May/June Ethics Reader Poll Results
Noam Stadlan, MD
Chair, NASS Committee on Ethics & Professionalism Department of Neurosurgery, North Shore Hospital Evanston, IL
Below are the results from the March/April and May/June Ethics polls.
March/April
For those who care for patients who have pain (or answer as if you do): Which response best describes your practice?
I prescribe opioids only for very specific situations without deviation (for example postoperatively or for patient with clearly delineated pathology on imaging and symptoms related to that pathology)
I am flexible in my opioid prescriptions, a lot depends on my gut or gestalt
I never prescribe opioids
May/June
Please think carefully about the patients to whom you have prescribed opioids. Do you think that you may have some subconscious bias (such as more likely to prescribe to a particular gender, ethnicity, or age than others) that affects who gets them and who doesn’t?
No
Maybe
More likely than not
Yes, now that I think about it
Response from Dr. Stadlan
I would like to think that I am not biased in my care of patients. However, one busy clinic day I realized that I had seen two patients with essentially identical problems, and had prescribed narcotics for one and not the other. The one who received narcotics was demographically similar to me, the other wasn’t. Many studies have shown that there is systemic bias in health care. This means that many or even all of us may treat patients differently simply based on their demographics. Even if it is subconscious, it is still bias and results in suboptimal care.
The first poll results illustrate that most of us prescribe pain medications based on strict criteria. Algorithms and criteria are important and useful, but do not always provide optimal guidance for each and every patient. Sometimes we need to use our experience and intuition.
But it is vitally important that we consciously and deliberately consider whether it is our intuition, or our subconscious bias that is informing our decisions. The second poll results show that nearly half of the respondents, in retrospect, may have subconscious bias. Subconscious bias can and will remain subconscious unless it is brought to conscious attention for examination and rectification.