A Doctor's Bias

Physician bias arises through multiple pathways: unconscious stereotypes during patient consultations, avoidance shaped by past experiences, and oversimplification of patient conditions due to physical fatigue. Prejudices stemming from appearance—clothing, tattoos, or obesity—are equally common.

Occasionally, patients from detention facilities visit outpatient clinics or are hospitalized with correctional officers in attendance. The solemnity of uniforms and the tension created by prison garb make the ward atmosphere peculiar. During rounds, my imagination would run wild—wondering if patients might exaggerate symptoms to avoid returning to facilities, or if scenes from movies might unfold: feigned illness, violent outbursts, escape attempts. Yet in decades of hospital work, none of these ever materialized. The more I approached patients with suspicion and cynicism, the more my clinical judgment faltered. Only after gaining experience did I realize they were simply patients with physical ailments. I learned to focus on their faces and ailing bodies rather than their clothing.

Bias activates readily when confronting patient beliefs. When I first encountered a patient refusing blood transfusions on religious grounds, I insisted transfusion was medically unavoidable. Looking back, I even made arrogant, harsh statements—that treatment would be impossible without it. I resented why they had come to me. But I later learned that in a society guaranteeing religious freedom, respecting patient beliefs is not physician courtesy but obligation.

About 15 years ago, I encountered another patient needing a liver transplant but refusing transfusions. This time, I stepped back from my former stance and sought surgical possibilities while honoring their beliefs. I consulted experienced colleagues and reviewed accumulated medical knowledge and evidence. I learned then that medicine is not a discipline imposing correct answers but a practice finding possible paths within constraints. Above all, I came to see how easily my own bias spoke under the guise of "what's best."

Today, I strive to find treatments respecting patients' beliefs.

Specialized treatment settings breed numerous biases. Living-donor liver transplantation exemplifies this. When family members express willingness to donate, physician explanations can sound like coercion. Well-intentioned thoroughness may function as pressure. Ensuring time for the other person to speak matters more than extensive explanations. When transplant candidates relay questions through potential donors, we must guard against relational asymmetry as much as informational accuracy. Detailed answers might inadvertently pressure someone into feeling obligated to donate.

Experience develops physicians. Familiarity accelerates judgment but sometimes narrows vision. As experience accumulates, we easily fall into the arrogance of believing we have gradually shed our biases. Paradoxically, new biases typically arrive wearing the face of old experience. Experience becomes raw material for fresh prejudice.

I no longer aim to become a "bias-free doctor." I choose a more realistic goal: pausing when my judgment comes too quickly, questioning again when my conviction feels too firm. Bias cannot be eliminated but can be managed. The capacity to see the patient first in the examination room ultimately comes from repeating that management.

I am Choi Kyu-sung, a doctor living amid bias.