Practice Management

Racism in medicine: Implicit and explicit


 

Moving forward

That racial biases are steeped so thoroughly into our culture and consciousness means that moving beyond them is a continual, purposeful work in progress. But it is work that is critical for everyone, and certainly necessary for those who care for their fellow human beings when they are in a vulnerable state.

Health care systems need to move toward equity – giving everyone what they need to thrive – rather than focusing on equality – giving everyone the same thing, said Jenny Baenziger, MD, assistant professor of clinical medicine and pediatrics at Indiana University, Indianapolis, and associate director of education at IU Center for Global Health. “We know that minoritized patients are going to need more attention, more advocacy, more sensitivity, and more creative solutions in order to help them achieve health in a world that is often stacked against them,” she said.

Dr. Jenny Baenziger, assistant professor of clinical medicine and pediatrics at Indiana University, Indianapolis

Dr. Jenny Baenziger

“The unique needs of each patient, family unit, and/or population must be taken into consideration,” said Dr. Unaka. She said hospitalists need to embrace creative approaches that can better serve the specific needs of patients. Equitable practices should be the default, which means data transparency, thoroughly dissecting hospital processes to find existing inequities, giving stakeholders – especially patients and families of color – a voice, and tearing down oppressive systems that contribute to poor health outcomes and oppression, she said.

“It’s time for us to talk about racism openly,” said Dr. Kara. “Believe your colleagues when they share their fears and treat each other with respect. We should be actively learning about and celebrating our diversity.” She encourages finding out what your institution is doing on this front and getting involved.

Dr. Johnson believes that first and foremost, hospitalists need to be exposed to the data on health care disparities. “The next step is asking what we as hospitalists, or any other specialty, can do to intervene and improve in those areas,” he said. Focusing on unconscious bias training is important, he said, so clinicians can see what biases they might be bringing into the hospital and to the bedside. Maintaining a diverse workforce and bringing UIM physicians into leadership roles to encourage diversity of ideas and approaches are also critical to promoting equity, he said.

“You cannot fix what you cannot face,” said Dr. Unaka. Education on how racism impacts patients and colleagues is essential, she believes, as is advocacy for changing inequitable health system policies. She recommends expanding social and professional circles. “Diverse social groups allow us to consider the perspectives of others; diverse professional groups allow us to ask better research questions and practice better medicine.”

Start by developing the ability to question personal assumptions and pinpoint implicit biases, suggested Dr. Baenziger. “Asking for feedback can be scary and difficult, but we should take a deep breath and do it anyway,” she said. “Simply ask your team, ‘I’ve been thinking a lot about racial equity and disparities. How can I do better at my interactions with people of color? What are my blind spots?’” Dr. Baenziger said that “to help us remember how beautifully complicated and diverse people are,” all health care professionals need to watch Nigerian novelist Chimamanda Ngozi Adichie’s TED talk “The Danger of a Single Story.”

Dr. Baenziger also stressed the importance of conversations about “places where race is built into our clinical assessments, like eGFR,” as well as being aware that many of the research studies that are used to support everyday clinical decisions didn’t include people of color. She also encouraged clinicians to consider how and when they include race in their notes.7 “Is it really helpful to make sure people know right away that you are treating a ‘46-year-old Hispanic male’ or can the fact that he is Hispanic be saved for the social history section with other important details of his life such as being a father, veteran, and mechanic?” she asked.

“Racism is real and very much a part of our history. We can no longer be in denial regarding the racism that exists in medicine and the impact it has on our patients,” Dr. Unaka said. “As a profession, we cannot hide behind our espoused core values. We must live up to them.”

References

1. Lucey CR, Saguil, A. The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue. Acad Med. 2020 Mar;95(3):351-356. doi: 10.1097/ACM.0000000000002939.

2. Flores L. Increasing racial diversity in hospital medicine’s leadership ranks. The Hospitalist. 2020 Oct 21.

3. Smedley BD, et al, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Washington: National Academies Press; 2003.

4. Heins A, et al. Physician Race/Ethnicity Predicts Successful Emergency Department Analgesia. J Pain. 2010 July;11(7):692-697. doi: 10.1016/j.jpain.2009.10.017.

5. U.S. Department of Health and Human Serves, Office of Minority Health. Infant Mortality and African Americans. 2019 Nov 8. minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23.

6. Jacobs ZG, et al. The Association between Limited English Proficiency and Sepsis Mortality. J Hosp Med. 2020;3;140-146. Published Online First 2019 Nov 20. doi:10.12788/jhm.3334.

7. Finucane TE. Mention of a Patient’s “Race” in Clinical Presentations. Virtual Mentor. 2014;16(6):423-427. doi: 10.1001/virtualmentor.2014.16.6.ecas1-1406.

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