, trust me, you are excusing the medical community which many factors play but that doesn’t matter in the overall problem. Look at Serena Williams’ birth story. No reason she should not have been heard due to any of your “outside factors” should come in to play.

  77. Thank you for mentioning the biologic differences between races! The show made it sound like it was racist to think there could possibly differences based on race. I just gave a kinetics lecture about the differences in CYP enzyme activity across the different races. It killed me when they made the idea of it seem crazy!

  78. Please discuss bias in regards to weight. I lost over 200lbs, 100lbs in a handful of months.(Not okay at all.) I'm still fat but rather than remember I'm working on it, I've been told I'm lucky to have a Dr at all due to my weight and pre-existing conditions. Between those comments and being given the wrong meds in the hospital, almost bleeding to death, given things I'm allergic to, and overdosed on insulin… I now have even worse anxiety and don't want to seek treatment. I almost died last December because I had pneumonia (again) and I desperately didn't want to go to the hospital. Obviously I chose to go but I walked in with an O² of 72. I hope the buff Dr that always took the stairs but smelled like aftershave, cigarettes, and air freshener knows his smoking is just as likely to kill him as my fat will me. Oh and his BMI is too high as well.

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