Overcoming Biases in Healthcare with Empathy

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host Steph Bayer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio. And I'm very pleased to have with me today Professor Rachel Godsil. Rachel, welcome to Studies in Empathy.

Rachel Godsil: Thank you so much. Very glad to be here. I appreciate the invitation.

Steph Bayer: We're so excited that you joined. Rachel Godsil is a distinguished professor of law at Rutgers Law School and at Chancellor's School Justice Scholar. She's the co-founder and co-director of the Perception Institute, an institute devoted to creating solutions to reduced discrimination and other harms linked to cultural and social identity differences. We're glad to have her join us today as we talk about overcoming biases and healthcare with empathy. Thank you so much for being here.

Rachel Godsil: I'm very happy to be here. This is one of the areas Perception cares most about.

Steph Bayer: You are in a really important line of work now more than ever. Can you talk about what sparked your passion for social justice and how you entered this field?

Rachel Godsil: I can, and I obviously agree with you, that this is a moment where all the issues that we're talking about are of such urgent concern and it's wonderful to have the conversation. I frankly started thinking about social justice issues as a kid. I grew up in Milwaukee, Wisconsin, which like Cleveland is a Midwestern city that has many wonderful qualities but is also highly racially segregated. My parents, my dad was from St. Louis, my mom was from Denver and we moved to Milwaukee and both of my parents cared a lot about civil rights issues. And so my childhood circle of friends was a pretty multiracial Sesame Street like utopia in certain respects. But that was not what I saw reflected in the city around me. And even as a kid, that just made me feel uncomfortable. So in thinking about what I wanted to do with my life as a kid, first person in my family to go to law school, my dad's a roofer, my mom is a labor activist, but somehow being a lawyer was where I wanted to go, but I wanted that to be devoted to social justice issues.

Steph Bayer: That's wonderful. And I love the Sesame Street description. I can totally picture it. As we were talking about more about the details. What are some of the prominent biases that we're seeing in healthcare maybe, if you can talk about that or just overall, that we need to address first.

Rachel Godsil: So in healthcare, like in the rest of every domain that matters, the prominent biases that seem to cause the most extraordinary direct, very clearly linked harm is race and particularly anti-Black bias. And this is not to say that people in healthcare hold those views consciously. There's every reason to believe that's not the case, but there's so much evidence in the medical field to show the correlation between a patient's race and their care that it's just undeniable.

Steph Bayer: The equity in healthcare is something we need to address immediately. So how do we it? How do we overcome the bias that exists?

Rachel Godsil: What research shows pretty powerfully, and this research actually comes directly out of healthcare, is that when healthcare providers become genuinely aware that a patient's race may affect their healthcare treatment, there are immediate steps that can be taken that will prevent that from happening. And I'll give some examples. There was a study done in 2007 that showed that residents implicit biases as measured, and I'm happy to talk about this, by the implicit attitude test, didn't correlate to the residents' diagnosis of patients. And this was based upon residents being given a batch of patient files and being asked to diagnose a particular condition. In this case it was a heart condition. But the residents biases did affect their treatment recommendations. So residents who had a higher degree of anti-Black bias were significantly less likely to recommend the gold standard treatment, which in that case was something called thrombolysis to Black patients.

So that was a wakeup call, big wakeup call in medicine and to medicines, I think, to give credit, a lot of work has been done in the years since, and in subsequent studies in 2013, 2014, what was shown is that when there's a clear protocol, there can be just a complete break between someone's bias and their treatment recommendations. So in similar studies, even where residents showed a high degree in this sort of online test, which again I'm happy to talk about, that wasn't reflected in the treatment recommendations if the protocol was clear. So one thing that is an immediate just really powerful message for any healthcare provider, if there's a clear protocol that is ensured, that there's no bias baked in following that will actually eliminate bias. So that's one answer.

Steph Bayer: That's a really fascinating approach because we like to talk about personalized medicine and being empathetic, but this is where that personalized medicine can be built on top of the protocol or on top of the defined pathway. You mentioned was the implicit attitude test, is this the online test? Talk to me more about what that is.

Rachel Godsil: Yes. So with the implicit ... So first of all, just to make sure we're on the same page, when we talk about implicit bias, what we mean is the automatic association of stereotypes and or attitudes toward a particular group, often without our conscious awareness. So that's really different than explicit bias that someone consciously knows that they hold even if they try and hide it.

Steph Bayer: That's a really good point.

Rachel Godsil: So just, it's really important to keep our terms straight. The reason that we are careful in using the term implicit bias instead of unconscious bias is it's not something that we can fix just by becoming conscious of the risk. If you say unconscious bias, it sounds like, okay, if I know that I have the risk of bias, then I don't have unconscious bias anymore. But with what the implicit refers to is the automaticity of the association or the image in our brain. And that just happens like that. And we can talk about examples of how that works in regular life to make that really apparent. What the implicit attitude or association test does is it allows you to sort test your brain essentially by engaging in a little online exercise where you see can your brain as quickly associate positive and negative words with one the faces or the names of one group versus another.

And we can all Google it, Google Implicit Association test, and it'll pop on your screen. And what it's looking for is ideally you would think, okay, if I'm a person who consciously wants to be egalitarian and there's a Black face and a white face and positive words and negative words, I can as quickly press a button relating each face to the positive and each face to the negative, and that'll be pretty equal. And if we go too slow, the test kicks us off. Because what the test is really looking for is when we're moving at speed, what happens in our brain?

Steph Bayer: Oh.

Rachel Godsil: The research shows basically globally is that again, we are all vulnerable to implicit biases towards some group. Anti-Black bias is among the most prevalent, although in the United States body size and age are even more extreme. So this is something where it's just what's in the back of our brain, what these associations are. So that's what the IAT helps us do is to figure out where are we vulnerable as people to having our behaviors not aligned with our conscious values. And that's really exciting about it is it just gives us that information. So it's the beginning of the figuring out what do we do next?

Steph Bayer: You mentioned that our brains in real life, so this test sounds fascinating and I think we all can Google it and be more aware, and I've taken it in the past and I am surprised at the results because I strive to be egalitarian and I was surprised that I have biases and I'm sure we all do. So I shouldn't have been surprised. But you mentioned there's examples in our everyday life where you're automatically reacting. Can you flesh that out so we can maybe apply it to what that might actually look like?

Rachel Godsil: Sure. The best example I can give that works for Midwesterners, not so well for people in New York City, I'm in Brooklyn right now, is driving. When you first learn to drive, it's really, really challenging and you have to think about every single thing you do where you put your hands, when you move your foot, when you look up at the mirror, if you drive manually that seems like it's going to be impossible, but after you've been accustomed to driving, you can have a chat. Obviously some people text and put on lipstick, not recommending that, but it becomes automatic. It's a behavior that we engage in automatically and don't think about. So that's a behavioral version of our brain's automaticity.

Then when we think about our response to images or to objects that we see affect our everyday behavior, one example that one of our colleagues uses is coffee in a cup. It's unimaginable that any of us would pour coffee anywhere but in a cup, even if we were thinking about 1,000 other things. You see a cup, you've got your coffee, you pour the coffee into the cup. Silly example. But again, as my colleague likes to say, "Have you ever poured coffee into your shoe?" No. Right. You wouldn't do it because the association between coffee and cup is just so automatically intensely in our brain.

There's literally millions of examples of that because most of what we do and most of what our thoughts are based upon schema or categories, shortcuts that exist in our brain. And we categorize people too. And that generally serves really useful functions. So for example, if you see someone running into the street, if it's an adult, you don't think anything of it. If it's a child, you might actually certainly first look and you might even go and reach out to the child and bring the child back to safety because the difference in your brain between a child and a small child's safety and running into the street and adult's ability to assess their surroundings. So this is something that is so implicit. Social cognition, the way our brains work is just a facet of every aspect of every day of our life. It only becomes a risk or a problem when it's this implicit bias preference for or aversion against a group of people that again, doesn't align with our behaviors and that can lead us to treat people in ways that cause harm.

Steph Bayer: Those are really strong examples. Thank you for that. As we think through, and you said the way we overcome our bias is to have first step is to find some awareness around it. And I also hear these are some automatic responses. So how can organizations and caregivers, those that see patients in this term be aware that discrimination's happening and be proactive in resolving it?

Rachel Godsil: So I'd like to give two answers to your question because you asked about both individuals and institutions. You say those in some sense need to be divided because with institutions there's a whole host of steps that institutions, to your point, should be proactively taking to try and make sure that implicit biases aren't driving decisions of any sort or outcomes of any sort or the way people are treated, either decisions that are made about people or behavior toward them. Because we know that's important too. And we want to talk about empathy and the experience of empathy, Interpersonal empathy and the experience of that is obviously a really important part of healthcare. So institutions, there's again a range of steps that institutions need to take. The first we would argue is to do an evaluation or an analysis of what's going well in institution, Where are people being treated well, What does the data say about patient outcomes that suggest, great, we're doing well here and we can be confident that our practices are leading to the outcomes that we care about.

And where does our data say we need to be really concerned? So institutions really should start by spanning out and looking at all the information that they have available to them and seeking information if they haven't been disaggregating either patient outcome data, patient likelihood of going to a second visit, all the different ways in which healthcare success can be measured, institutions have to start with data and then essentially identify the set of new practices, new policies, new trainings, all the things that they're going to do to respond to what they learn in the data very effectively based upon what they find.

A perception we're really worried about kitchen sink approaches because that's, it's a terrible use of everyone's time and some of the critiques of implicit bias trainings are valid because if all you're doing is an institution to address implicit bias is having someone come in and tell you, let's be concerned about implicit bias, you're really not doing anything. So I'm happy to talk more about that later, but I think it's also really important and valuable for any individual who has any sphere of power, influence, or effect to be aware that there's steps that we can take in the next 15 minutes. The minute you stop listening to the podcast, there's some steps that individuals can take within their sphere of influence too. And so I'm happy to talk about those steps as well if that's helpful.

Steph Bayer: I would love to hear more. Please the individual steps sound and fascinating as well. And I love the data approach for organizations to focus.

Rachel Godsil: So with respect to individuals, the research has two sort of separate lines of evaluation. One is how do we actually reduce our biases overall so we can really sort of in a broad sense, proactively make it less likely and that we will either act more positively toward one group or more harmfully toward another. And there's actually five steps that a professor at University of Wisconsin, Patricia Divine and her colleagues have identified that if each of us as individuals engage in these five steps regularly, that can increase our concern and our care for people across groups and can help break the monolith in our brain and can also again affect our behavior. So those five steps that I'm ... Should I name all five?

Steph Bayer: Yes.

Rachel Godsil: So those five steps begin with what they call stereotype replacement. And what that refers to is what are the behaviors that I engage in that are response to stereotypes. So you really do kind of an audit of your behavior. It's kind of the individual equivalent of the institutional audit. So you audit your behavior, what am I doing that could potentially be a response to stereotypes and what kinds of behaviors could be a shift from that? One of the examples that's given is a student at the University of Wisconsin in doing this audit realizes when a Black male walks by her, she does this little clinch and holds her purse close to her. That's a response to a stereotype and it's harmful because for that person what's been signaled to him is I'm afraid of you. And that's a horrible feeling for a student to have walking to class in the morning. So stereotype replacement, auditing our behavior.

The second step is counter stereotypic imaging. We're surrounded, we're barraged by images of people that are stereotype laden, filled with stereotypes. So from the TV news to stereotypes, the television shows or movies or books, just they're constant. So one of the things that we can proactively do is avail ourselves of counter stereotypical images that aren't sort of idealized pictures of people in different groups, but instead are complex and multifaceted again, that help break the monolith. And that's one of the reasons why the taking the implicit association test and figuring out who am I going to be directing all this effort toward is really helpful. So who are the groups that I need to have some counter scientific imaging around me? So that's step two.

Step three is actually really exciting because it's a way of engaging with people, which is just good social practice. It's called individuation. And what it refers to is instead of assuming that we know things about people because of the group that they're in, which again our brains kind of do automatically, we seek information about people that helps us get to know them as unique individuals and as undoubtedly as an empathy-based person, you probably know this is actually an empathy tool as well. There's some really powerful research that if someone is told that a person who's unhoused prefers broccoli over carrots, it immediately humanizes that person in ways that they often have not been humanized, because you think of this as a person who has preferences about vegetables. So I'm not suggesting that we walk around asking people about their vegetable preferences, but individuation as just a practice seeking information about people is actually helping to break the monolith.

One of the things that's important is as we individuate to be mindful of the fact that our interactions are with someone of another group, because one of the things that can happen is we individuate with one person and we say, "Oh, I see you as the person you are." But that person's isolated in their brain as that person. So we have to kind of be mindful both this is an individual unique person of a particular group or identity and I'm learning something about that person to help me complicate the views I might have of that group.

The fourth, also fantastic because it's generally helpful, is perspective taking. Again if there's a group about whom we learn that we are vulnerable to stereotypes, learning information about how the people within that group may experience the world differently from the group that I'm in can help break the monolith and can help increase empathy, which is again, really important for decreasing bias generally. The final step and the most exciting actually is peer to peer interpersonal contact over time resulting in relationships and friendships and real respect based interactions. That's the only sort of completely successful over time genuine bias reduction that exists. And so in some sense, all four of those earlier steps are precursors to having really positive intergroup relationships with people that again, help us break the monolith.

So as you can tell this is life journey work, this is not something you can go and do this afternoon and be like, "Okay great, I'm good." So the reason we think this is exciting and we love to encourage people to engage in these steps is because this is all how to create the world we all want to live in. But as a healthcare provider with power, we can't wait till you're done with that, right? That's not okay. So bias override is the second strand of research and the bias override is what can I do to make sure that these automatic attitudes or stereotypes that exist in my brain don't affect my behavior?

And so one that we already talked about is if I'm a healthcare provider and there's a protocol that is really well substantiated protocol, follow it. Don't go with your gut and deviate unless you've really interrogated the reasons why and gotten a lot of clarity that the reasons why are based upon something very, very specific and genuine and rigorously evaluated about that person. But oftentimes deviations from protocol happen because I've got a gut instinct and bias is in our gut. So following protocol, really important. Ensuring that protocols exist to the extent possible and that there's not as much sort of discretion and ambiguity, really important.

But then there's the element of interpersonal contact and interpersonal interaction that we know is so important to healthcare and that's where health is struggling most, to be honest. So some of the studies that I described that were exciting, that showed some improvements have to do with those areas where there are protocols, but there are a few recent studies, one involving end of life care where evaluated sort of the degree of eye contact and touching and interpersonal contact. And they showed a significant difference with white doctors and Black patients versus white patients. And that's heartbreaking.

Steph Bayer: It is.

Rachel Godsil: Individual interaction we know is so important to the healthcare recipient to feel like they're being genuinely cared for. So that's where in some sense for healthcare providers to be mindful of how they're engaging with their patients can be really important. And there's actually some strategies that can be helpful to both address bias, which can impede and get in the way of effective healthcare provider patient relationships. And another phenomena that I hope you'll let me talk about, which is racial or identity anxiety. And so again, in order to talk about the strategies, if it's comfortable for you to hear about a related phenomena, I'd love to be able to explain that because the strategies are actually linked both to bias and to anxiety. And I think that's important.

Steph Bayer: Well, I would love to turn to that next. I appreciate that you gave us some tactics of here are five steps, here's the bias of variety and how you can follow it through. But let's talk strategy and you called it racial or identity anxiety, that's a term I'm not familiar with. Can you define that first and then tell me what that strategy is?

Rachel Godsil: Absolutely. So intergroup anxiety or racial anxiety refers to the anxiety that can be experienced and a cross group interaction when the fear is that the difference is going to leave the interaction not to go well, that's sort of very generic. As you can imagine, it's experienced differently depending upon if you're in the group that's empowered, in group, dominant group, whatever language you want to use or if you're in the group that's often stereotyped. So for the group who's often stereotyped, the concern is am "I going to be discriminated against? Am I going to experience bias? Am I going to be harmed in this interaction?" That raises anxiety, that raises cortisol, that raises cognitive interference. So that's on the receiving end. The person who's worried about being on the receiving end of this interaction.

The person in the empowered group or the non-stereotyped group, that person, often, again, as a white female, I'm certainly someone who's felt this myself as a white person in a cross race interaction, my worry might be, "Am I going to act in a way that's discriminatory or is the way that I act or the things that I say going to be perceived as discriminatory?" And we might say, Well, isn't that the whole point of this entire discussion that people who are in position of power, who hold dominance should be?

Here's the difference. Am I worried about the way that the person is experiencing interaction or am I worried about how I am being perceived? It's a focus on me. I'm anxious and my anxiety can get in the way of my actually treating the person the way I want to treat them. And the research has shown that racial anxiety experience by white people tends to be externalized onto the person with whom they're interacting. So the way that I act, if I feel anxious, can look a lot like the way I act. If I'm biased, I might be avoidant, my body language might be closed, I might be less likely to actually spend a lot of time with the person because I'm feeling anxious in the moment. I might be somewhat avoidant to spending time with the person altogether. My brain is sort of cognitively disrupted. So I may make exactly the mistake I didn't want to make like calling the person the wrong name. I mean a whole host of harms can follow from my worry about how I am being perceived. Hence our concern with this topic in healthcare because how a healthcare provider from the receptionist to the nurse practitioner, to the doctor interacts with the patient we know is so important. And if any of those people are worried about how they are being perceived, the patient is likely to experience this as bias.

Steph Bayer: That is a perspective I hadn't understood before and I appreciate you bringing it to the table. From a strategy perspective, what should we do?

Rachel Godsil: Multiple strategies exist, which is exciting. The first is, as with bias, just being aware, just giving a name to this, just knowing that this is a thing has actually been shown to give folks some clarity. This is something that I should be mindful of. And so that's the beginning is being aware that this is, it's a unique risk and I think it's particularly important for healthcare institutions to be aware of the distinct difference between bias as one set of risk factors and anxiety as another. Because we can imagine a scenario where a healthcare institution amps up concern about bias in ways that triggers anxiety. And so it looks like no progress has been made because you have a bunch of racially anxious healthcare providers going around, acting in ways that are actually seeming like bias. And so everyone thinks the whole thing failed.

So naming the two as distinct though sometimes related phenomena is really important for the person, for any of us, ourselves, any of the mindfulness techniques that we use in other contexts to reduce our anxiety, they're useful here too. Literally breathing, taking a few steps, priming ourselves as we go into an interaction, envisioning it going well as opposed to being seized up with anxiety. All of that can really help focusing not on how I'm being perceived, but how is the person I'm speaking to experiencing the interaction, focusing on the other rather than self that can reduce anxiety.

But the strategy that has the most clarity is called behavioral script. So if you have a carefully designed, respect based entry point for an interaction cross group, that you know is likely to be received well, because you've validated it, you've said it before, it gives you utter confidence that when you go in and talk to the person you're speaking with, you are speaking from a good place, you are focusing on their interests and you know what to say. And so when you actually speak with a person, you are calm, you're asking thoughtful questions, you know the person's name, how to pronounce it, you're addressing them respectfully.

You're then sending signals to the person. You are a person deserving of respect. I'm here to listen to you. And as you can imagine, that person's anxiety goes down. So it's a positive feedback loop. So behavioral scripts, which aren't things you read, needless to say, but just clarity on the steps that we're taking. Really, really helpful. And one of the suggestions, and the reason I keep on saying respect based is there's some powerful research showing that there's some difference in what the most effective entry points are for an initial interaction based upon race and keeping those in mind can be helpful.

Steph Bayer: Well, yeah. What's an example of the entry points for race that might be different?

Rachel Godsil: So what the research shows is that oftentimes in cross race interactions, people who are white seek to be liked. And so there's like an over positivity and ingratiation that we can engage in. There's a recent article, a relatively recent study that came out called Brittle Smiles, showing kind of this over friendliness that again is based upon this desire to be liked. That need is not well received because it can feel very not respect based in research from particularly Black and Hispanic or Latino, Latinx folks. Ensuring that they are respected is really important. And this question of whether you like someone or not is secondary to being assured of respect. Whereas for many who are white, we kind of presume that we're respected. So you go right to the liking part.

And so what we really emphasize is instead of coming in with a, "So hi, Steph, so great to meet you. I'm Rachel, I'm your doctor, this is going to be great. Can't wait to find out what your symptoms are," where I'm going for sort of warm and friendly. If I come in with a respect based entry, "I'm Dr. Godsil," actually I'm not a doctor, but if I come with a respect based entry, with using your proper name, finding out how you'd like to be addressed, you saying, I really interested in hearing exactly what you are interested in sharing with me today. This is a time for you to kind of convey your symptoms. And this whole team is here for you. That respect based entry, coming from a place of, "I want to assure you that I'm here to listen to you, to engage in patient-based care, patient-centered care" goes an enormously long way.

Steph Bayer: That's a great, great example. And here at the Cleveland Clinic, we strive to teach relational communication. And I think what you've added to that goal is that relationships look different based on your lived and learned experiences. And you need to take that into account even as you start that relationship. And that's really powerful.

Rachel Godsil: One thing that we generally talk about our perception is it can be very hard for a clinician or anyone in a healthcare setting to deviate because they're moving fast and a lot's going on. And sometimes it can be hard to know when you would deviate and when you wouldn't. So frankly, our recommendation and I’m curious to hear how you receive this, our recommendation is this respect based entry point works well with everyone. And so I think it's hard to say to a healthcare provider, you have to somehow know who to engage in one way versus another. That's a big ask. And so that's why when we come up, when we work with our expert advisors to come up with strategies, we try to come up with strategies that will be well received and will benefit each person with whom they're used so that we can have as much clarity and essentially simplicity for the folks who are doing the work as possible. And so I'm curious if from your perspective, this idea of a respect based entry point seems like one that would work, would be patient-centered, broadly speaking, because we've had pretty positive responses to that.

Steph Bayer: It certainly resonates with me the relational communication that we strive to deliver. It's about meeting people where they are and as individuals. And I think a respect based entry point allows that to happen quicker. And you mentioned that our providers are very busy, that time is limited, unfortunately, and this is a way to ensure that we don't have any other barriers. So I think that's an excellent suggestion and something that we should take away from this conversation. I want to kind of turn us as we start to end our time together about the empathy conversation. So I've heard a lot of examples of empathy in some of these strategies and tactics, but what is your view on what the role of empathy is in overcoming bias or the racial identity anxiety? How does empathy play into this space?

Rachel Godsil: So thank you so much for the question. There's the abundance of research that’s in many ways, quite heartbreaking, that suggests that it is harder for us to feel empathy across group. And that lack of empathy can very much get in our way in terms of our willingness to sort go the extra. And this has been seen in healthcare as well as a host of other fields. There's some research showing that some of the very, very powerful deviation and the degree of pain medication that's received based upon race is based upon differential levels of empathy. So there's some very, very clearly identified harms linked to differential empathy so it's definitely an issue of enormous concern. Some of the research is actually very hopeful, showing that some of the strategies that I shared earlier can be very helpful on the empathy point.

So the perspective taking, for example, has been shown to be a very useful strategy in helping lift up people's ability to empathize a cross group. So if we're given an invitation and information where we can, again, imagine ourselves experiencing life in the way that another group may and the kinds of obstacles that a person faces based upon the race or ethnicity, that can be a helpful way of increasing empathy. And so perspective taking is definitely one entry point to empathy when again, people have relationships, organic relationships outside of work where they're interacting with people of other groups that lifts up their empathy.

So those are, I think, the most easily shared, broadly speaking and scalable are these perspective taking opportunities. And there's again, a wide array of ways to do that. Having people watch short movies or videos or audios where you're hearing something from someone else's perspective and you're invited to listen to that and think of yourself, think of how you would feel if you were in that perspective. And so if healthcare providers have some empathy for that worry that can help them see the patient's behavior through a different lens and respond more empathically, which of course can then allow the patient to see that care and concern diffusing their worry that they're being seen through stereotype. So empathy can play such a powerful role in healthcare efficacy with healthcare providers being in some sense the drivers of that by having this issue lifted up.

Steph Bayer: Those are great points and I think empathy's about making an authentic connection as well. And that is that whole interaction that we're going to strive for as we overcome the bias and the anxiety in our last minute or so here. What did I not ask you? Or what do you think we want to leave with that we want to make sure we get out want? This has been a phenomenal conversation. I wish we had even more time for it. But if we're going to leave the audience with one piece of advice or a nugget, where did we miss so far?

Rachel Godsil: I don't think we've missed anything specific, but what I would love to of end with is how much hope we can actually have that these strategies can make a real difference because people have to have it. Both healthcare providers and patients have to have a sense of hope that where we are isn't where we're going to stay. And so that's what I would want to really lift up is that in, I'm sure many of your listeners and you are familiar with the idea of a growth mindset, but it really is critical that if we think of this issue of kind of bias in healthcare is intractable, it's much more intractable. If we think of it as something that there's actually a wide array of strategies that if engaged can make an enormous difference, it makes an enormous difference. We've been fortunate enough to see the difference in working with different healthcare providers and in experiencing how patients benefit and bloom when healthcare providers engage with them with some of these strategies in mind.

So I would just want to leave with, it may seem a little Pollyannish in this moment or naive, but we've really seen it and my colleague, Apo Ato, who does a lot of work on maternal health and that we know that's a big area of focus is ensuring maternal health, particularly for Black mothers giving birth and experiences that they've had, there is hope even in that area, which can feel so painful when healthcare providers engage collectively with patients in this way toward ensuring that they genuinely feel cared for and are cared for as we know they ought to be.

Steph Bayer: I love leaving that on a message of hope and growth. Thank you. Thanks for joining us today.

Rachel Godsil: My pleasure. Thank you so much for having me.

Steph Bayer: This concludes the Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.