Sickle cell and implicit social cognition by Tola Dehinde

Sickle cell and implicit social cognition by Tola Dehinde

I have always wondered about what role the above also known as 'implicit bias or unconscious bias' plays in the lives of anyone living with sickle cell disease? I have had it in various areas of my life and will give you some examples of it further down but let's look at what the definition of implicit bias is.

What is the definition of implicit social cognition? According to, implicit biases are unconscious attitudes and stereotypes that can manifest in the criminal justice system, workplace, school setting, and healthcare system. There are many different examples of implicit biases, ranging from categories of race, gender to sexuality.

Implicit bias refers to attitudes and beliefs that occur outside of our conscious awareness and control. Implicit biases become evident in many different domains of society. Healthcare is another setting where implicit biases are present. Racial and ethnic minorities and women are subject to less accurate diagnoses, curtailed treatment options, less pain management, and worse clinical outcomes (Chapman, Kaatz, & Carnes, 2013).

I have had my fair share of implicit bias against me because of sickle cell and below are some examples of it:

I had an experience not too long ago whereby I needed to have my home adapted because of sickle cell. The social worker who came to see me from the adult care assessment unit was rather dismissive of my request at the interview. I then asked her if she knew about sickle cell. She replied in an offhand manner and said something to the effect of, 'yes, you have pains sometimes,' and made a face, as if to say it is no big deal. Her response made me aware that she was using some implicit bias to not deal with my request and I decided that I was not going to have a conversation with her any longer. She continued asking questions, I replied but minimally because I had made up my mind. I needed to take the matter over her head and pay grade. I did and after she received an email from those I reported the matter to, the next time she talked to me on the phone her attitude and manner had changed and I was able to get what I wanted at the time.

Another area where I have experienced implicit bias is in hospital, on admissions decades ago. The medical team and from reading stories in the paper recently about people with sickle cell not being given the right treatment, I submit to you that the medical teams do have an implicit bias in them. How does it reveal itself? Well in my case, it was a situation where I was having a painful crisis and I had perhaps been given a low pain injection that was not working or had not worked and so I am in pain, crying and screaming the ward down. I rang the bell and told the nurse that what I was administered was not enough for me and I got a response of 'I will go and call the doctor.' Usually, there should be an interval of four hours before the next injection but I could not wait another three hours of hell and agony. Most times, in the middle of the night, no doctor would come over and if they do, they are dismissive and patronizing. Some doctors will tell the nurse over the phone that no opioids can be administered, some will come and tell me to my face, that I must not get addicted to drugs etc. These types of stereotypes are harmful to the patient medical professional relationship.

Another incident that I remember so well, happened at the clinic that I attend as an outpatient. This was some years ago. On this particular afternoon, I went to my outpatient's clinic and after giving blood, I waited patiently in the reception area for me to be called in by one of the haematology doctors. Eventually, I was called in; I had taken one of the sachets of morphine that I still had at home with me. I should have written the name and strength of the tablet for the doctor but that day I did not. I do so now. Consequently, I told the doctor that the tablets had expired and asked if she could please prescribe another one for me. She gently took the tablets from me and left the consultation room. She came back and started giving me some excuses on why I could not be prescribed morphine. The same morphine that had been prescribed to me at the same clinic and hospital. I looked at her and was just smiling because I didn't bring the whole pack with me. I thought to myself that she must think I was dumb. She did not prescribe morphine to me and again, I could tell it was because she thought I was an addict. I left wondering, how does one combat implicit bias that seems so entrenched in the medical profession?

Now, I am glad to say that the clinic and hospital that I go to, do prescribe morphine to sickle cell patients. I am not a drug addict but when I am having a painful chronic and severe crisis, I take morphine for as long as I need to take it, till the pain goes. Morphine does not agree with my system and I tend to throw up quite a lot when I take it and so, believe me when I say, I really do not want to take any tablets at all. Plus the fact that strong opioids make me bloated and constipated. Who wants all that hassle on top of having a sickle cell crisis? I know I don't.

How can we overcome implicit social cognition that is over the place from one's workplace to other areas of society? You overcome it by speaking out about it and by challenging it. If you sense it, then say something. I used to not say anything and take it in my stride but not anymore. Now, I am vocal about saying this situation is not right and could have been handled better or differently. If we don't challenge our narratives, who will? A system that does not care? I hope that if you live with sickle cell, this column will encourage you to start speaking out and calling out implicit biases.

If you would like to get in touch with me about this article or about Sickle cell, do get in touch: and do visit my blog: My book on, "Sickle Cell – HOW TO LIVE WITH SICKLE CELL,'' is available for purchase on OkadaBooks and Amazon.

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