# Pain — GCMD Library living collection

Everything in the library about pain — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 78 cited statements

## Episodes
### Evidence & Research
- [PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424) — video · 11:59 · [machine version](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424.md)

### Case-Based Learning
- [Opioid over prescription: Practice Gap discussion at Update Course 2018](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343) — video · 8:27 · [machine version](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343.md)

### Patient & Family Education
- [Unconscious Bias](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300) — podcast · 58:27 · [machine version](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=0) Case presentation and initial discussion of opioid alternatives (Ep 1)
- [2:42](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=162) Disposal programs and the opioid epidemic context (Ep 1)
- [5:20](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=320) Practice change testimonial and disposal methods (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=0) Introduction and Context: Recognizing Unconscious Bias (Ep 2)
- [3:22](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=202) Defining Implicit Bias and Examples from Practice (Ep 2)
- [10:05](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=605) Personal Experiences: Explicit vs. Implicit Bias (Ep 2)
- [16:52](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1012) Social Identity and Privilege (Ep 2)
- [21:36](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1296) Addressing the "I Chose the Best" Defense (Ep 2)
- [27:28](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1648) Responding to Test Results and the Journey of Change (Ep 2)
- [37:43](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2263) Research-Proven Mitigation Strategies (Ep 2)
- [47:53](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2873) Key Takeaways and the Role of Leadership (Ep 2)
- [53:47](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=3227) Advice for Young Female Surgeons and Closing Remarks (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=0) Study presentation: perioperative opioid use in pediatric inguinal hernia patients (Ep 3)
- [3:18](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=198) Initial commentary and questions on length of stay, regional blocks, and gender differences (Ep 3)
- [5:04](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=304) Discussion of length of stay, spinal anesthesia, and age considerations (Ep 3)
- [7:48](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=468) Panel questions on study design, laparoscopy, institutional education, and gender dimorphism (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients. — Isabel Hageman (clinical) [Ep 3 · 0:33](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=33)
- There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults. — Isabel Hageman (guideline) [Ep 3 · 0:40](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=40)
- The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne. — Isabel Hageman (clinical) [Ep 3 · 0:52](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=52)
- Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids. — Isabel Hageman (clinical) [Ep 3 · 0:58](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=58)
- 20% of patients received opioids intraoperatively, which was mostly fentanyl. — Isabel Hageman (clinical) [Ep 3 · 1:41](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=101)
- Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter. — Isabel Hageman (clinical) [Ep 3 · 1:46](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=106)
- 33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids. — Isabel Hageman (clinical) [Ep 3 · 1:53](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=113)
- No patients received an opiate prescription at discharge. — Isabel Hageman (clinical) [Ep 3 · 2:02](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=122)
- Increasing age increased the risk for postoperative and total opiate use. — Isabel Hageman (clinical) [Ep 3 · 2:06](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=126)
- There was a significant association between female sex and total opioid use. — Isabel Hageman (clinical) [Ep 3 · 2:06](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=126)
- Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids. — Isabel Hageman (clinical) [Ep 3 · 2:16](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=136)
- Addition of regional blocks significantly lowered postoperative opiate use. — Isabel Hageman (clinical) [Ep 3 · 2:23](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=143)
- General anesthesia was found to be a risk for total, but not postoperative opioid use. — Isabel Hageman (clinical) [Ep 3 · 2:23](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=143)
- Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world. — Isabel Hageman (opinion) [Ep 3 · 2:33](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=153)
- There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients. — Isabel Hageman (opinion) [Ep 3 · 2:46](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=166)
- Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional. — Isabel Hageman (clinical) [Ep 3 · 2:54](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=174)
- Todd has seen a big change in practice over the last decade, from giving everybody narcotics after surgery to not prescribing narcotics at all. — Todd (opinion) [Ep 3 · 3:25](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=205)
- The median length of stay was elevated due to premature infants and children already admitted to the hospital who had inguinal hernia surgery as one reason for admission. — Isabel Hageman (clinical) [Ep 3 · 5:07](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=307)
- Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU. — Isabel Hageman (clinical) [Ep 3 · 5:33](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=333)
- General anesthesia was a risk factor for opioid use in general. — Isabel Hageman (clinical) [Ep 3 · 6:19](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=379)
- The institution is moving towards more spinals only for inguinal hernia repairs. — Isabel Hageman (opinion) [Ep 3 · 6:26](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=386)
- Matthew Mitchell in Akron has been doing cases under spinal anesthesia where patients are wide awake, don't move during surgery, don't need PACU, and go home immediately. — Todd (clinical) [Ep 3 · 6:46](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=406)
- In very young children, spinal anesthesia is easier to perform because they don't experience the potentially traumatic aspects of being in the OR as older children might. — Isabel Hageman (opinion) [Ep 3 · 7:05](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=425)
- The median age of patients in the study was 3 months, making spinal anesthesia ideal, especially since caution with narcotics is important in young children. — Isabel Hageman (clinical) [Ep 3 · 7:27](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=447)
- All patients in the study were open inguinal hernia patients, not laparoscopic. — Isabel Hageman (clinical) [Ep 3 · 8:23](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=503)
- There was no association found between length of stay and opiate use, though this may be due to the small sample size of patients who received opioids. — Isabel Hageman (clinical) [Ep 3 · 8:25](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=505)
- The study was a retrospective audit, so groups (general anesthesia only, spinal only, or both) were determined by looking back at what patients received, not selected beforehand. — Isabel Hageman (clinical) [Ep 3 · 8:55](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=535)
- There was no institutional education around opioid prescription at the time of the study or before. — Isabel Hageman (clinical) [Ep 3 · 9:51](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=591)
- Two or three years before the study, the warnings around opioids and their classification level were changed in Australia, which may have influenced opioid use at RCH. — Isabel Hageman (opinion) [Ep 3 · 9:51](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=591)
- In older populations, the theory for gender differences in opioid requirements is that males are reluctant to report pain while females will ask for painkillers. — Isabel Hageman (opinion) [Ep 3 · 10:50](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=650)
- In the very young study population where there is no verbal communication about pain, it is especially interesting that females have higher opioid requirements, and the reason is unclear. — Isabel Hageman (opinion) [Ep 3 · 11:12](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systemati-5424?t=672)
- Acetaminophen (Tylenol) plus NSAIDs (e.g., ibuprofen/Motrin) are equally as effective as narcotics for pain relief without the side effects of headache, constipation, and nausea. (clinical) [Ep 1 · 0:43](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=43)
- 5% of children will become long-term opioid users if they are given opioids, according to research by Kelly Harbaugh at the speaker's institution. (epidemiological) [Ep 1 · 1:14](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- The problem of pediatric opioid use exists not just with surgeons but also with dentists and all kinds of healthcare providers. (epidemiological) [Ep 1 · 1:14](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- Subsequent opioid prescriptions children receive are not necessarily from the surgeon who gave the first prescription. (epidemiological) [Ep 1 · 1:14](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- Excess opioids given to patients are probably the biggest entry point for narcotics into our system and subsequent abuse. (opinion) [Ep 1 · 1:14](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- Parents keep leftover opioid prescriptions, which then leak into society. (epidemiological) [Ep 1 · 1:14](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- The most common reason for house burglaries now is those seeking drugs left over in drawers or medicine cabinets. (epidemiological) [Ep 1 · 2:42](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=162)
- After stopping routine narcotic prescriptions for hernias and appendectomies, the speaker has not had one single patient call complaining about pain management. (clinical) [Ep 1 · 5:20](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=320)
- Most urban areas now have traces of opioids in their water supply because so many people flush medications down the toilet. (epidemiological) [Ep 1 · 7:21](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=441)
- Children have presented with bad toxic reactions after swallowing fentanyl patches, mistaking them for candy or gum. (clinical) [Ep 1 · 7:21](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=441)
- Michigan has a network (Michigan Open/opiate network) that conducts drives at high schools throughout the state where parents or patients bring opiates for collection, removing immense amounts of opiates from the system. (epidemiological) [Ep 1 · 7:50](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=470)
- No one recognizes they have implicit bias, and everyone has it to different degrees about different groups (religions, gender, sexual preference). — Mary Brandt (opinion) [Ep 2 · 4:55](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=295)
- Anyone not in the dominant group (white male Protestants) will have experienced implicit bias; women in surgery and medicine universally have. — Mary Brandt (opinion) [Ep 2 · 6:04](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=364)
- Microaggressions are 'very tiny paper cuts'—not blatant prejudice but repeated small insults (e.g., men talking over women, 'mansplaining,' 'he-peats') that take a toll over time. — Mary Brandt (clinical) [Ep 2 · 7:55](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=475)
- People in dominant positions are responsible for calling out microaggressions and bias, not those experiencing them. — Mary Brandt (opinion) [Ep 2 · 9:10](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=550)
- At Hopkins in 2005–2006, implicit bias testing showed that people have bias based on where they sit (Hopkins vs. Harvard) and that white preference exists because white individuals get more recognition and opportunities. — Julie Freischlag (epidemiological) [Ep 2 · 10:05](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=605)
- Julie Freischlag learned 20 years after the match that the UCSF surgery chair decided he didn't want any women in the program, so the three ranked women (including her) were excluded. — Julie Freischlag (clinical) [Ep 2 · 11:20](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=680)
- All of Julie Freischlag's search committees now must go through implicit bias testing and examination. — Julie Freischlag (clinical) [Ep 2 · 12:23](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=743)
- Unconscious biases are associations or preferences occurring outside awareness and control; they can influence decision-making so that even well-intentioned, egalitarian clinicians may treat people differently based on gender, race, age, height, weight. — Quinn Capers (clinical) [Ep 2 · 12:44](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=764)
- In a case Quinn Capers was made aware of, an outside oncologist assumed an underrepresented minority patient's cancer relapse was due to noncompliance with chemotherapy; genetic testing later showed the cancer had mutated, but the delayed switch in therapy came too late and the patient died. — Quinn Capers (clinical) [Ep 2 · 14:10](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=850)
- There is data that physicians unconsciously associate underrepresented minorities with medical noncompliance. — Quinn Capers (epidemiological) [Ep 2 · 16:20](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=980)
- If you are in a dominant group (white, male, Protestant, cisgender), you never have to think about your social identity during interactions—'you've never had to think about what's water.' — Mary Brandt (opinion) [Ep 2 · 17:50](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1070)
- Many people assume surgeons can't lead organizations because they're 'so narcissistic and self-centered that they can't see beyond the operating room'; Julie Freischlag had to overcome this stereotype when seeking dean/CEO positions. — Julie Freischlag (clinical) [Ep 2 · 20:00](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1200)
- A panel that is purely white males will not attract many listeners nor be believed. — Julie Freischlag (opinion) [Ep 2 · 22:40](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1360)
- To diversify panels, one can ask trainees (especially women or underrepresented minorities) who they admire in the field, or reach out via email/text to people outside one's immediate network. — Julie Freischlag (clinical) [Ep 2 · 24:01](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1441)
- When assembling panels, people typically ask 'who do I know?' or call a colleague for recommendations, which perpetuates homogeneity; intentionality is required to achieve diversity. — Quinn Capers (opinion) [Ep 2 · 25:50](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1550)
- Todd Ponsky admits he thinks of who to put on panels by recalling who he's seen on other panels, thereby perpetuating bias. — Todd Ponsky (clinical) [Ep 2 · 27:28](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1648)
- Implicit bias arises from how you were raised, the people around you, your parents, hometown, and high school—not from personal moral failing; recognizing it should prompt action, not shame. — Julie Freischlag (opinion) [Ep 2 · 28:18](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1698)
- Appreciative inquiry—asking 'why? tell me more' instead of assuming you know the answer—helps overcome implicit bias. — Julie Freischlag (clinical) [Ep 2 · 29:10](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1750)
- Recognizing implicit bias is the first step; it exists in 100% of people, it's not your fault (media and society reinforce it), but you have a responsibility to behave differently. — Mary Brandt (opinion) [Ep 2 · 30:59](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1859)
- Addressing implicit bias is hard work, a journey that will make you extremely uncomfortable; when you get uncomfortable, that means you're making progress. — Mary Brandt (opinion) [Ep 2 · 32:00](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1920)
- Robin DiAngelo's book *White Fragility* explains how pervasive race issues are in society and how white people have a responsibility to respond appropriately; it addresses the defensive 'I'm not biased' reaction. — Mary Brandt (guideline) [Ep 2 · 32:40](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1960)
- Physicians are good-hearted people who want to do the right thing, but unconscious biases can 'hijack our good intentions' and lead to inequitable care. — Quinn Capers (opinion) [Ep 2 · 34:07](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2047)
- Research-proven strategy: find common group identities with patients (e.g., both grew up on a farm, both fans of the same sports team); discovering a shared group identity reduces unconscious bias. — Quinn Capers (clinical) [Ep 2 · 34:50](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2090)
- Perspective-taking—imagining what a patient went through to get to the appointment (parking, stress, taking time off work)—builds empathy, and empathy actively opposes unconscious bias. — Quinn Capers (clinical) [Ep 2 · 35:50](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2150)
- At Ohio State, after the 140-member admissions committee took three Harvard IATs (sexuality, male career stereotype, black-white race) and received bias training, the college admitted the most diverse class in its history the very next cycle. — Quinn Capers (epidemiological) [Ep 2 · 37:43](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2263)
- Ohio State now mandates annual admissions committee orientation with IAT testing and a vignette-based workshop on implicit bias reduction strategies. — Quinn Capers (clinical) [Ep 2 · 39:00](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2340)
- Mary Brandt's three key points: (1) you have implicit biases that are getting in your way; (2) they hurt individuals and the profession by preventing diverse hiring/retention; (3) addressing this takes courage, and those in power must call out bias when it happens. — Mary Brandt (opinion) [Ep 2 · 40:20](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2420)
- In medicine's hierarchy, younger and more diverse individuals are not comfortable calling out bias, so leaders must be public about it and say 'I'm sure you didn't mean to offend, but this is what we heard.' — Julie Freischlag (opinion) [Ep 2 · 42:30](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2550)
- When someone reports an offensive incident, leaders must listen with an open mind, because implicit bias may cause the leader to have heard it differently than the person who was harmed. — Julie Freischlag (opinion) [Ep 2 · 43:30](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2610)
- Julie Freischlag recounts a lecture at her college that young women found offensive but an older white male thought was great—'people will hear different things' based on their identity. — Julie Freischlag (clinical) [Ep 2 · 44:20](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2660)
- Leaders will make mistakes and should publicly apologize: 'I didn't mean it to sound that way. That's not really how I feel, but I'm so glad you brought it to my attention.' — Julie Freischlag (opinion) [Ep 2 · 45:10](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2710)
- Forgiveness is important on this journey; most people want to improve, and a small percentage are 'hopeless,' but kindness keeps people encouraged to change. — Julie Freischlag (opinion) [Ep 2 · 46:00](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2760)
- In a wrestling match between your conscious mind and your unconscious mind, your conscious mind will win every time—if you know what your unconscious biases are. — Quinn Capers (opinion) [Ep 2 · 46:51](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2811)
- You are at highest risk for unconscious bias driving decisions during times of high cognitive load (thinking about 3–4 things at once), time crunch (e.g., emergency room), and sleep deprivation (post-call). — Quinn Capers (clinical) [Ep 2 · 47:30](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2850)
- 'Consider the opposite' strategy: before making a decision, force yourself to go back to the data looking for evidence to support the opposite conclusion (e.g., if you think a student can't succeed academically, look for evidence they will). — Quinn Capers (clinical) [Ep 2 · 48:20](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2900)
- The IAT should not be used to screen people out of jobs or committees (that would assign conscious intent to unconscious associations); it should be used to guide education and professional development. — Quinn Capers (opinion) [Ep 2 · 49:30](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=2970)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A decade ago, the IOM (Institute of Medicine) was telling clinicians they weren't adequately managing people's pain. — The host summarizing the discussion [Ep 1 · 4:07](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- Consumption of hydrocodone increased 200% and oxycodone increased 500%. — The host summarizing the discussion [Ep 1 · 4:07](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- Opioid deaths have quadrupled. — The host summarizing the discussion [Ep 1 · 4:07](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- Pediatric hospitalizations and emergency ward visits related to opioids have doubled. — The host summarizing the discussion [Ep 1 · 4:07](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- Most pediatric opioid-related hospitalizations and emergency visits are a result of prescribed medications. — The host summarizing the discussion [Ep 1 · 4:07](https://qa.library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- Implicit bias is defined by the Kirwan Institute at Ohio State as 'the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner.' — Mary Brandt summarizing the discussion [Ep 2 · 4:16](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=256)
- In a study of diverse doctors, minority children were consistently given less pain medicine than white children, with no reason except implicit bias and stereotypes. — Mary Brandt summarizing the discussion [Ep 2 · 5:30](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=330)
- Social identity is 'the portion of an individual's self-concept derived from perceived membership in a relevant social group' (gender, sexual orientation, etc.). — Mary Brandt summarizing the discussion [Ep 2 · 17:09](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1029)
- It has been proven in business that diverse, inclusive teams make more money, make more progress, and attract more people. — Julie Freischlag summarizing the discussion [Ep 2 · 21:58](https://qa.library.globalcastmd.com/watch/unconscious-bias-1300?t=1318)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai