Racial bias in medicine is frightening.

[wut?]

Excerpts from The Washington Post article titled, "The disturbing reason some African American patients may be undertreated for pain" by Sandhya Somashekhar

"African Americans are routinely under-treated for their pain compared with whites, according to research."

"Researchers at the University of Virginia quizzed white medical students and residents to see how many believed inaccurate and at times "fantastical" differences about the two races -- for example, that blacks have less sensitive nerve endings than whites or that black people's blood coagulates more quickly. They found that fully half thought at least one of the false statements presented was possibly, probably or definitely true."
" those who held false beliefs often rated black patients' pain as lower than that of white patients and made less appropriate recommendations about how they should be treated."

"A 2000 study out of Emory University found that at a hospital emergency department in Atlanta, 74 percent of white patients with bone fractures received painkillers compared with 50 percent of black patients. Similarly, a paper last year found that black children with appendicitis were less likely to receive pain medication than their white counterparts."

Having these kinds of beliefs has real implications on patients and the care they receive. What is being done to combat this? This stuff is really sad.

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[966212]

As a URM AA, not much will be done. This is America. I've learned to deal with it. Still fighting for more than 2 AA's students in a medical school class. Most kids on here complain at the few URM's that are in a class and most medical schools don't care. One way to help this is to get recruit more minority physicians but that simply won't happen because most schools don't care.

 

[OchemOficionado]

Probably nothing, but as a Black person, I may be jaded by the history of this country.

I’ve been asking for a while what’s being done about the amazingly high rate of birth complications and death rates related to the pregnancies and birth experiences of Black women in the country, and I still don’t know.

 

[wut?]

Probably nothing, but as a Black person, I may be jaded by the history of this country.

I’ve been asking for a while what’s being done about the amazingly high rate of birth complications and death rates related to the pregnancies and birth experiences of Black women in the country, and I still don’t know.

This is what prompted me to look more into this. It's shocking that Black women of all social classes are more likely to die from birth related complications than white women with only a high school education.

 

[wut?]

As a URM AA, not much will be done. This is America. I've learned to deal with it. Still fighting for more than 2 AA's students in a medical school class. Most kids on here complain at the few URM's that are in a class and most medical schools don't care. One way to help this is to get recruit more minority physicians but that simply won't happen because most schools don't care.

It kind of seems like health disparities are taught only to check one more thing off the list, and not as something that has real implications if not addressed properly.

 

[OchemOficionado]

This is what prompted me to look more into this. It's shocking that Black women of all social classes are more likely to die from birth related complications that white women with only a high school education.

I’m not shocked at all. Makes sense . . . considering.

 

[dr_kateb]

"First, it is possible that patients declined analgesia despite having pain, and this phenomenon could be different between races."

Until this is addressed everyone can stop race-baiting.

 

[OchemOficionado]

"First, it is possible that patients declined analgesia despite having pain, and this phenomenon could be different between races."

Until this is addressed everyone can stop race-baiting.

Lol, can’t even mention race without being accused of something.

While what you quoted is possible, it’s also true that bias absolutely plays a role in some physicians not believing black patients and/or under prescribing them.

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

 

[Future_Bone_Docta]

As a URM AA, not much will be done. This is America. I've learned to deal with it. Still fighting for more than 2 AA's students in a medical school class. Most kids on here complain at the few URM's that are in a class and most medical schools don't care. One way to help this is to get recruit more minority physicians but that simply won't happen because most schools don't care.

MD School admissions stats from AAMC website:

Average GPA for AA to matriculate into medical school= 3.51
Average MCAT for AA to matriculate into medical school= 505 (67th percentile)

Average GPA for Asian to matriculate into medical school= 3.75
Average MCAT for Asian to matriculate into medical school= 513 (89th percentile)

To say "most medical schools Don't care" is a flat out lie. Clearly efforts are being made to bring URM applicants to matriculation into medical schools. The stats Don't Lie.

 

[deleted480308]

As a URM AA, not much will be done. This is America. I've learned to deal with it. Still fighting for more than 2 AA's students in a medical school class.

Plenty of schools with more than two, and the qualified AA applicants largely get in just fine

Most kids on here complain at the few URM's that are in a class

no, there hasn't been any amount of people complaining about too many AA students

and most medical schools don't care. One way to help this is to get recruit more minority physicians but that simply won't happen because most schools don't care.

again no. School really do try to court and recruit urm students overwhelmingly to the point that if they aren't good enough at it (despite whatever they try) their accreditation is at risk

 

[dr_kateb]

Lol, can’t even mention race without being accused of something.

While what you quoted is possible, it’s also true that bias absolutely plays a role in some physicians not believing black patients and/or under prescribing them.

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

There are biological differences between races. The problem is telling which are false and which are true which schools should do a better job of teaching.

 

[OchemOficionado]

There are biological differences between races. The problem is telling which are false and which are true which schools should do a better job of teaching.

Not the type of biological differences that are pertinent to this topic thought. One example was someone saying Black people have thicker skin and therefore we can handle more pain than a white person.

It would be cool if Med schools added something in their curriculum to help address this issue, but something also has to be done to help reshape the practices of some that already physicians.

 

[OchemOficionado]

To say "most medical schools Don't care" is a flat out lie. Clearly efforts are being made to bring URM applicants to matriculation into medical schools. The stats Don't Lie.

I agree that plenty of schools definitely seem like they are trying. Most schools don’t have more than a handful of Black students per class, so I also see the other commenter’s point. That and the fact that the number of black physicians in the US has only increased by 3% in the last 55ish years. Most likely due to HBCUs is my guess, but I could be wrong.

 

[Future_Bone_Docta]

I agree that plenty of schools definitely seem like they are trying. Most schools don’t have more than a handful of Black students per class, so I also see the other commenter’s point. That and the fact that the number of black physicians in the US has only increased by 3% in the last 55ish years. Most likely due to HBCUs is my guess, but I could be wrong.

I understand where you are coming from. Black students are very under-represented in medicine and it is a problem. But I would address that problem more due to lack of qualified applicants, AS WELL AS lack of total applicants. I would hardly say you can throw that blame on the institution. When push comes to shove we are talking about medical school, and shaping future doctors. It is hard to get into for a reason. You are given the responsibility of saving lives. So keeping high qualifications on matriculation is important.

 

[OchemOficionado]

I understand where you are coming from. Black students are very under-represented in medicine and it is a problem. But I would address that problem more due to lack of qualified applicants, AS WELL AS lack of total applicants. I would hardly say you can throw that blame on the institution. When push comes to shove we are talking about medical school, and shaping future doctors. It is hard to get into for a reason. You are given the responsibility of saving lives. So keeping high qualifications on matriculation is important.

Wasn’t trying to blame. In fact, I said a lot of schools definitely seem to be trying. Not going to get into a URM qualification debate, we’ve all seen enough of those, so my apologies for not addressing the rest of your comment.

 

[Future_Bone_Docta]

Really?

Explain why URMs are still under-presented in medicine?

read the above post

 

[Future_Bone_Docta]

Wasn’t trying to blame. In fact, I said a lot of school are definitely trying. Not going to get into a URM qualification debate, we’ve all seen enough of those, so my apologies for not addressing the rest of your comment.

I am 100% with you on that one, I was trying to avoid that too hahaha.

 

[wut?]

I am 100% with you on that one, I was trying to avoid that too hahaha.

But the point of this thread wasn't to talk about URM qualifications for med school. It's about the very real racial bias that occurs when treating black patients. Knowing about this can make you a better doctor instead of deflecting.

 

[Future_Bone_Docta]

But the point of this thread wasn't to talk about URM qualifications for med school. It's about the very real racial bias that occurs when treating black patients. Knowing about this can make you a better doctor instead of deflecting.

Yeah I know. Applicants/matriculants were brought up in the next comment below the real purpose for some reason. I was addressing that comment.

 

[wut?]

Yeah I know. Applicants/matriculants were brought up in the next comment below the real purpose for some reason. I was addressing that comment.

Sorry, I thought you were the person who tried to deflect by talking about biological differences/race baiting

 

[966212]

Yeah I know. Applicants/matriculants were brought up in the next comment below the real purpose for some reason. I was addressing that comment.

that "some" reason was too suggests a potential solution to the bias. Producing more physicians from these backgrounds can help mitigate these bias Tyler59.

 

[Future_Bone_Docta]

that "some" reason was too suggests a potential solution to the bias. Producing more physicians from these backgrounds can help mitigate these bias Tyler59.

This is getting a little bit too opinion- based for me, I am pursuing medicine.... not politics. I need facts an statistical evidence..not an opinionated, emotional debate. So like stated above, I am going to avoid the URM qualification debate.

 

[Goro]

Not the type of biological differences that are pertinent to this topic thought. One example was someone saying Black people have thicker skin and therefore we can handle more pain than a white person.

It would be cool if Med schools added something in their curriculum to help address this issue, but something also has to be done to help reshape the practices of some that already physicians.

One of the things my school is doing is to educate students on implicit bias. You'd be surprised at how many kids from diverse, far left, sunny CA will pick out the black person among a field of six random faces when asked "which of these patients do you think is the heroin addict". On this particular exercise, it was actually the Caucasian 60 year old woman.

 

[OchemOficionado]

One of the things my school is doing is to educate students on implicit bias. You'd be surprised at how many kids from diverse, far left, sunny CA will pick out the black person among a field of six random faces when asked "which of these patients do you think is the heroin addict". On this particular exercise, it was actually the Caucasian 60 year old woman.

Wooow. Not surprising though. Have you seen the doll experiment? Even when it’s done with Black preschoolers they choose the darkest skin doll when asked which is bad, or ugly. We all have implicit biases, and when several agents of socialization tell a black kid that they aren’t desirable/worthy, even they will have biases against themselves.

I mentioned the health disparities Black women experience during pregnancy/birth earlier. You’d think the stats would be different if they had a Black doctor, (and I haven’t seen any stats on this), but from what I gather they probably aren’t.

All that to say it isn’t just a white/black problem, it’s a problem period.

 

[skeptastic]

Wooow. Not surprising though. Have you seen the doll experiment? Even when it’s done with Black preschoolers they choose the darkest skin doll when asked which is bad, or ugly. We all have implicit biases, and when several agents of socialization tell a black kid that they aren’t desirable/worthy, even they will have biases against themselves.

I mentioned the health disparities Black women experience during pregnancy/birth earlier. You’d think the stats would be different if they had a Black doctor, (and I haven’t seen any stats on this), but from what I gather they probably aren’t.

All that to say it isn’t just a white/black problem, it’s a problem period.

I seriously wish that the Minority Studies course I recently took was a requirement at every school, as a core course. Even for someone like myself, who prides himself on being socially conscious, a lot of what I learned was eye-opening. Implicit bias is a terrible and real issue in American society. Socialization has certainly done a number on us all. The doll experiment broke my heart way back in undergrad (psych major). I also think it's really, really important that we all become more aware of the difference between implicit bias and racism. Many of us mistakenly view someone who holds bias as racist, when they've often just been socialized to uphold common stereotypes and are more prejudiced than racist.

 

[deleted480308]

Wooow. Not surprising though. Have you seen the doll experiment? Even when it’s done with Black preschoolers they choose the darkest skin doll when asked which is bad, or ugly. We all have implicit biases, and when several agents of socialization tell a black kid that they aren’t desirable/worthy, even they will have biases against themselves.

I mentioned the health disparities Black women experience during pregnancy/birth earlier. You’d think the stats would be different if they had a Black doctor, (and I haven’t seen any stats on this), but from what I gather they probably aren’t.

All that to say it isn’t just a white/black problem, it’s a problem period.

It’s far more likely to be related to insurance rates and who can afford private docs vs county health depts

 

[dr_kateb]

I seriously wish that the Minority Studies course I recently took was a requirement at every school, as a core course.

What a terrible thing to wish on people.

 

[OchemOficionado]

It’s far more likely to be related to insurance rates and who can afford private docs vs county health depts

Nope. It crosses socioeconomic classes.

 

[deleted480308]

Nope. It crosses socioeconomic classes.

Link?

 

[OchemOficionado]

Link?

“ Nothing Protects Black Women From Dying in Pregnancy and Childbirth
Not education. Not income. Not even being an expert on racial disparities in health care.”

https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth

“CONCLUSION:  In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.”

Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007-2014. - PubMed - NCBI

 

[deleted480308]

“ Nothing Protects Black Women From Dying in Pregnancy and Childbirth
Not education. Not income. Not even being an expert on racial disparities in health care.”

https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth

“CONCLUSION:  In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.”

Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007-2014. - PubMed - NCBI

1. For real, your font size is ridiculous
2. it's a tragic story but nothing about that storyline seems to be racial discrimination by the health care system. It was a real miss on an already very complicated patient.
3. I can't see the full text of the study you are linking, does it show unequal outcomes or does it show actual racial discrimination?

 

[OchemOficionado]

1. For real, your font size is ridiculous
2. it's a tragic story but nothing about that storyline seems to be racial discrimination by the health care system. It was a real miss on an already very complicated patient.
3. I can't see the full text of the study you are linking, does it show unequal outcomes or does it show actual racial discrimination?

Lol, I copy and pasted it using my phone and that’s how the final post came out. I promise, if wasn’t that big at first. LMAOOOO.

Look, I just posted two examples since you asked for a link. (I’ve seen someone tell you to google it in response to you asking for a link before and it wasn’t pretty.) The information is out there and I’ve provided a starting point. You’ll have to research the subject more if you’re actually interested. I don’t want to enter a cycle of me feeling that you’re just out to prove the opposite of whatever I post, and me responding.

 

[wut?]

What a terrible thing to wish on people.

Do you have anything of substance to add to the conversation or are you just hellbent on proving that health disparities in medicine (specifically toward black Americans) doesn't exist despite tons of information/studies on it already out there?

 

[wut?]

1. For real, your font size is ridiculous
2. it's a tragic story but nothing about that storyline seems to be racial discrimination by the health care system. It was a real miss on an already very complicated patient.
3. I can't see the full text of the study you are linking, does it show unequal outcomes or does it show actual racial discrimination?

I think the point of the articles is that implicit bias towards African American women and not outright racial discrimination is at play here.

Quotes:
"Those problems are amplified by unconscious biases that are embedded throughout the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme"

"Black expectant and new mothers frequently told us that doctors and nurses didn’t take their pain seriously — a phenomenon borne out by numerous studiesthat show pain is often undertreated in black patients for conditions from appendicitis to cancer. "

 

[dr_kateb]

Do you have anything of substance to add to the conversation or are you just hellbent on proving that health disparities in medicine (specifically toward black Americans) doesn't exist despite tons of information/studies on it already out there?

None of the studies definitively prove systemic and explicit racism.

Implicit bias is real, but so is the human capacity for self-pity.

 

[966212]

Sigh. These guys will be your future co-workers lol.

 

[wut?]

None of the studies definitively prove systemic and explicit racism.

Implicit bias is real, but so is the human capacity for self-pity.

To argue with you would mean going in depth about the history of racism in this country and how racism doesn't go way, but changes its form from explicit ( think Jim Crow) to not explicit (see above studies mentioned) but I don't believe you have the capacity to have that conversation. And mentioning "the human capacity for self pity" when health disparities is a real thing in medicine shows your lack of empathy and prejudices.

 

[OchemOficionado]

None of the studies definitively prove systemic and explicit racism.

Implicit bias is real, but so is the human capacity for self-pity.

I'm not sure that the point of this thread was to prove that. . . or to prove anything really. I think the point was more of, it is clear these issues exist for Black people being treated in the US. What is being done about it?

Instead, some people have decided to focus on debating whether bias/racism exists in medicine. Regardless of what we call it it's happening and it is specifically linked to race.

 

[dr_kateb]

Sigh. These guys will be your future co-workers lol.

I could say the same.

 

[OchemOficionado]

Sigh. These guys will be your future co-workers lol.

They already are! Haha. They are our co-workers, bosses, politicians, peace officers, teachers, doctors, receptionists, farmers, mail men, etc. We're used to it, just hoping for better in the future.

 

[deleted480308]

I'm not sure that the point of this thread was to prove that. . . or to prove anything really. I think the point was more of, it is clear these issues exist for Black people being treated in the US. What is being done about it?

Instead, some people have decided to focus on debating whether bias/racism exists in medicine. Regardless of what we call it it's happening and it is specifically linked to race.

But what do you want done about differences in outcomes by race that aren’t happening because of racial discrimination by the health system?

 

[OchemOficionado]

But what do you want done about differences in outcomes by race that aren’t happening because of racial discrimination by the health system?

Again, the post wasn’t about the exact causes of these health disparities, as there are several, but what medical/health professionals are currently doing to combat this known issue.

I’m not an expert in public health, so I defer to them when it comes to finding solutions to health disparities, regardless of cause.

 

[deleted480308]

Again, the post wasn’t about the exact causes of these health disparities, as there are several, but what medical/health professionals are currently doing to combat this known issue.

I’m not an expert in public health, so I defer to them when it comes to finding solutions to health disparities, regardless of cause.

But that sort of post has the problem of implying that racism is the reason and that if somehow, someone was less racist the disparity would dissappear. That’s medically inaccurate

I think there couls really be something to the pain treatment and I think that’s worth following with better studies but you are throwing a real wide net without statistical justification

 

[OchemOficionado]

But that sort of post has the problem of implying that racism is the reason and that if somehow, someone was less racist the disparity would dissappear. That’s medically inaccurate

I think there couls really be something to the pain treatment and I think that’s worth following with better studies but you are throwing a real wide net without statistical justification

I didn’t get that implication from the post. I said myself that there are several different causes to the health disparities being discussed. Someone treating minority patients becoming less racist certainly wouldn’t hurt the patient’s outcome, that’s for sure.

The stats are there about Black women and ob/gyn are out there, dude. I don’t think there would ever be enough evidence to convince you though. We can let it go.

 

[deleted480308]

I didn’t get that implication from the post. I said myself that there are several different causes to the health disparities being discussed. Someone treating minority patients becoming less racist certainly wouldn’t hurt the patient’s outcome, that’s for sure.

The stats are there about Black women and ob/gyn are out there, dude. I don’t think there would ever be enough evidence to convince you though. We can let it go.

I’m not at all arguing there aren’t differences in outcomes. I’m saying it hasn’t been proven they are treated differently. I’m all for researching, and correcting bad actors when we find them

 

[966212]

I didn’t get that implication from the post. I said myself that there are several different causes to the health disparities being discussed. Someone treating minority patients becoming less racist certainly wouldn’t hurt the patient’s outcome, that’s for sure.

The stats are there about Black women and ob/gyn are out there, dude. I don’t think there would ever be enough evidence to convince you though. We can let it go.

Lol just give up man. These guys are stuck in their ways.

 

[Crayola227]

This is getting a little bit too opinion- based for me, I am pursuing medicine.... not politics. I need facts an statistical evidence..not an opinionated, emotional debate. So like stated above, I am going to avoid the URM qualification debate.

There is absolutely data supporting that for some minorities having a physician of their same minority has positive effects on treatment and outcomes. Not saying that we should only have white docs for white patients or any other thing like that. Just saying, it is not just a matter of politics and no evidence relevant to actual medical practice.

Also, there are studies that actually suggest benefits to colleagues NOT of the same minority in having physicians of a different minority in their workplace.

The effect is measurable. I'll not get into where the conclusion/discussion bit on these studies considers why these effects exist, just that they do. Personally I would not be surprised if it does relate to the biases discussed in this thread.

Also, politics affects our practice, so while some may choose not to engage in politics, it's not completely avoidable entirely. There are plenty of schools and residency programs that will ask you to comment on political issues that directly impact our care. Because at minimum you need to understand how politics impacts your practice. Others may decide that part of their ethical duty to improve care (which we all should strive to continue to improve care) through politics. So while I wouldn't say everyone needs to do this, acting like it's not a legitimate part of medical practice... is a very narrow view.

We are discussing very real biases that affect the care of our patients, some of whom are at the lower end of various serious disparities (HTN managment, stroke, MIs, teen pregnancy, STDs, infant mortality, on and on). Without getting into qualifications, it's completely on point to discuss if increasing the representation of certain minorities in the physician workforce might be one avenue for addressing these issues.

 

[Future_Bone_Docta]

There is absolutely data supporting that for some minorities having a physician of their same minority has positive effects on treatment and outcomes. Not saying that we should only have white docs for white patients or any other thing like that. Just saying, it is not just a matter of politics and no evidence relevant to actual medical practice.

Also, there are studies that actually suggest benefits to colleagues NOT of the same minority in having physicians of a different minority in their workplace.

The effect is measurable. I'll not get into where the conclusion/discussion bit on these studies considers why these effects exist, just that they do. Personally I would not be surprised if it does relate to the biases discussed in this thread.

Also, politics affects our practice, so while some may choose not to engage in politics, it's not completely avoidable entirely. There are plenty of schools and residency programs that will ask you to comment on political issues that directly impact our care. Because at minimum you need to understand how politics impacts your practice. Others may decide that part of their ethical duty to improve care (which we all should strive to continue to improve care) through politics. So while I wouldn't say everyone needs to do this, acting like it's not a legitimate part of medical practice... is a very narrow view.

We are discussing very real biases that affect the care of our patients, some of whom are at the lower end of various serious disparities (HTN managment, stroke, MIs, teen pregnancy, STDs, infant mortality, on and on). Without getting into qualifications, it's completely on point to discuss if increasing the representation of certain minorities in the physician workforce might be one avenue for addressing these issues.

Do you have any links or resources with data? Not trying to be an a-hole, I am actually genuinely interested!

 

[Goro]

On page two are sources as to why diversity in Medicine is a good thing:
https://www.aamc.org/download/493340/data/lsl2018validity.pdf

One conclusion I draw from the later pages is that if we want to recruit more URM students with good stats, we have to make them aware of the resources available, at least for MCAT study.

 

[libertyyne]

On page two are sources as to why diversity in Medicine is a good thing:
https://www.aamc.org/download/493340/data/lsl2018validity.pdf

One conclusion I draw from the later pages is that if we want to recruit more URM students with good stats, we have to make them aware of the resources available, at least for MCAT study.

The problem is the pipeline. AA's are less likely compared to the national average to complete a Bachelors degree, this starts from High school, middle school and even possibly before.

Asking medical schools to undue all of society's educational disparities is huge ask. But they do go out of their way to recruit qualified candidates.