Florida’s first case of COVID-19 was confirmed on March 1st, the day before my inpatient pediatric clerkship began. I spent my morning in clerkship orientation and afternoon in a COVID debriefing session where I learned about the screening algorithm used to determine who would be eligible for our very limited testing access, as we expected cases to begin appearing and climbing in our own hospital at any moment. The strong emphasis placed on only ordering tests for those with international travel history or known exposure put me at ease. Our city is small without a major airport; I doubted whether I’d meet a single patient that would meet testing criteria.
My COVID-19 briefings shifted over the next several weeks from large group formal training sessions, to team-based Grand Rounds via Zoom, to isolated, frantic Google searches from home once medical students had been dismissed from the hospital. Despite the distressing coverage, one theme, in particular, haunted me differently: how COVID-19 was demonstrating higher mortality rates among populations of minority and lower socioeconomic status (SES), possibly explained by biased early screening procedures. By focusing on international travel history, we had unknowingly zoomed-in on COVID-19’s manifestation within populations of a higher SES — those with the privilege or social circles who are able to engage in such a luxury.
This experience turned my understanding of bias and identity inside out — or rather, outside in.
I had been cognizant of my bias towards others at times, but never have I identified my capacity to be actively complicit in extending bias myself. Not once, during the weeks of screening patients of minority and lower SES backgrounds, did I consider the unfairness in the assessment process for a test they may have needed. I could have done more to inform them and their loved ones of their need for isolation, close monitoring, and opportunity for intervention before it was too late. I am ashamed of my arrogance, heartbroken for my broken system. Yet, I remain grateful for this experience and this new insight into how bias can take hold of me if I am not continuously holding myself accountable in finding ways to work against it.
A fourth-year medical student and PCP Team Co-Leader reflects on the impact of biases among health care providers during COVID-19.