By Rahil Modi Rahil (he/him) is a second year Computational and Systems Biology major. He's originally from Minneapolis, MN and is passionate about the intersection between medicine, technology, and public health/policy and how it can be leveraged to make healthcare more advanced and accessible to all. In his free time, he likes spending time with friends and family, obsessing over his fantasy football lineup, and learning how to improve his golf game. "Here I was being told that I'm too dark". Morgan, a 27 year old black woman, was told by a doctor to try skin lightening creams after developing dry skin and breakouts from moving from Massachusetts to California. In an interview with Healthline, she mentioned that she was shocked; she had the notion that Californians are “really open, liberal, and progressive”, but she still experienced overt racism in a healthcare setting.
Monique Tello, a practicing physician at Massachusetts general hospital, recounted that one of her patients, who was a black woman that had a painful medical condition, got turned away by emergency room staff because they felt that she was trying to get free pain meds. The patient got appropriate care at another location, but she felt that--because she was black--she was treated poorly by the first healthcare center she went to. Unfortunately, these experiences are common in patients of color, especially black patients. These attitudes towards patients of color have dire consequences across all areas of healthcare. According to a 2018 study, African Americans are statistically less likely than their Caucasian counterparts to receive primary care from a cardiologist when admitted to the ICU. Frontiers in Pediatrics, a leading pediatrics research journal, found that from 2005 to 2016, black and Hispanic children experienced significantly longer wait times than white children and were 28% and 3% less likely, respectively, to be admitted to the hospital following an Emergency Department visit. Additionally, University of Virginia professor Sophie Trawalter explains that black patients are significantly less likely to be prescribed pain medication and that they generally receive lower doses than their white counterparts when they are. With the litany of racial issues in the healthcare system, it becomes important to consider what causes these inequities and what can be done to rectify them. Despite healthcare workers’ best intentions, they neither recognize their implicit biases towards patients of color nor do they understand the impacts that their bias can have on their patients’ health outcomes. Implicit bias, the unconscious attribution of particular qualities to a member of a social group or class of people, is really difficult to recognize and combat since it’s unconscious, and in today’s polarized society, people, including healthcare workers, are usually defensive when getting called out for perpetuating racism. But this defensiveness both prevents improvement in the quality of patient care and leads to harmful consequences. A 2007 study showed that physicians implicitly preferred white patients over black patients, despite self-reporting that they treated them the same. The study adds that some of the bias resulted from an implicit stereotype that black people were less cooperative with medical procedures. Such a stereotype has a cyclical effect. If a physician believes that a patient is less likely to cooperate with their suggested method of treatment, the physician is not likely to prescribe them treatment, which then feeds into the patient’s distrust of the healthcare system when they deal with negative health outcomes. It’s clear that physicians’ implicit bias against patients of color has effectively segregated health outcomes based on race. It is also important to understand the systems in place that allow for such outcomes to occur over time. During the antebellum period, physicians attributed slaves’ poor health to their supposed biological inferiority rather than to their poor living conditions as slaves. These mindsets still persist today. A 2016 study showed that half of a sample of white medical students and residents believed that black patients had a higher pain tolerance than their white counterparts by virtue of their "biological differences". Additionally, when clinical trials yielded results that varied by race, some researchers propose genetic differences between races, despite no supporting evidence. According to the American Medical Association (AMA), race serves as a “stand-in” for unmeasured social and biological factors. Given that diagnoses and treatments are given with a consideration to race, it demonstrates the lack of robustness in the healthcare system. The amount of racial inequities within the healthcare system is overwhelming, and it begs the question: where can we start? First and foremost would be to center the marginalized groups in conversations regarding education, policy, and innovation. Former governor of Minnesota Mark Dayton said that Philando Castile's death was "not the norm" in Minnesota, demonstrating a lack of understanding of the difference in the “normal” for black and white Minnesotans. In order to understand marginalized perspectives in healthcare, there needs to be greater representation of these groups in healthcare, especially in leadership positions. There, they will be able to share their perspectives, potentially changing medical school curriculum that reflects a more holistic view of their experiences. Additionally, medical algorithms that use race as a proxy for unmeasured social and biological factors need to be changed; race is a mere oversimplification that leads to disparate health outcomes for marginalized groups. One innovation is measuring the “unmeasured” variables that race serves as a proxy for. For example, a metric that measures various social determinants of health, such as access to nutritious food, clean water, education, economic stability, and more, can be designed and implemented in diagnostic algorithms. Lastly, and perhaps most importantly, there needs to be more transparency in the diagnosis process. Physicians need to work with their patients to understand their social circumstances and need to be transparent with the diagnosis process so that patients are more likely to cooperate and are more comfortable in a clinical setting. The Hippocratic oath, recited by many medical students at their graduation, includes a promise to keep the sick “from harm and injustice”. Unfortunately, it seems as though injustice is a common theme in the American healthcare system. Given the disparate health outcomes for patients of color compared to their white counterparts due to the individual implicit bias of physicians and the systemic bias of American healthcare, it becomes imperative that solutions for these problems are implemented quickly and effectively. A good first step would be to change the “normal” by centering the marginalized in leadership positions and to understand their perspectives.
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