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Racism in Medicine

(Image Source: @bill_oxford)

by Briana Livelsberger

(Note: I recognize that this article does not fully capture racism within medicine as it is both written from an outsider’s perspective and brief. I include additional sources that help show how much racism affects the medical field.)


These past few weeks have brought to light what many Americans have ignored or been unaware of: the racism and brutality that Black individuals face within our police force. However, a common statement made by many whites has been making its  rounds on social media and in the news, “A few bad apples.” This phrase disregards the fact that the way our police system works allows for many cops to be racist and cruel. It isn’t just a “few bad cops.”

Racism is rampant in many of our country’s institutions such as the police, government, education, work, etc. But one place that racism lives that may not be talked about is within our medical system.

Generally, our medical system is difficult to navigate. Women usually aren’t taken as seriously as men, the chronically ill as the healthy, and the LGBTQ+ as the straight and cisgendered. But one of the biggest disparities is between those who are Black and those who are white. While there are many doctors, nurses, and hospitals with blatantly racist attitudes, implicit bias causes problems that are harder to fix.


Implicit Bias

Implicit bias is defined by the Kirwan Institute for the Study of Race and Ethnicity as “the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.” Since implicit bias affects us without being fully aware, it can be difficult for us to realize that we have biases and the impact they have on our decisions or actions towards others.

According to research, it’s been found that, “even when access-to-care barriers such as insurance and family income were controlled for, racial and ethnic minorities received worse health care than nonminorities, and that both explicit and implicit bias played potential roles” (APA). With these biases at play, physicians either knowingly or unknowingly act according to what they consider to be true. Often, these judgments are based on stereotypes that have existed for decades.

Research by Lisa A. Cooper also found that physicians that ranked high in implicit bias more often lead conversations with black patients, causing patients to trust these physicians less (APA). In response to a lack of support from doctors, patients “had more difficulty remembering what their physicians told them, had less confidence in their treatment plans, and thought it would be more difficult to follow recommended treatments” (APA). Patients learn to distrust doctors and have less confidence in their suggestions, causing doctors to become frustrated if they don’t realize that it was their behavior that started it all.

For example, a physician goes to see a patient. If the patient is Black, the physician may end up talking more and spending less time with the patient. The physician may not recommend as many treatment options or talk extensively about treatment options as they might when seeing a white patient. In turn, the patient sees that the physician is not letting them speak much, not taking time to focus on them, and not suggesting treatments in a way that makes them feel like the treatments are doable. As a result, it becomes difficult for the patient to follow with the suggested treatment.

 

Racial Disparities in Disease and Treatments

A meta-analysis, “found that black/African American patients were 22% less likely than white patients to receive any pain medication” (AAMC). In this analysis, it was also found that the disparity was greatest when treating backache, migraine, and abdominal pain (AAMC). Black patients also don’t get effective pain treatment when recovering from surgeries or giving birth. Often, this happens because it is thought that Black individuals have a higher pain tolerance or don’t feel pain, making pain treatment seem unnecessary. It is also thought that Black individuals are drug addicts, making medications such as opioids unavailable to them, regardless of whether they are drug addicts or not.

Many health conditions also affect Black Americans more than white Americans. According to the CDC, around 56% of Black women over 20 are obese. For white women, around 39% are obese. Around 44% of Black women have hypertension while only 34% of white women do. About 13.8% of Black Americans are in fair or poor health in comparison to the 9.5% of white Americans in fair or poor health.

Why? Because Black Americans don’t have the same access to healthcare as other groups do. There isn’t always enough money to see physicians as often as needed or to afford treatments. This in combination with the inability to be taken seriously by physicians makes getting the proper treatments and care difficult.

These disparities, however, are further highlighted by how the coronavirus has been affecting Black Americans.

 

COVID19

According to the APM Research Lab, Black Americans are dying, “above their population share in 30 states and most dramatically, in Washington, D.C.” In my state, more Black Americans have died than anyone else according to APM’s tracker. Black Americans are less likely to receive treatment or testing for COVID19, making them more likely to die from the virus.

 

Racist Algorithms

Another cause for the racial disparity in treatment is the fact that algorithms that hospitals use to determine who gets into what healthcare program have a bias against Black Americans too. These biases occur because of assumptions the algorithm makes, such as health expenses. As a result, many Black Americans are classed as not having many health problems because of low health expenses, even though it was shown later on that this was not true (Ledford, Nature). Rather, the low health expenses came from not being able to afford to see doctors as often as the health conditions usually require for proper management.

 

What Can be Done

Many researchers studying racism and implicit bias have been trying different strategies to help lower the effects of implicit bias within the field of medicine. Some studies found that finding ways for physicians to see the patient as an individual rather than a person belonging to a group helps decrease implicit bias. Some studies show that one can lower implicit bias by having medical students work closely with Black patients and with doctors who don’t behave discriminatorily towards them. However, one thing that has been shown to not be effective is to just talk about how implicit bias is a problem during standard sensitivity training.


Final Thoughts

With all of this information about the increased health risks and mortality rates, how can it be that there are just “a few bad apples?” Racism is pervasive throughout every facet of what makes America run.

Our healthcare system needs to change. From how we treat each other, to being able to access care, we need to make the medical field more welcoming and supportive for those in the Black community. Because, as long as one group of people is unable to get the care they need, how can we say that our country has good healthcare?


Sources:

https://www.aamc.org/news-insights/how-we-fail-black-patients-pain

https://www.apa.org/monitor/2019/03/ce-corner

http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/

https://www.cdc.gov/nchs/fastats/black-health.htm

https://www.cdc.gov/nchs/fastats/white-health.htm

https://www.apmresearchlab.org/covid/deaths-by-race

https://www.nature.com/articles/d41586-019-03228-6


Additional Reading:

https://www.ncbi.nlm.nih.gov/books/NBK220347/

https://www.medicaleconomics.com/news/how-implicit-bias-harms-patient-care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638275/

https://www.washingtonpost.com/outlook/2020/05/18/most-medical-professionals-arent-racist-but-our-medical-system-is/

https://www.nytimes.com/2020/01/13/upshot/race-and-medicine-the-harm-that-comes-from-mistrust.html

https://www.apa.org/monitor/2019/03/ce-corner

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