The Bias behind Your Undiagnosed Chronic Pain | Sheetal DeCaria | TED

Translator: Cristina Blanco Reviewer: Servizo de Normalización Lingüística

As a doctor in the field of pain management,

Como doutora experta na xestión da dor,

I work in a world where you bring us your pain

traballo nun eido onde nos traedes a vosa dor

and we treat it.

e nos tratámola.

We ask questions,

Facemos preguntas,

we take the symptoms you present,

anotamos os síntomas,

we decide what tests to run.

decidimos que probas facer.

We listen with compassion and wisdom

Escoitamos con compaixón e sabedoría

and choose the best course of action

e eliximos o mellor procedemento

based on our knowledge and experience combined with science.

baseado no coñecemento e na experiencia ademais da ciencia,

And sometimes in a very small window of time.

e algunhas veces nun tempo récord.

As physicians, we took a sacred oath to do no harm.

Como médicos, temos unha regra non escrita que é non mancar.

And the system has gone to great lengths to teach us

O sistema ten progresado moito á hora de instruírnos

and set up guidelines to make sure that we treat every patient equally

e establecer protocolos que aseguren que tratamos a cada doente en igualdade

and without judgment.

e sen nesgos.

As we stand there in your moment of pain,

Cando vos temos alí con dor,

we run your situation through every filter we have

avaliamos a situación atendendo a cada filtro que temos

to give you the best care.

para darvos o mellor coidado.

And for most of us,

Para a maioría,

this is more than just a job.

isto é máis ca un traballo:

It's a calling.

é unha chamada.

But as we stand there in your moment,

Pero cando vos temos alí con dor,

looking at your story from all the different angles

mentres revisamos o historial dende diferentes perspectivas

and all the different rational voices in our head

e consideramos todas as posibilidades racionais

run through the decision making process,

que nos veñen a cabeza durante o proceso,

there's another voice in the mix.

hai outra voz que se fai oír.

And this voice,

E esa voz

well, it isn't rational or informed.

non é racional nin informada.

Yet, it often dictates our decisions.

Aínda así, a miúdo, dita as nosas decisións.

And we don't give it a second thought

E non lle damos outra volta,

porque, veredes,

because you see,

esa voz existía moito antes de comezar a estudar medicina.

this voice existed long before we began studying medicine.

And so we accept it as truth.

Polo tanto, aceptámola como verdadeira.

And this voice sometimes calls the shots.

Con frecuencia é esa voz a que toma a decisión.

It's what I refer to as the undiagnosed bias.

Iso é o que eu denomino nesgo do non diagnosticado

And it's causing suffering and death for many with chronic pain.

e está causando sufrimento e a morte a moitos dos que padecen dor crónica.

I have spent the last 15 years studying pain.

Levo quince anos estudando a dor,

Its cause, its treatment and its management.

as súas causas, tratamento e xestión.

But it wasn't until I found myself sitting on the other side of the exam room

Pero non foi ata que me atopei sentada do outro lado na consulta

that I noticed the crack in the foundation of pain management.

cando caín na conta da fisura no fundamento da xestión da dor,

When I discovered that hidden voice that exists in all of us.

cando descubrín esa voz oculta que existía en todos nós,

That hidden voice, which I termed the undiagnosed bias,

esa voz oculta que denominei nesgo do non diagnosticado

is more commonly known as implicit bias,

e que a miúdo se coñece como nesgo implícito

which is a bias that exists based on our unconscious beliefs and associations.

é un nesgo baseado nas nosas crenzas e asociacións inconscientes.

Implicit bias in health care was brought to light in 2003,

O nesgo implícito na saúde deuse a coñecer no 2003

when the Institute of Medicine published a report titled "Unequal Treatment."

cando o Institute of Medicine publicou o estudo “Unequal Treatment”.

They found that regardless of insurance and income status,

Demostraron que, independentemente do seguro médico e do nivel de ingresos,

racial and ethnic minorities received worse care.

as minorías raciais e étnicas recibían peor trato.

And when it comes to pain,

E, se falamos de dor,

research shows that bias extends beyond minorities

a investigación mostra que hai nesgos máis alá das minorías:

to also include women and even children.

tamén as mulleres e incluso as crianzas se ven afectadas.

Dr. Susan Moore was a Black female physician

A doutora Susan Moore era unha doutora negra.

whose story was heard around the world in 2020.

A súa historia difundiuse polo mundo en 2020.

The story of a doctor who struggled to receive the care she knew she needed.

É a historia dunha doutora que batallou para que lle desen os coidados necesarios.

Her pain was due to a health issue that she fully understood

A súa dor viña dun problema médico que ela entendía á perfección

and described in medical lingo to her doctors.

e que describía na xerga médica aos seus médicos.

Yet her pain was dismissed.

Malia todo, negaban a súa dor.

When she posted her experience to a group of thousands of fellow physicians,

Cando compartiu a súa experiencia cun grupo de miles de colegas médicos,

there was an uproar of support.

houbo un clamor afervoado.

I mean, no one could accept that a doctor would treat a patient,

Quero dicir, ninguén podía aceptar ese trato vindo dun facultativo,

let alone a fellow colleague like this,

e menos sendo do gremio,

simply based on how they look.

simplemente baseándose na aparencia.

But that's the problem with implicit bias.

Pero este é o problema co nesgo implícito.

Most of the time you are unaware you even have it.

A maioría do tempo non somos conscientes sequera de que o temos.

I remember the year I went from doctor to patient.

Recordo o ano en que pasei de doutora a doente.

It started off as a small pain in my foot that just wouldn't go away.

Comezou todo cunha dor lixeira no pé que non melloraba.

Well, it grew worse,

O caso é que empeorou

to the point that it overshadowed my life.

ata o punto de que limitaba a miña vida.

It was this constant companion affecting my work and my family life.

Esta inseparable compañeira afectaba o meu traballo e a miña vida familiar.

I finally went to go see a foot surgeon and was told,

Finalmente, fun a un cirurxián podólogo e díxome:

"Source not clear.

“A causa non está clara.

Probably tendons were inflamed," he said.

Probablemente sexan os tendóns inflamados.”

And he prescribed a boot and some physical therapy.

E receitoume unha bota e rehabilitación.

But the pain worsened, and it spread to my hip and my back.

Pero a dor empeorou, e estendeuse ata a cadeira e as costas.

I sought out more medical specialists, even holistic practitioners,

Busquei máis médicos especialistas, incluso médicos da medicina integral.

all with different theories,

Todos tiñan diferentes teorías,

but no clear diagnosis or source of pain.

pero non me daban un diagnóstico claro nin daban coa orixe da dor.

I began to feel like I was going to have to live with this forever.

Empecei a sentir que ía ter que vivir con isto para sempre.

And as the pain kept progressing with no clear diagnosis,

Como a dor era cada vez maior e non tiña un diagnóstico claro,

I even thought to myself,

incluso cheguei a pensar:

"Wait.

“Espera.

Am I making this up?

Estareimo inventando?

Is my pain even real?"

É real a miña dor?”

In an online survey of 2,400 American women

Nunha enquisa en liña a 2400 mulleres estadounidenses

with a variety of chronic pain conditions,

que padecían dor crónica de diferentes orixes,

91 percent felt that the health care system

o 91 % sentía que o sistema sanitario

discriminated against them.

as discriminaba.

And nearly half were told that the pain was all in their heads.

A case a metade dixéranlle que a dor estaba na súa cabeza.

So let's go ahead and dispel that pain myth right away.

Avancemos e desterremos

ese mito da dor de vez.

If you're worried that your pain is in your head,

Se vos preocupa que a dor estea na vosa cabeza,

you're right.

tedes razón,

Because pain is in everyone's heads.

porque a dor está na cabeza de todos nós.

You see, pain can't take place without our brains.

A dor non pode darse sen o cerebro.

When you step on a nail, for example,

Cando pisamos un cravo, por exemplo,

you stimulate nociceptors, or specialized nerve cells,

estimúlanse os nocirreceptores, ou células nerviosas especializadas,

that send a message through your spinal cord to your brain.

que envían unha mensaxe a través da espiña dorsal ao cerebro.

Well, your brain then decides what it's going to do with that signal.

O cerebro decide entón que vai facer con ese sinal.

If it senses something dangerous,

Se sente algo perigoso,

it will process that experience as painful

procesará esa experiencia como dolorosa

to prevent you from further injury.

para protexernos de danos maiores.

And the decision by the brain to process it as painful

A decisión de que o cerebro a procese como dolorosa

is based on environmental and social cues

basease en sinais medioambientais e sociais,

as well as by culture

así como culturais

and one's past experiences.

derivados de experiencias pasadas.

Now, contrary to popular belief,

Agora, ao contrario da crenza popular,

not all pain is related to tissue damage.

non todas as dores se relacionan con tecido danado.

Pain is actually defined

A dor, en realidade, defínese

as an unpleasant sensory and emotional experience

como unha experiencia sensorial e emocional desagradable

that can be associated with actual

que pode asociarse con un deterioro

or potential tissue damage.

do tecido real ou potencial.

You can have real pain

Podemos ter dor de verdade

with no physical injury

sen dano físico

or source.

ou causa.

Pain is the one thing that can't be measured

A dor é unha cousa que non se pode medir

by a monitor or lab test.

cun monitor ou cunha análise.

It's hard to quantify or qualify.

É difícil de cuantificar ou cualificar.

It's measured on a scale of zero to 10

Mídese nunha escala de cero a dez

that is based on one's own perception of what they're experiencing.

que se basea na nosa propia percepción do que sentimos nese momento.

Pain, then, is subjective.

A dor, polo tanto, é subxectiva.

And as doctors,

E, como médicos,

our process of treating pain begins with identifying its source.

o procedemento para tratar a dor comeza identificando a causa,

Which presents a problem when there is no source.

o que presenta un problema cando non hai causa,

For when there's no source, it becomes open to interpretation.

porque, cando non hai causa, está aberto a interpretación.

And interpretation becomes open to that undiagnosed bias.

E a interpretación está aberta a ese nesgo do non diagnosticado.

Did you know that the different sexes experience pain differently?

Sabiades que os diferentes sexos experimentan a dor de xeito diferente?

Now, for the sake of this talk, when I say female versus male,

En beneficio desta charla, cando digo “femia” fronte a “macho”,

I'm referencing sex assigned at birth.

estoume referindo ao sexo asignado ao nacer.

And when I say woman versus man or non-binary,

Cando digo “muller” fronte a “home” ou “non-binario”,

then gender identity is at the core of the point.

entón o xénero é o punto de mira.

Females have more nerve fibers than men,

As femias teñen máis fibras nerviosas cós machos

and there's a hormonal influence to a variety of chronic pain conditions.

e as hormonas afectan varias enfermidades que causan dor crónica.

At puberty, rates of chronic pain rise faster in girls than boys.

Na puberdade, o índice de dor crónica aumenta máis rápido nelas ca neles.

And as females approach menopause,

E, cando as femias chegan á menopausa,

sex differences in chronic pain begin to disappear.

as diferenzas entre sexos no referente á dor crónica desaparecen.

Females experience more recurrent pain, longer-lasting pain

As femias experimentan dor de forma máis recorrente

and higher overall levels of chronic pain than men.

e a dor dúralles máis e é máis aguda ca no caso dos machos.

Yet the majority of studies on the treatment of chronic pain

Aínda que a maioría dos estudos do tratamento da dor crónica só se fixeron

have only been conducted in men.

en machos.

Did you know that women are more likely than men

A elas danlles con máis frecuencia tranquilizantes no canto de analxésicos

to be given anti-anxiety medications instead of painkillers

when they present to the emergency department

cando acoden ás urxencias

complaining of severe abdominal pain?

queixándose dunha dor abdominal aguda.

Even for extremely urgent conditions

Aínda que teñan un cadro extremadamente urxente

such as chest pain from a heart attack,

como dor no peito similar ao dun ataque ao corazón,

women experience delays in life saving-interventions

no caso das mulleres, hai retraso nas intervencións que salvan vidas

that can prevent death.

e poden previr a morte.

Research shows that clinicians more often suggest psychosocial causes

Os estudos demostran que os médicos clínicos atribúenlles causas psicosociais

such as stress or family problems to women patients in pain

como o estrés ou problemas familiares ás mulleres con dor,

when they would more often order lab tests

mentres que pedirían probas diagnósticas

for a male patient with the exact same symptoms.

para homes coa mesma sintomatoloxía.

For Black women such as Dr. Moore, they suffer two blows.

As mulleres negras coma a Dra. Moore padeceron dous embates:

The insulting notion that they are overdramatic

a idea insultante de que eran esaxeradas

due to their gender,

dado o seu xénero

along with the erroneous view that because their skin is Black,

xunto coa percepción errónea de que, debido a que a súa pel era negra,

they are impervious to pain.

eran inmunes á dor.

A 2016 study of a group of medical students found that nearly half believed

Un estudo duns estudantes de medicina en 2016 descubriu que case a metade crían

Black people have thicker skin than white people,

que, fronte aos brancos, a xente negra tiña a pel máis grosa,

less sensitive nerve endings,

menos terminacións sensitivas

or that their blood clots more quickly.

ou que o seu sangue callaba máis rápido.

The origin of these outrageous claims dates back to slavery

A orixe destas afirmacións intolerables lévanos ao tempo da escravitude

and the 19th century experiments by Dr. Thomas Hamilton,

e aos experimentos do século XIX do doutor Thomas Hamilton,

who tortured Black slaves

que torturou escravos negros

to prove that Black skin was deeper than white skin.

para probar que a pel negra era máis grosa que a branca.

And Dr. James Sims, a gynecologist,

E ao doutor James Sims, un xinecólogo

conducted experimental surgeries

que fixo cirurxías experimentais

on enslaved Black women without anesthesia,

en mulleres escravas negras sen anestesia

contributing further to false beliefs

e contribuíu inda máis ás falsas crenzas

that Black women experience less pain.

de que as mulleres negras percibían en menor medida a dor.

There were times that I found it ironic

Pareceume paradoxal

that as an anesthesiologist,

que, como anestesióloga

whose livelihood is centered around managing pain,

que vive de xestionar a dor,

that I would suffer from chronic pain myself.

chegase a sufrir dor crónica eu mesma,

And so, like Dr. Moore, I became my own advocate

así que, coma a doutora Moore, volvinme a miña propia defensora

and dove deep into the root causes of my own pain.

e lanceime a buscar a orixe da miña propia dor.

After five years, thousands of dollars and many hours spent in pain,

Despois de cinco anos, miles de dólares, e moitas horas padecendo dor,

I finally found the cause by diving into integrative and functional medicine.

finalmente atopei a causa mediante unha medicina integral e funcional.

Now my pain was due to physical imbalances triggered by childbirth,

A miña dor debíase a desequilibrios físicos provocados no parto,

years of stress and sleep deprivation,

anos de estrés e falta de sono,

and a dietary sensitivity that had been triggering inflammation.

e unha sensibilidade alimentaria que me causou inflamación.

Over time, I healed myself.

Co tempo, cureime.

And finally, the pain began to ease.

Por fin, a dor empezou a aliviar.

But while my own pain did fade,

Porén, mentres a miña dor se esvaecía,

my passion for other people with chronic pain grew stronger.

a miña paixón pola xente con dor crónica robustecíase.

Now doctors aren't the enemy.

Ollo, os médicos non son inimigos.

If you ask physicians why they went into medicine,

Se lles preguntas por que se meteron a médicos,

you would hear "to help people."

dirán que “para axudar a xente”.

So much so, that during disasters and global pandemics,

Tanto é así que, cando hai desastres naturais ou pandemias globais,

health care workers kiss their own families goodbye

os sanitarios despídense das súas propias familias

to go take care of yours.

para coidar as nosas.

They work tirelessly during codes to resuscitate your loved ones

Traballan sen tregua nos paros cardíacos reanimando os nosos e choran se morren.

and shed tears when they lose them.

But with exhaustion, time pressures and overcrowded emergency rooms

Pero o cansazo, a presión do tempo e as salas de urxencias ateigadas

comes the ability for that hidden voice to take over our rational one.

dan paso a esa voz escondida que asume o cargo da racional.

Now the health care system has been teaching bias training,

Hoxe, o sistema sanitario dá formación sobre os nesgos,

and studies show little to no explicit bias in health care, which is great,

e os estudos mostran pouco nesgo explícito ou ningún, o que está ben,

but we continue to see implicit bias

pero seguimos vendo nesgos implícitos

in a percentage of health care practitioners.

nunha porcentaxe dos sanitarios,

Because it operates in an unintentional and unconscious manner,

porque eses nesgos implícitos danse de maneira accidental e inconsciente.

implicit bias begins outside the walls of the hospital

O nesgo implícito empeza fóra das paredes do hospital

and is brought in unknowingly.

e dáse dentro inconscientemente.

And it's not just doctors.

E non só os médicos.

Bias exists in all of us.

Os nesgos existen en todos nós.

We can all do better.

Todos podemos facelo mellor.

How?

Como?

Well, the first step is awareness.

Ben, o primeiro é ser consciente.

We need to begin by identifying our stereotypes.

Necesitamos empezar a identificar os nosos estereotipos

And then rewrite the stories of the people we meet.

e despois reescribir as historias da xente que coñecemos.

When a woman sits down next to us, ask ourselves:

Cando unha muller se senta á nosa beira, preguntarnos:

What would we say if this were a man?

“Que lle diría se fose un home?”.

Would our answer change?

Cambiaría a nosa resposta?

And for those whose pain has been dismissed, fight to be heard.

E a todos os que se vos negou a dor,

loitade para que vos escoiten.

Finding the right doctor can feel a little bit like dating.

Dar co médico axeitado é un pouco como as relacións.

You may need to swipe through a few to find the right one for you.

Pode que teñades que pasar por varios ata dar co axeitado.

(Laughter)

(Risas)

But don't give up.

Pero non vos rindades.

And don't delay seeking treatment.

E non retrasedes a procura de tratamento.

The sooner you are properly diagnosed,

Canto antes vos diagnostiquen axeitadamente,

the greater chance you have of breaking your pain cycle.

máis posibilidades teredes de romper co ciclo da dor.

As physicians, we took an oath at our white coat ceremonies

Como médicos, o día que nos deron a bata branca xuramos

to first do no harm.

non magoar

And most of us live by that sacred oath.

e moitos de nos guiámonos

por ese xuramento sagrado.

But part of that vow needs to include staying in check with that inner voice

Pero parte dese xuramento precisa englobar examinar esa voz interior

to make sure that we aren't writing a story

para garantir que non estamos escribindo a historia

that our patients haven't told us yet.

dos pacientes antes de que nola conten.

Because it is our duty as physicians

Porque é o noso deber como médicas e médicos

to replace the undiagnosed bias with empathy.

substituír o nesgo do non diagnosticado pola empatía.

And to all of you out there who are suffering with chronic pain,

A todos os que sufrides dor crónica,

we hear you.

oímosvos.

And we're ready to listen.

E estamos listos para escoitarvos.

Thank you.

Graciñas.

(Applause)

(Aplauso)