Being a Transgender Ally and Unconscious Bias

Being a Transgender Ally and Unconscious Bias 
2015 LGBTQ Health Care Speaker Series for knowledgeable providers
Live! From the Kaiser Permanente Center for Total Health Washington, DC USA
March 26, 2015 • 12:30 - 1:30 PST • 3:30 - 4:30 EST
Ted Eytan, MD, MS, MPH • The Permanente Federation, LLC • @tedeytan
© 2015 The Permanente Federation, LLC

Intended Learning Outcomes & Disclosure
What does it mean to be an ally & what happens?
What’s unconscious bias and why should I care?
What causes it?
I’m a clinician / leader / citizen - what can I do about it?
Disclosure
I ! Kaiser Permanente!

Build Your Best Life Total Health Festival, with Capital Pride, Washington, DC • Kaiser Permanente 2014 Gold Sponsor
I’m an ally
(also a family doctor,
a Permanente physician,
a Kaiser Permanente member,
a Washington, DC resident)
Hi. I’m Ted.

We’re here from the future
Kaiser Permanente Center for Total Health
Washington, DC, April 1, 2014

So are you.
Kaiser Permanente LGBTQI Health Symposium
Los Angeles, CA • April 13, 2013

A father and his son are in a car accident. The
father dies at the scene and the son, badly injured,
is rushed to the hospital. In the operating room,
the surgeon looks at the boy and says, “I can’t
operate on this boy. He is my son.” How can this
be?

The brain sees what it wants to see
“there is no immaculate perception”
A father and his son are in a car accident. The
father dies at the scene and the son, badly injured,
is rushed to the hospital. In the operating room,
the surgeon looks at the boy and says, “I can’t
operate on this boy. He is my son.” How can this
be?
Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations
1094-1096). Random House Publishing Group.

A mother and her daughter are in a car accident.
The mother dies at the scene and the daughter,
badly injured, is rushed to the hospital. In the
operating room, the surgeon looks at the girl and
says, “I can’t operate on this girl. She is my
daughter.” How can this be?

The brain sees what it wants to see
“there is no immaculate perception”
Source:http://en.wikipedia.org/wiki/File:Peripheral_drift_illusion_rotating_snakes.svg

we use tools to help us see accurately…
Bocce in the Park, Meridian Hill Park, Washington, DC, USA, April 20, 2014
Source: Ted Eytan, MD, http://www.ﬂickr.com/photos/22526649@N03/13957191713

Why we’re having this dialogue
ALL of us
– have biases
– are human beings
– want to be the best
for the human
beings we serve
Yes, ALL of us
“We live in a time when discrimination
looks less like a segregated lunch
counter…and more like a doctor failing
to inspire trust in your daughter and
improperly diagnosing her illness” -
Johnson, 2014
“…in a time where discrimination still
looks like a segregated lunch counter
for transgender and LGBTQ people” -
Eytan, 2015
Source: Godsill R, Goff PA, Tropp L, Powelll JA. The Science of Equality Volume 1: Addressing Implicit
Bias, Racial Anxiety, and Stereotype Threat in Education and Health Care. 2014. Available at: http://
perception.org/uncategorized/perception-institute-releases-the-science-of-equality/.

How we’re having this dialogue
Use of language
– “discrimination,” “homophobia,” “bias”
– if defensive, notice it and accept the
discomfort of unlearning and
relearning.
– “This requires a desire to know,
motivation to become informed,
willingness to correct mistakes”
Personality lens
– Amiable-amiable with a z versatility
– aka “Double rainbow,” “Glass 3/4 full”
Source: http://www.cookross.com/docs/UnconsciousBias.pdf

Drs. Jennifer Slovis, Susanne Watson, and Judy Lively • Community Partner awards
Transgender Law Center Annual Gala, San Francisco, CA • October 3, 2013
http://www.ﬂickr.com/photos/22526649@N03/10327667743

Rebecca Goldfader, ARNP • Community Partner awards
Transgender Law Center Annual Gala, San Francisco, CA • October 3, 2013

Explicit Attitudes = aware, endorsed
Ability to claim as our own
– “We oppose discrimination in all
forms”
– “When I look back I want to be
on the right side of history”
Measured by asking
“This ability to examine the
contents of our own minds
and manipulate them is
uniquely human.”
Negative attitudes, relative to whites
Source: Phelan SM, Dovidio JF, Puhl RM, et al. Implicit and explicit weight
bias in a national sample of 4,732 medical students: The medical student
CHANGES study. Obesity (Silver Spring). 2014;22(4):1201–8. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/24375989 [Accessed April 2, 2014].

Implicit Attitudes = unconscious, automatic
“Ultimately, we believe our
decisions are consistent with our
conscious beliefs, when in fact, our
unconscious is running the show”
Not accessible through
introspection
Measured indirectly
Noticed directly!
Active area of study in employment,
law, education, medicine, across
industries
Source: Staats C. State of the Science: Implicit Bias Review 2014. Columbus, OH; 2014. Available at: http://kirwaninstitute.osu.edu/
implicit-bias-review/.,http://armylgbt.org.uk/army-reserve-quarterly-features-army-lgbt-conference/; http://www.cbsnews.com/news/
ferguson-policing-eric-holder-implicit-explicit-racial-bias/
Young
Reserve
Officer’s
Workshop
Brno,
Czech Republic
YROW is an annual week-long
programme run by the Interallied
Confederation of Reserve Officers
(CIOR) and is designed to be a
young officer's first international
exposure to colleagues from NATO
and its Partners.
Dates: 29 Jul to 3 Aug 2013.
Location: Brno, Czech Republic
Open to: TA junior officers
(2Lt to Capt)
YROW is sponsored by HQ Army,
eligible for MTDs, and all travel costs
are covered including flights etc.
It consists of a week of seminars,
practical exercises, command tasks
and a lot of social interaction with
about 18 other NATO member states.
A social, interesting, and useful
week of getting to know the
countries you probably will be going
to work with in the future.
Potential candidates will need
a recommendation by their
chain of command and to meet
various criteria.
For further information contact:
Maj Mike Curtis-Rouse R Signals
UKRFA SO2
07747 565 497
mikecurtisrouse@gmail.com
ARQ Summer 2013
“The attendance of those in the chain of
command at the conference demonstrates a
marked and increasing commitment to good
management practices in the Army.
The Army aims to create a working
environment in which everyone can be
authentic about themselves, because
it improves operational effectiveness,”
concludes Major Jenkins.
The next LGBT conference is for all services in
the Armed Forces, and will be organised by
the Royal Navy at MOD Main Building on
28 June 2013.
TA
soldiers from the
Lesbian Gay Bisexual
and Transgender (LGBT)
community met those in the chain of
command at the third annual Army
LGTB conference held in March.
The theme of this year’s conference was
“Cultivating LGBT Talent” to address the fact
that there are few visibly LGBT soldiers or
officers in senior roles despite recent statistics
from Phase 1 and 2 recruits indicating that
around one in six new soldiers joining their
units in 2013 are in this group.
“The concern is that LGBT senior soldiers and
officers feel unable to be open about their
sexual orientation or gender identity, or that
they leave before achieving senior positions,”
explains Major Damian Jenkins, chairman of
the Army LGBT Forum.
“We don’t know how big the Army LGBT
community is, but the first Army-gathered
statistics on gender identity and sexual
orientation of Phase 1 and 2 recruits in 2012
showed that 1.5 per cent of men and 15 per
cent of women leaving the Phase 2 training
were lesbian, gay or bisexual. This means
that around one in six people joining their
new units in 2013 are LGBT.”
Also in the 102-strong audience were
commanding officers, adjutants, trainers,
and medical officers, to learn about unconscious
biases and the effect these have on the
promotion potential of LGBT soldiers
and officers.
Conference
Confronts
Unconscious
Biases
37
UK Army LGTB
Conference, 2013
CBSNews, March, 2015

Deb Friesen, MD and Rachael St.Claire, PsyD
Receipt of Human Rights Campain, 100%
Corporate Equality Index Award, April 1,
2014, New York City, NY
National Diversity and Inclusion Conference,
Kaiser Permanente, November 22, 2013, San
Francisco, CA

Brenda McComb, PhD
Trustee, Oregon State University (with Provost Sabah Randhawa)
Dean of Graduate Programs, Oregon State University
Professor of Forestry
Trans* Ally
Source: http://oregonstate.edu/leadership/trustees; http://pinterest.com/oregontrans

Juliet Greenwood, PhD
Associate Dean for Academic and Student Affairs
Associate Professor, Biochemistry and Biophysics
Oregon State University
Source: Juliet Greenwood, PhD

Being an ally in a world less loving
“Edith’s Crisis of Faith”
All in the Family
air date 12/25/1977
Watch: http://j.mp/edithbunkerally

It’s hard to be an ally
“Will they want
cross-species
transplants next?”
“Not all
the medical groups
share “Ted’s” point of
view”“Ted, people with
HIV were dying” “I
fully expect the numbers
to increase”
“Ted, are you a t—-y?”
“Wasn’t that
stabbing victim a
sex worker?”
“You’re violating HIPAA”
Source: http://dcist.com/2013/06/transgender_woman_stabbed_up_to_40.php

quick answers…
No
I think they believe in science, though
Yes, and we’re saddened by it, too
Yes, more human beings able to live
their lives through better health
If it recruits your humanity, believe that
I am. And, you can never say that word
in front of me again.
Many humans who are (illegally)
denied employment are.
“Receiving anger is a sacred task” -
(Ronald Heifetz, Leadership on the Line)

It’s harder to be a patient
“We need
to understand what
our competition is
doing”
“This is
cosmetic / aesthetic
surgery”“Care is very
expensive”
EXCLUSION: “Services, drugs,
or supplies related to sex
transformation”
“Top Surgery is reserved for
breast cancer patients and members
who have purchased the
'Transgender Rider’"
“Top Surgery has not been
universally accepted as treatment
for transgender Dysphoria [sic] - its
considered ‘elective'."

What does our history tell us?
Incorrect - AMA H-158.950
Incorrect - Multiple actuarial
analyses declared “de minimis”,
“immaterial”,”insignificant”
Incorrect - AMA H-158.950
Is this Fair Treatment?
– American Medical Association, District of
Columbia, other states, Title VII, and the
Affordable Care Act, Section 1557
– sex discrimination now includes gender
identity and expression
– “in contradiction to the medical
profession’s prized values of equity and
respect”
quick answers…
Sources: American Medical Association H-185.950, Economic Impact Assessment,
Gender Nondiscrimination in Health Insurance, State of California, OCR Transaction
Number: 12-000800, DC Dept of Insurance, Securities and Banking, Affordable Care
Act, Section 1557, Holder, et. al, Appeal No. 0120120821,1. Stroumsa D. The state of
transgender health care: policy, law, and medical frameworks. Am. J. Public Health.
2014;104(3):e31–8. Available at: http://ajph.aphapublications.org/doi/abs/10.2105/
AJPH.2013.301789 [Accessed April 3, 2014].

It’s hardest to just be…
http://www.contracostatimes.com/walnut-creek/ci_24475186/walnut-creek-woman-
found-i-680-identiﬁed

27
Paul de Kruiff, Kaiser wakes the Doctors, 1943

#transformKP: Total Health and Social Innovation
Labor-Management Partnership all-hands
December 2, 2014 • San Francisco, CA USA
Ted Eytan, MD, MS, MPH • The Permanente Federation, LLC • @tedeytan
© 2014 The Permanente Federation, LLC
Desert Center, 1933
When any human being is hurt, or sick and full of toxins and down
with energy at ebb tide - then of all times the surroundings should
be most beautiful, most gentle.” - Sidney Garfield, MD

“Black patients are to be treated like everybody else. There is no segregation at our
facilities.”- Henry J. Kaiser (digital display, Kaiser Permanente Center for Total Health, 2011)

Help Kaiser Permanente
become a leader in providing
Trans*-inclusive care.
Kaiser Permanente is looking at
transgender, gender-expansive,
and gender non-conforming
person care in a new way, and
we want to partner with you
to create high quality care that
meets you where you’re at.
We are starting an exciting
project that will provide insight
directly to our nurses, doctors,
leaders, and staff to inspire us to
focus on your total health, so you
can focus on a great life. We are
not just looking to provide the
best clinical care possible,
we want to understand and
address your needs, goals, and
what makes you tick.
We are looking for people who
would be interested in any of
the following opportunities. We
are able to offer honorariums for
your participation, and we ensure
the privacy and confidentiality
of what is shared in a safe,
comfortable environment for
you. We treat everything you
share with us with confidentiality,
respect, and empathy.
We are interested in:
• Meeting trans-identified, gender-expansive,
and gender non-conforming people who are,
or have been, Kaiser Permenente members.
• Interviewing you in your home or another
comfortable place for 2-3 hours.
• Interviewing you along with a close
friend or family member so that you can
both provide your perspectives together.
• Learning what it’s like to be you by
shadowing you through part of your day.
• Seeing Kaiser Permenente from your
perspective by shadowing you on a visit.
Who are we? We are the Innovation Consultancy
at Kaiser Permanente. We work with people in
a human-centered, empathic way to understand
their experiences and design new and better
ways for Kaiser Permanente to meet their health
and wellness goals and needs.
Here are the tentative dates for our fieldwork.
If you can’t do these dates, we can be flexible:
February 24-27, March 10-13, March 17-20
Thank you for your interest. For more info, or to
express your interest, please contact
Katherine Duong: katherine.t.duong@kp.org or
Dana Ragouzeos: dana.n.ragouzeos@kp.org
#KPLantern: California / Oregon / Vancouver, BC 2015
Dana Ragazeous, Lead
Scott Heisler, RN, Core Team
Katherine Duong, Co-Lead
Bill Strull, MD, Core Team
Chris McCarthy, KP Innovation Consultancy
Arli Christian, JD, National Center for
Transgender Equality

Sylvia Rae Rivera (1951 – 2002) American bisexual transgender activist and trans woman
http://highkixx.com/2012/01/

Marsha P Johnson, 1944-1992, Black Transgender Rights Activist

Ruby Jade Corado, Humanist-Transgender woman, Mayor Vince Gray, Washington, DC
October 18, 2014 • http://www.ﬂickr.com/photos/22526649@N03/14958436953

with Kapriece Williams, Corado-Walker Wedding, Washington, DC, October 18, 2014
Photo: Lane Hudson, http://www.ﬂickr.com/photos/22526649@N03/15392654087

Biology, not intention (mostly)
“since wars begin in the minds of
men, it is in the minds of men
that the defences of peace must
be constructed”
– 1947 constitution of UNESCO – the
United Nations Educational, Scientific
and Cultural Organization
It’s just biology
We’re all biased
That’s boring
It’s what you do with it that matters
Denise Lascar, Trans* Ally, Ruff Plastic Surgery
Washington, DC • October 8, 2013

Implicit Association Test (IAT)
Developed 1998
Easily taken at http://projectimplicit.net
KP Learn: “Unconscious bias”
#00643343
Available for bias in age, weight,
gender, sexual orientation
– currently no test for gender identity/
expression
About 5 minutes long
“The IAT has demonstrated enough
reliability and validity that total denial is
implausible” (Kang & Lane, 2010)
Sangeeta Iyer, MD, Internal Medicine Specialist
Transgender services champion
Kaiser Permanente Capitol Hill Medical Center
Washington, DC

Implicit Association Test: I’m human

Tessa Scheller, CRNA
Certified Registered Nurse
Anesthetist
Kaiser Permanente Northwest
Retired 2008
Kaiser Permanente member
advisor, national transgender
champions group (as of 2014)

Yes to more.
Yes to more me. More massages. More laughter.
More friends. More intimacy. More sleep. More
water. More bike rides. More visits to a doctor
or therapist. Yes to vitamins. Yes to one more
salad this week. Yes to more dancing. Yes to
more life. Yes to outliving homophobia.Canadian Rainbow Health Coalition
Coalition Santé Arc-en-ciel Canada
crhc
csac
Yes to more.
Yes to more me. More massages. More laughter.
More friends. More intimacy. More sleep. More
water. More bike rides. More visits to a doctor
or therapist. Yes to vitamins. Yes to one more
salad this week. Yes to more dancing. Yes to
more life. Yes to outliving homophobia.
Check in at outlive.ca
Courtesy Transgender Health Information Program, Vancouver Coastal Health Authority • http://transhealth.vch.ca

TRS-80 vs iPhone
1000x Speed Difference
Zilog Z80
1.77 MHz
Apple A8
1.4 GHz
"Apple A8 system-on-a-chip" by Henriok
- Own work. Licensed under CC0 via
Wikimedia Commons - http://
commons.wikimedia.org/wiki/
File:Apple_A8_system-on-a-
chip.jpg#mediaviewer/
File:Apple_A8_system-on-a-chip.jpg

Conscious vs Unconscious
687,500x Speed Difference - Brain wins!
16-40 bits/second
11,000,000 bits/second

Conscious vs Unconscious
687,500x Speed Difference - Brain wins!
Source: Stanley D, Phelps E, Banaji M. The Neural Basis of Implicit Attitudes. Curr. Dir. Psychol. Sci. 2008;17(2):164–170.
[Accessed April 1, 2014].

Your brain on walking - same pathways (?)
activated
activated
activated
deactivated
it works better
Source: Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nature Reviews. Neuroscience. 2008;9(1):58–65..
Slide created by Ted Eytan, MD | @tedeytan | December, 2012

Implicit attitudes inﬂuence behavior
Resident Physicians, 2007
– Reduced likelihood to prescribe
thrombolytics for African American patients
associated with implicit bias
– Higher likelihood of prescribing
thrombolytics for African Americans if they
were aware of what the study was
measuring
Survey based study
28% response rate
Source: Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and
white patients. J. Gen. Intern. Med. 2007;22(9):1231–8. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?
artid=2219763&tool=pmcentrez&rendertype=abstract [Accessed January 28, 2014], Staats C. State of the Science: Implicit Bias Review
2014. Columbus, OH; 2014. Available at: http://kirwaninstitute.osu.edu/implicit-bias-review/.
Resident Physicians, 2007

Impact: hypertension control
Blair, et. al
– Kaiser Permanente &
Denver Health
– 210 Physicians
– 190 Community Members
– 4,794 patients
Clinician Implicit Bias
Quality of clinical
Encounters
Patient's Perceptions
of Physician
Medication
Adherence
Hypertension
Control
Clincian's
Perceptions and
Judgements of
Patient
Treatment
Intensiﬁcation
Source: Blair I V, Steiner JF, Hanratty R, et al. An Investigation of Associations Between
Clinicians’ Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and
Blood Pressure Control. J. Gen. Intern. Med. 2014:18–20. Available at: http://
www.ncbi.nlm.nih.gov/pubmed/24549521, Blair I, Steiner J. Clinicians’ implicit ethnic/racial
bias and perceptions of care among black and Latino patients. Ann. Fam. …. 2013:43–52.
Available at: http://www.annfammed.org/content/11/1/43.short [Accessed April 21, 2014].
Blair I V, Havranek EP, Price DW, et al. Assessment of biases against Latinos and African
Americans among primary care providers and community members. Am. J. Public Health.
2013;103(1):92–8. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?
artid=3518332&tool=pmcentrez&rendertype=abstract [Accessed March 29, 2014].

Impact: hypertension control
Quality of clinical
Encounters
of Physician
Medication
Adherence
Hypertension
Control
Clincian's
Perceptions and
Judgements of
Patient
Treatment
Intensiﬁcation
72 - 82% preference for Whites
Lower if Black, Latino
Black: proportional to implicit bias
No difference: White, Black, Latino
Lower if Black, Latino
NOT related to implicit bias
Lower if Black
NOT related to implicit bias
Source: Blair I V, Steiner JF, Hanratty R, et al. An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and Hypertension Treatment,
Medication Adherence and Blood Pressure Control. J. Gen. Intern. Med. 2014:18–20. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24549521,
Blair I, Steiner J. Clinicians’ implicit ethnic/racial bias and perceptions of care among black and Latino patients. Ann. Fam. …. 2013:43–52. Available
at: http://www.annfammed.org/content/11/1/43.short [Accessed April 21, 2014]. Blair I V, Havranek EP, Price DW, et al. Assessment of biases against
Latinos and African Americans among primary care providers and community members. Am. J. Public Health. 2013;103(1):92–8. Available at: http://
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3518332&tool=pmcentrez&rendertype=abstract [Accessed March 29, 2014].
18% - 28% of physicians WITHOUT implicit bias

In the health of people who are trans* …
Quality of clinical
Encounters
of Physician
Treatment
adherence
medically
necessary care
Clincian's
Perceptions and
Judgements of
Patient
Treatment
recommendation
Adapted from Blair I V, Steiner JF, Hanratty R, et al. An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and
Hypertension Treatment, Medication Adherence and Blood Pressure Control. J. Gen. Intern. Med. 2014:18–20. Available at: http://
www.ncbi.nlm.nih.gov/pubmed/24549521 [Accessed April 12, 2014].

In the health of people who are trans* …
Quality of clinical
Encounters
of Physician
Treatment
adherence
medically
necessary care
Clincian's
Perceptions and
Judgements of
Patient
Treatment
recommendation
"explicit clinician bias ⛔️ denial of coverage
% self administration
"explicit & implicit insurance bias
&no employment
⚠️clinical competence "implicit patient bias
(no preventive care
Source: https://twitter.com/TRANSLATINAS_NY/statuses/304597877425049600; http://www.dailykos.com/story/2014/04/18/1292952/-Illinois-Transwoman-Refused-Medical-
Care-Because-Religious-Freedom?showAll=yes, adapted from Adapted from Blair I V, Steiner JF, Hanratty R, et al. An Investigation of Associations Between Clinicians’ Ethnic or
Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control. J. Gen. Intern. Med. 2014:18–20. Available at: http://www.ncbi.nlm.nih.gov/pubmed/
24549521 [Accessed April 12, 2014];http://www.metroweekly.com/2015/03/transgender-men-facing-discrimination-in-healthcare/
)little research
*few positive exemplars

In the health of their caregivers….
Medical students who are “out”
! 68% : sexual identity
! 34% : gender identity
only up from 44% two decades
ago (sexual identity)
Source: Mansh M, White W, Gee-Tong L, et al. Sexual and Gender Minority Identity Disclosure During Undergraduate Medical Education: “In the Closet” in Medical School. Acad.
Med. 2015;Publish Ah. Available at: http://journals.lww.com/academicmedicine/Fulltext/publishahead/Sexual_and_Gender_Minority_Identity_Disclosure.98848.aspx.
In interacting with residents and
attendings, it is clear through general
conversation and oﬀhand comments that LGBT is
unfamiliar and, at best, a joke. (26-year-old,
third-year, gay, white, male, U.S. MD
student)
On my surgery rotation, we saw a male- to-
female transgender patient who had “do-it-
yourself ” silicone breast implants which had
become infected. He [sic] was treated like a
freak by the residents and attendings behind
closed doors, joking at his [sic] expense. (25-
year-old, third-year, lesbian, white, female,
U.S. MD student)

Homophobia
makes me sick.
Canadian Rainbow Health Coalition
Coalition Santé Arc-en-ciel Canada
crhc
csac
Check in at outlive.ca
Homophobia
makes me sick.
No really it does. All that negative messaging
soaks into our skin like toxic radiation. How do
you get rid of it? Easy. Visit outlive.ca for the
little things you can do to take care of yourself.
They’re easy and you’re worth it.
Courtesy Transgender Health Information Program, Vancouver Coastal Health Authority • http://transhealth.vch.ca

Alex Scott, National Center for Transgender Equality and Metropolitan Police Department
International Transgender Day of Remembrance • Washington, DC • 11/20/14

Where do implicit biases come from?
Accrued and change passively
Documented in children as young as 6 years old
Nature/Nurture : YES
– Our commitment is to be fair regardless
"Wrong information always shown by the media
Negative images is the main criteria
Infecting the young minds faster than bacteria
Kids wanna act like what they see in the cinema"
Black Eyed Peas, Where is the Love (2003)

http://walnutcreek.patch.com/
groups/police-and-ﬁre/p/
pedestrian-killed-after-being-
hit-by-a-car-on-walnut-creek-
freeway

Can we eliminate it? Is it malleable?
“There is a pretty obvious reason for
this: 90% of the mug shots in my local
paper are blacks.”
“What hope is there, however, to
exterminate my acknowledged
implicit bias which is clearly based
on seeing the world the way it
exists (alas)?”
Source: http://annfammed.org/content/11/1/43.full/reply#annalsfm_el_25471
Yes!
+

If you don’t like the world the way it is, change it
“Rider” - eliminated
“Exclusions” - eliminated
Medically necessary care,
including surgery, must be
covered, in all plans,
including individual and
group
All DC Government plans
now include medically
necessary care Chester McPherson, Insurance Commissioner
Washington, DC ends discrimination in health insurance
February 27, 2014

Caprice Williams, Mayor Vince Gray, Consuela Lopez, Andy Bowen, Washington, DC
March 6, 2014 • http://www.ﬂickr.com/photos/22526649@N03/12998223535

Debiasing Techniques that you can should use
Contact
– “Involving equal status, cooperation
to achieve common goals, and
supported by important societal
institutions”– “
– Intergroup
– Extended
– Imagined
Access to positive exemplars
Mindfulness
“If this, then that”
“Life is for Living, Now I Can!” - Beth
Charing Cross GIC, London, GB

Ruby Jade Corado • Ted Eytan
Stonewall LGBTQ & Allies Athletic League, Washington, DC USA • February 12, 2015

Bianca Rey, Bestselling Author Janet Mock, Melanie Hiller • Washington, DC • Feb 25, 2014

instagram.com/tedeytan , May, 2014

Debiasing Techniques that you should promote
Measure: Implicit Association Test
– Encourage, don’t mandate
Reframe
– From: Discrimination, Protected Class
– To: Fair treatment, Respect
Question
– The illusion of objectivity

Don’t forget to listen
Create: The “tell me more” culture
Practice “perspective taking”
Kaiser Permanente Los Angeles Medical Center, May 2, 2014
Photos: Ted Eytan, http://www.ﬂickr.com/photos/22526649@N03/14088671614

Exercise
Spend the next 60 seconds imagining
yourself meeting a person who is
transgender for the first time. Imagine
that the interaction is relaxed, positive,
and comfortable
Now, list as many things as you can
about the interaction that you just
imagined
Source: Turner RN, Crisp RJ. Imagining intergroup contact reduces implicit
prejudice. Br. J. Soc. Psychol. 2010;49(Pt 1):129–42. Available at: http://
www.ncbi.nlm.nih.gov/pubmed/19302731 [Accessed March 25, 2014].

Catherine White Holman (1954-2009)
pioneer, social worker and
advocate, Vancouver, BC
Marria Townsend, MD, Gail Knudson, MD, Nick, MSIV
Three Bridges Community Health Centre, Vancouver, BC, March 19, 2015

Today : A world learning to love better
“Skyzone”
http://j.mp/edithbunkerally
March 15, 2014
Source: http://xﬁnity.comcast.net/blogs/tv/2014/03/14/exclusive-clip-undercover-boss-
features-transgender-employee/; http://transhealth.vch.ca
Transgender Health Information Program
Vancouver Coastal Health Authority
March 19, 2015

Advice from experts
“own the fact the fact that you’re not exceptional. you are in this sweet
spot of judges, lawyers, police, all of whom have bias. If you care, it would
make sense to find out.” - Jerry Kang, JD, Professor of Law, UCLA
April 15, 2014
“Don’t present this as scary. This behavior is malleable
and contextually sensitive.”
- Irene Blair, Phd, Associate Professor, Psychology and
Neuroscience, University of Colorado
April 11, 2014
“If there is one bisexual man in your unit his fitting in
depends on how open to diversity your unit is. It is NOT
based on how hard he tries to fit in.” - Sasha Scott & Damian
Jenkins, UK LGTB Army Forum
June, 2013

We’re all misfits with a dream (of better health)
Future gender neutral restroom
Garfield Innovation Center, San Leandro, CA, September 22, 2014
photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/15144080399,
March on Washington, 50th Anniversary
Washington, DC USA, August 28, 2013

Bianca Rey and Melanie HIller, Ofﬁcers in KP Pride Mid-Atlantic States, Martin Luther King Jr. Memorial Library
Washington, DC, • Feb 25.2014 • http://www.ﬂickr.com/photos/22526649@N03/12791074333

Nico Quintana, Rally for Transgender Health Equality, Washington DC • March 30, 2013
https://ﬂic.kr/p/e7nVNC

Rebecca Goldfader, ARNP, Kaiser Permanente San Francisco, January 29, 2014

Stonewall Bocce, Logan Circle, Washington, DC • October 31, 2013

Capital Pride, Washington DC • Kaiser Permanente Silver Sponsor • June 8, 2013

Bianca Rey, Melanie Hiller, Ruby Jade Corado, Caprice Williams, Casa Ruby DC
February 25, 2014 • http://www.ﬂickr.com/photos/22526649@N03/12784261603

Community leaders Ruby Corado and Melanie Hiller • Washington, DC • March 27, 2014

LGBT Health Awareness Week • March 25, 2013
Kaiser Permanente Center for Total Health
With Paula Woodward (American College of Physicians), Susan Rowe, Margo Williams (ACP)

Rally for Transgender Health Equality, Washington DC • March 30, 2013

purple heart!
Kristin Beck, Northern Virgina LGBTQ Pride, October 5, 2014
photo: m.v. jantzen: https://ﬂic.kr/p/pxpr2D

Ruby Jade Corado, D.C. Humanist-Transgender woman, Casa Ruby DC, Washington, DC
February 25, 2014 • http://www.ﬂickr.com/photos/22526649@N03/12784261603

Baltimore Pride, June 15, 2013, Baltimore, MD, USA

Lane Hudson, Community Leader, and Ruby Jade Corado, D.C. Humanist-Transgender
woman Washington, DC • March 27, 2014

Being a Transgender Ally and Unconscious Bias

Being a Transgender Ally and Unconscious Bias

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