I have always felt that straightforward, non-aggressive questions regarding any issues, conscious or unconscious can help clarify confusion. It is at least worth a try. On the other hand, if the negative bias appears too strong or the anxiety too great, I would recommend a change in provider.
There was a recent online survey that showed 81% of patients withheld medically relevant information. Of those, 81.8% withheld information because they didn’t want to be lectured or judged.³ Well, that generally does not sound like a trusting relationship.
So how do we get through this conundrum: real bias by the physician, fear of bias by the patient and withholding information? We also need to recognize that there can be bias, positive or negative, of the patient towards the health care worker.
There is a weight on the patient’s side of the equation. Regarding the use of cannabis, I would give the same advice in giving a history as I would for alcohol use, exercise and eating.
First, the patient should be honest with themselves. This is best done by keeping an accurate diary of the use of cannabis; whether medical or recreational or both. With this in hand, the physician is given more definitive information for their judgements of patient care. An answer of “just a moderate amount” or “only socially” gives such a wide variance of quantity that it can be misinterpreted. Although it is quite boring to do so, having a diary of use over two weeks, along with effects, can significantly improve a discussion about cannabis.
In the end I feel honest, straightforward discussions with accurate information leads to better health care. Age or type of advanced training of a healthcare professional does not increase or decrease bias. There is continued research about bias which will improve our knowledge of the issues.
“On a more discrete level, we are trying to achieve a better understanding of how situational factors like stress and time constraints could activate bias and influence treatment decisions.” 4
I like to think that health care providers go into their chosen field with an open mind about their patients and their lifestyle choices. In the end, healthcare workers are well educated, but are people too, with their own imperfections trying to partner with their patients for better health care.
¹ Monitor on Psychology, March 2019 pg 33² Health Communication, Vol 32, No 4, 2017³ JAMA Netw Open. 2018;1(7):e185293. doi:10.1001/jamanetworkopen.2018.52934 Monitor on Psychology, March 2019 pg 37
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