Racial bias in medicine is frightening.

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"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.
that is definitely a false statement. As a black patient, every one always tries to give me NSAIDs.

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I’m not as sure how to productively work on unconscious bias except to be thorough and systematic, work with a hopefully diverse team, and ask myself would I make any different decision if some characteristic of this patient were different. If I’m deviating from my standard approach to a problem is it for good reason.

I think things like implicit bias testing and education about healthcare disparities raise awareness of the potential for problems but don’t really offer a solution. Feedback on my personal performance and practice could be helpful - like if I personally am offering less evidence based treatment for the pain level in a particular condition, or am intervening less aggressively on risk factors or chronic conditions for my black patients vs my white patients, I would definitely want to know so I can adjust my practice but the mechanism isn’t in place. Our county hospital is working on providing this individual level feedback re disparities in care or outcome last I heard. Since it’s probably an aggregation of small decisions that might be unconsciously biased, rather than explicit intentional neglect or hostility except in outlier cases, that leads to disparate outcomes for people with the same access and SES, I think that’s what it would take for meaningful change.
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