Bias in Healthcare Theme Analysis

As a physician, author Seth Holmes is horrified to see Triqui migrant workers’ health complaints ignored, misunderstood, or dismissed outright when they seek medical care in the United States. Based on the experiences of three men whose medical treatments he observes—Abelino, Crescencio, and Bernardo—Holmes shows that doctors and nurses consistently blame migrant workers for their own pain rather than recognizing the external factors that cause it. As a result, these doctors and nurses not only fail to treat migrant workers’ medical issues, but in many scenarios, they actually make them worse. Holmes argues that, because of modern Western medicine’s “clinical gaze”—or its narrow view of what causes disease—health practitioners are largely blind to the social, cultural, and other contextual factors that lead to health problems. And unless they build this awareness, they’re unlikely to effectively treat many of their patients—especially those from marginalized backgrounds.

Modern Western medicine’s default worldview (the “clinical gaze”) assumes that disease is an objective phenomenon rather than a subjective one, which leads medical practitioners to objectify patients and overlook the contextual factors that actually cause many diseases. Citing the influential French historian and philosopher Michel Foucault, Holmes argues that the “clinical gaze” became the norm in the late 18th century, when scientists started viewing disease as an objective problem with a specific body part, rather than a subjective problem afflicting “the whole person.” Accordingly, they started to prioritize “objective” criteria over “subjective” ones. For instance, doctors and nurses often view X-rays and official paperwork as more authoritative than actual conversations with their patients—but this leads them to overlook important elements of their patients’ conditions or personal history.

Similarly, because doctors view their own observations as “objective” and their patients’ as “subjective,” they frequently assume that patients are wrong for not conforming to their expectations—rather than seeing that their expectations sometimes do not reflect people’s real experiences. For instance, Holmes notes that doctors once sent a Triqui man to a mental asylum because he couldn’t communicate in Spanish, so they thought he was insane. In reality, the man only spoke Triqui and never learned Spanish. This shows that, because of their inflexible assumptions, doctors sometimes worsen their patients’ condition rather than improving it. Moreover, because healthcare practitioners define disease as dysfunction in an individual body, they often assume that the problem lies within the patient, even when it’s caused by social, cultural, or economic factors that patients do not control. For instance, a Mexican doctor tells Holmes that Triqui people are disproportionately sick because they don’t cook well or shower enough—while ignoring that they don’t have access to adequate food or running water in the first place. This shows that, because doctors assume that disease is caused by personal failures, they deliberately ignore the social, cultural, and economic factors that often truly cause it.

As a result of their clinical gaze, medical practitioners badly mistreat migrant workers, lose their trust, and often worsen their pain rather than healing it. Holmes illustrates this process through three case studies: Abelino’s knee pain, Crescencio’s headaches, and Bernardo’s stomachaches. Abelino has severe knee pain from working crouched down on the Tanaka Brothers Farm for many years. However, rather than talking to Abelino, the doctor gives him an X-ray, concludes that he “[does] not know how to bend over,” and says that he needs to exercise his knee by returning to work on the farm. When this worsens his pain rather than alleviating it, Abelino returns to the doctor, who decides that Abelino is unreliable and doesn’t understand his own pain. Because the doctor treats him as a set of body parts and considers his “subjective” reports less reliable than her “objective” tests, she ends up wasting Abelino’s time and covering up the real cause of his illness: overexertion from farm work.

Crescencio gets severe headaches whenever his managers at the farm scream racist insults at him. The only thing that helps these frustrating headaches is heavy drinking, and Crescencio worries that he’ll inevitably take out this frustration on his wife and children. However, when he visits a doctor to get help, the doctor immediately decides that Crescencio is an abusive husband who needs to go to therapy, fix his drinking, and take responsibility for his problems rather than blaming his bosses. Rather than actually listening to Crescencio’s individual story, the doctor simply assumes that he fits a stereotypical mold and treats the stereotype, not the person in front of her. Again, this shows how doctors are misled by their assumptions that dysfunctional bodies cause disease, and that these dysfunctions follow consistent patterns.

Finally, Bernardo has experienced severe stomach pain ever since the Mexican Army kidnapped and tortured him several years prior. When he visits a clinic, however, the doctor decides that Bernardo has “no past medical history,” tries to treat him for chest pain instead of stomach pain, and attributes his ailment to a boxing accident. They ask him to wait for several hours, but he needs to return to work, so he leaves—and the insurance company bills him $3,000 because he voluntarily left the clinic without finishing his treatment. Like Abelino and Crescencio, Bernardo primarily experiences health practitioners and institutions as distant and indifferent: they refuse to acknowledge his actual medical problems or explain their decisions, because they view him as a biological puzzle to solve rather than a human being to treat.

Based on their experiences, it's no wonder that many Triqui people believe that “doctors don’t know anything.” Doctors learn to view patients as biological objects rather than human subjects, and this often blinds them to the social factors that actually can cause disease. Of course, structural pressures often make it even more difficult for them to provide adequate care. By combining his two fields, anthropology and medicine, Holmes hopes to help other physicians see how their medicalized worldview is limiting and sometimes counterproductive. Instead, doctors must account for the social factors that contribute to illness.