Medical Training Can Reinforce Racial Bias
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- เผยแพร่เมื่อ 20 ก.ย. 2022
- Racial disparities are rampant in healthcare. In addition to structural inequalities, the issues are partly due to racial bias among healthcare workers. These biases stem, in part, from the way race is presented in medical curricula.
For a deeper dive on this topic, visit Dr. Andrea T. Deyrup's website, www.pathologycentral.org
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Those statements from Robbin's Pathology are still in my book 10th edition
Yes, this is an issue that isn't just about race. Mental conditions and neurotypes such as ADHD and schizophrenia are presented in their most acute terms. The pathophysiology text in my nursing class is highly contrasting and doesn't generally focus on the spectrum of these traits. It does talk about gene penetrance for genetic diseases such as Huntington's Disease.
Important video. Very difficult to remember correlation isn't causation. Pattern seeking is deeply ingrained in us all.
Awesome video. Thank you for working for better health outcomes for all.
I had no idea about sickle cell anemia being hereditarily related to malaria prevalence, nor cystic fibrosis to cholera. Are there other diseases like that?
There's a great book called Survival of the Sickest by Dr. Sharon Moalem that you can read to learn all about that. :)
@@mustardsfire22 Thank you for the recommendation! That book looks like a great place to get started.
I believe that in order for healthcare providers and institutions to avoid racial bias, they must first assure that they examine and addressing their own biases and focus on implementing evidence-based practices to ensure equitable care, and promote diversity and inclusion in the healthcare workforce. These even may be unconscious biases that have been engrained in not only the individual’s personal experiences but also from professional training. And as stated previously, this has to apply from the institutional stand point just as much as the individual. It was only in the past few years that standardized lab work in America moved away from incorporating race into assessing GFR (glomerular filtration rate), despite there being little evidence to support this notion in the first place.
My skin was/is ruined due to a gross negligence in kenalog injections on a very minor hypertrophic scar. Dermatologist is white. When I returned to office, my skin was so thin and atrophied, you would see a purplish/red underneath. It looked horrific.The derm's colleague (another older white fellow) looked at me in disgust and treated me in such a way as to imply fault for his colleague's negligence. Sent me on my way without any solutions to help. I have heard that there's a bias towards black skin tones being "tougher" and "thicker". I have very thin skin as a petite woman.
In short, I've been look for surgical help for 2 years to fix what he did to me. I have also gone to therapy to help with the trauma of that experience and have become hyper critical of who treats me. When provided the choice, I choose other brown BIPOC medical professionals. However, this is a difficult task considering how little diversity is in healthcare.
Tough, I hope your future health experience will be better
having worked in admin for a major hospital, I can say we were given a 'racial sensitivity' packet to study to better engage and assist patients (this was mandatory hospital wide reading). It was... frightening. Think of every common stereotype of how certain races act and think and it was there as a severe over-generalization. now it did state not everyone is the same and a kind of 'your mileage may vary' blurb but the majority of it was just a nightmare, making that blurb get lost in the flood of b.s. It is this kind of training that leads to medical staff ignoring or arguing with patients about pain levels and patient needs and issues. i.e. the patient gets ignored.
In college, I had a medical sociology class that was super interesting, but one thing we talked about stuff like this. More specifically how it was helpful to have tools like this to better interact with patients (I think ours was a website to a hospital though) and I was reading through it and it was astounding how poorly done it was. Like yes these are cultural things, but I would guess that for example, most Asian (did not specify which asians) don't expect their doctor to bow to them to show respect in the US (this was in early 2021, but I don't know when the website was made/updated)
This was one of your best. Thank you so much.
see thats how my college instructors presented it. "African Americans have a higher incident of Sickle Cell anemia, because, the trait is beneficial to those at high risk for Malaria." along with the information i've forgotten about where the mutation to the Hemagoblin molecule occurred and what it did to the structure of the protein.
But it's not just african americans who are at higher risk--all populations from areas where malaria is (or was) endemic are at higher risk--not just people of african descent but also people of south asian descent, and some people of southern european and middle eastern descent, depending on which region of southern europe or the middle east their ancestry comes from. In other words, if you're from southern italy, you're at just as high a risk of sickle cell disease as someone from Senegal (in west africa), and at much higher risk than someone whose ancestry is from southern africa, despite you being 'white' and the South African and Senegalese persons being 'black'. This is why it's important to not rely on unscientific concepts like race.
A better predictor of social and health outcomes than race is zip code. Not only does this highlight that environmental factors are what cause a lot of outcomes traditionally attributed to race, it also captures the fact that redlining is still unofficially practiced today. Black home buyers are often not shown homes in white neighborhoods, for example, when they meet with real estate agents.
From a scientific standpoint, it's better to ask where a person lives to be able to predict things like asma, cancer, and legionnaire's disease because those have known environmental causes.
I agree, class over rides race.
@@sct4040 There has been no biological or genetic link to why blacks have higher creatinine level. According to “studies” some Hispanics also have been reported to have higher level of creatinine and muscle mass but how come ONLY African-Americans need a eGFR race adjuster for their kidney testing? African American are NOT homogeneous. “Race” is a social construct and race does not correlate with biological variables. Historically Blacks have always been compared to whites and There has always been a concerted effort to portray blacks as inferior with no scientific facts to support it. “Scientist” also claimed whites are genetically smarter than blacks 😅😂😂😂. That could not be further from the truth. This was just an attempt to denote that blacks are “different” than other races. Therefore further justify the horrors of slavery and their current plight
@@sct4040 Discrimination doesn’t recognize “class” when it comes to minorities in The US. Do some research please. There’s overwhelming data to support that
Before I even finish the video, thank you for making one on this topic 👌🏾
This reminds me of a corollary that I’ve wondered about for a while.
As a trans woman, when I navigate healthcare spaces, I’m often asked for assigned sex. But I’ve been on estrogen for over a year, so I don’t know if I’m actually providing the correct info for what specific medical information they’re using sex as a proxy for.
Likewise, there is a dearth of trans representation in academic research, specifically with regard to reproductive systems.
Yes, that's challenging. I don't imagine there are too many cases of any given disease among trans people, let alone "trans women on estrogen for a year."
3:14 is it really more effective to use percentages rather than say 1 of the 14 mentions of being white, then 1 of the 3 (or perhaps 2 of 6) and 3 of 7, and then obviously 1 of 1 (or 2 of 2). It's clearly a major problem that being white should be mentioned so much AT ALL relative to others, beyond its point in the diagnosis. But dude, the use of percentages on small populations really stands out
I think trust and communication is a big part of good healthcare, and if doctor's were taught how to commincate better and see patients as individuals, the medical treatment would be better, and patients would trust them.
I have heard so many infuriating accounts from many friends about dealing with doctors that didn't know how to treat patients that weren't cis-white-men. For many, this erodes confidence in the medical system as a whole, and I've heard several accounts where friends refuse to go see a doctor because they don't believe it would do any better than alternative (non-evidence-based) remedies. I'm really glad you made this video. These topics deserve more attention.
Great video 👍
I'm curious: I put in a comment thanking you for citing our work and directing people to my website/youtube channel which covers some of this material in greater depth. But my comment seems to have disappeared. Just wondering...
Hi! I think comments with links are often automatically deleted by TH-cam. For anyone that would like to see your work in greater depth, we'd be happy to put a link to your website in our description - we're always grateful to those who do the work we cite! :) -Tiffany
@@healthcaretriage Thank you! How do I get my link to you?
@@PathologyCentral We've put it in the description!
@@healthcaretriage Thank you!!! Appreciate all you do!
Love to see this be brought up more. Even though I knew about the different disparities with race and how conditions are chosen I hadn’t seen these numbers - thanks for sharing!
Stereotypes . . . Years ago, I, a pale-skinned Jewish man, came back from a medical exam in which the doctors had discussed the possibility I had Lupus. I jokingly said to a Black woman in our office that they thought I was a Black woman. She got me back with another stereotype, asking if I wanted to join her in getting some fried chicken and watermelon. How many offensive and ill-informed stereotypes could we have added into our short conversation?
PS Even back then, it was clear that Lupus was also a disease of men and of white folks as well as Black women. But the stereotype persisted. So we made fun of it.
PPS I do not have Lupus but I'm glad my doctors thought it was a possibility.
The military is one of the fields of work that has the most diversity, however the sad truth is tht racial bias in the medical field in the military is huge, i am a hispanic woman in the medical field in the military, and i have seen and experienced providers neglecting patients and ignoring concerns or not properly evaluating the patient due to their racial or ethnical background, its really sad to see specially with women of color, this are the things that make a difference between saving your patients life or not, or just being able to improve their quality of life. Sadly they only teach us one small subtopic under patient care for racial bias in medicine tht we go over for less than a minute during our medical training.
Someone please explain the racial correction in the kidney function formula and why it exists to me like I'm 5.
Thanks in advance.
Ok I don’t know the details but I know in general how things like this can happen and since no one else has replied to your question in over a month I’ll go ahead with my non specific explanation.
In medical studies there is always a lot of information gathered including patient questionnaires. When the analyses are done, if there is a significant factor there, such as the patient’s self described race, then that will often be included as part of the results even if the underlying reason is unknown. It is primitive for sure. More research should be done on if it’s specific DNA sequences that are at a higher prevalence in certain self described populations, or if it’s culturally related somehow of diets or other environmental factors occur at different rates between self described races. But in lieu of knowing what the actual underlying cause is, since self described race presumably has such a large correlation, it gets included.
@@adamstevens5518 Thank you for replying.
I definitely know that racial information, for better or worse, is often collected during medical studies.
What I don't understand is how after running test (blood test, urine test, etc.) and seeing the results they can disregard them because of someone's race.
Because this doesn't seem to be about perceived prevalence of diseases based on race. It's saying that the "normal" range for kidney function varies because of race which seems completely absurd.
Again IDK the details of the study so I’m basically just pulling stuff out of the air based on other things I know, but presumably the population that described themselves as black on average had different underlying laboratory test result. With race being such a crap term, who knows why, could be something in DNA, some diet that occurs at a higher prevalence in the population, could of course just have been random chance but one would hope they studied it well enough so they were confident in it. So they, again hypothesizing here, believe that the typical rates of underlying lab results is different in the population that describes themselves as black, so the lab results they need to see in order to make medical decisions can be different. For example say for a lab test a value of 6.8 is high in the populations that described themselves as white, but in another population 7.0 is high. Then different decisions might be made even for people having the same lab values if they are from different self described populations. Such as the example I have for self described white 6.9 would be a high lab value, but for self described black that is still in the normal range.
Brilliant, concise summary of a phenomenon that has frequently be described to me outside of the professional settings, by those affected by it.
And that very much resonates with my observations from the clinical day-to-day.
Excellent resource to draw on if these topics come up in the future, and to refer colleagues back to.
Thank you Dr. Caroll for you work.
Good stuff. We should talk about 'culture' too. Two apparently similar looking and presenting people can have diverse everything because of their views, family structure, etc.. Shame that such low resolution views of human groupings are still extant. It's almost as if, at every level, people were rushed and had to make due with low resolution views of the world that were just accurate enough to get the job done most of the time. You know, an evolutionary process.
I love that you brought culture into this discussion about racial biases because I agree with you that two people could be the same race but come from very different cultural backgrounds. This can be important in many aspects of medicine, the way we communicate with them, treat them medically, etc. The ethical principle of beneficence teaches us to treat with kindness and charity, and above all do good for others. Being culturally competent physicians is a way we can incorporate this principle in to our work, and many cultures emphasize beneficence over other principles. Some may be hesitant to treat others of another culture purely based on fear of making mistakes. They also may think this requires extra work on their part, but in my opinion its as simple as asking your patients questions about their values and beliefs when it comes to their medical care. This list is by no means all encompassing, but here are some important things that physicians should know to provide culturally diverse healthcare; views of suffering, views of afterlife, common spiritual beliefs, etc. An important of example is some cultures want physicians to disclose all information about serious illnesses, while others may not want you to do so. I encourage the next generation of healthcare providers to put the fear aside and embrace their ethical duties in practicing cross cultural medicine to the best of their abilities.
Or you know you could just stop using licensing tests that reinforce these concepts
Since most medical schools just teach to the test but no Let put it on the students and the teachers instead of the multi billion licensing boards and their testing partners
I never document race in my clinical notes, but I do document where they are from. A Bosnian has very different meatball health risks than a Serb, even though they are of the same anthropological descent and even a similar culture. If you are black from Georgia, Chicago or Nigeria makes a huge difference to health status. I think the key is to realize that everyone has a culture and not every disparity is due racism. In fact, not understanding cultural differences is, IMHO, a much more likely cause, in any racial category.
“Not every disparity is due to racism” no, but I think every disparity should be carefully scrutinized, especially by the people it effects. Obviously you’re right, some diseases are more prevalent in certain regions or in certain populations. But I reeeaaaally hesitate to fully attribute disparities to that until we have hard evidence that rules out human bias. I just don’t trust people to honestly evaluate their own implicit biases.
Well ... Yes, these issues are far better handled in the social sciences than medicine. However, there's nothing stopping medical and nursing students from taking appropriate coursework and continuing education credits in the sociology of race and ethnicity, the sociology of medicine/healthcare, the history of medicine (which should include the pseudoscience of race of the 19th century) and so on. Put it in the undergraduate curriculum. Revisit it in the graduate curriculum. Refresh and update it in continuing education credits.
Murica
Keep it up! :D
👋👋👋
I once looked up the cause of a still borns and the only explanation related to the situation was because I am black, I wondered then if changing my colour would be the cure. I found it so lazy from a group of people who spend millions curing and treating deceases, and it is detrimental for your mental health because you know the explanation is stupid but i must pretend that it made sense.
Could you link me to this article?
I'm not sure I understood. You're saying the reference gave being black as the cause of a stillborn baby? Can you point me to that reference?
The thumbnail kinda looks like a messed up version of Tiger Woods' face
Wait, what about Asians? We're the global majority. What about us? No mention? We have a VERY wide range of skin tones
When there is a problematic social construct, you’d think the goal would be to ridicule and get rid of that construct. To the extent that biologically related factors impact things, it’s the actual DNA differences that matter. Skin color is something that could likely be scientifically described and quantified. If race is a social construct and the things it ostensibly describes are better described by other more scientific methods, why is there not a larger push to get rid of this concept of race?
More doctors should be trained in nuance especially in race.
It's outrageous that it's 2022 and we're STILL having to dredge race-based pathology garbage out of the river-bottoms of modern medical practice and education.
These people are crazy and out of control.
Dr. Aaron Carroll, please be mindful of the following: Race and Hispanic origin are two separate and distinct concepts. The term Hispanic has nothing to do with biology. People of Hispanic origin do not conform to any biological, anthropological, or genetic criteria and can be of any race including white or black or Asian. Accordingly, any study attributing biological, anthropological or genetic criteria to people of Hispanic origin would include a systematic distortion of a statistical result due to a factor not allowed for in its derivation.
Oh come on. Thesame illness i live he dies?. This is total nonsense
Race as risk factor i not discrimination a t all. Are you dumb? When something is a risk factor, the docter gets a ..DSG in germany called, anyhiw he s allowed to give you medicine and treatment more. The others are discriminated, who aren t at risk (according to science) ..guess what..thats many more people.
Have you gone off the deep end, "doctor"? Both race and biological sex have implications for multiple disease categories, and you well know that. Why is that the case? For the same reason that particular communities have differences at all -- genetically they are not the same. The simplest example would be sickle cell anemia as an evolved trait to protect against malaria, an example that many other viewers will be familiar with as well. Where do mosquitos live? Near the equator, where sun is harsher and so melanin is needed to protect against skin cancer.
You also misrepresent the actual medical claim, I think on purpose. The causal line you draw is incorrect, and the correct formulation is "given the racial ancestry of a patient, particular diseases may be more common". For a differential diagnosis, that is incredibly helpful to know, the same as a family history. The common thread being genetics. The only point you correctly identified is that the color of skin does not correlate with outcome, and of course not. Is the white person from Ireland, Germany, Sweden, or Canada? Is the fair-skinned individual from Mexico, Saudi Arabia, or Yemen? Is the dark-skinned individual from Haiti, the Congo, or Kenya? But if I know where your family tree lies, that indeed does help with your care. Your genes don't make you a better or worse person, but they do hold over you predispositions for how your body will act. A very sad and intellectually dishonest video polluted by your political views and honestly disgraceful beyond measure.
You just enjoy typing nobodys reading all that. Ur first sentence invalidates your whole argument. Race is a social construct its never had a scientific basis.
...did you bother actually watching the video before going off on this rant? It's literally addressed at the beginning: race is much more of a socially constructed category than a genetic one. There's far more genetic diversity within "races" than between them.
Also this never once even mentioned sex, but way to combine a strawman and dog whistle to let us know about your transphobia.
did... did you watch the video...?
If you disagree with the claims then please cite your sources. I'd love to know why you think that this video is "disgraceful beyond measure". This episode was made because of new research proving that there are inaccurate elements in how these things are taught, not because there aren't any correlations. The problem is that were not taught enough about the causality. You maybe already knew everything about the cholera virus's connection to cystic fibrosis, but I would imagine it's not commonly known.. Bias amongst medical professionals are frequently causing harm and we need to work against that. I don't believe this video is political. It just tries to shed light on something that it seems were doing wrong based on unbiased research indicating such.
I did not get any of that from the video? He does say race plays a role (sex is not mentioned), only he emphasizes the difference between race as a social construct and the underlying genetics that don't lend themselves to stratifying people with the same ease. And the video even adds nuance about the play between genetics and environment (hispanics being high-risk for obesity 3:39) that is often overlooked or oversimplified. The data presented about the central role of race in diagnosis for whites vs non-whites (100% Native Americans!?) is telling.
You repeat the same things the video did, only without the data and nuance, and cap it with an unnecessarily agressive accusation of dishonesty. Might it be your political views coloring your understanding of the video?
There were times when I have to ask a patient as to what racial designation he or she wants to be. I'm referring to light skinned folks whose features are 99% European, example is Harry's wife Megan Merkel.
Clickbait af 🤦♂️ this is probably your single worst video yet 🤦♂️ I came here thinking you unconvered some groundbreaking research. Please remake this without the leftist talking points. Maybe start with the fact that even an inexperienced coroner can tell your race based on simple facial cranial anatomy. Do you seriously not think our students know what confounders and environmental variables are? Have your videos just been reduced to layman PSAs?
Click bait???? 🤨 There have literally been SO MANY studies that have shown how pervasive racism is in the medical field, yet you wanna act like there isn’t research & proof this problem exists? 🤦🏾♀️
As a mixed-race Black woman I’ve literally experienced this medical racial bias firsthand! I’m not just Black, I’m also Asian & European, but because all people see when they look at me is Black people assume things about me & my heath that’ve caused my heath issues to literally be ignored & have gotten much worse because of their ignorance!
If you wanna pretend that racism in the medical field doesn’t exist then fine! But just know that real people, like myself, are being effected by medical racism everyday because of it & no matter what you think this isn’t a left or right issue, it’s a human issue!
I, along with a lot of other Black, Hispanic, Indigenous, & Asian men & women my age, weren’t diagnosed with autism & ADHD until MUCH later in life because people still believe the pervasive myth that autism & ADHD only effects only effects younger white males! I haven’t been given pain medication when I desperately needed it & was told to just take regular ol’ aspirin for & when I got several teeth pulled because doctors assume I don’t feel pain as much as white people do! A lot of my other medical issues like scoliosis, muscle spasms, IBD, joint issues, GERD, as well as mental health issues I have have taken MUCH longer to finally get diagnosed & treated because people think “I look very healthy” since I’m thin & quite muscular! Even though I’ve been trying to tell doctors that I’ve been suffering with these health issues my entire life no one seemed to wanna listen or take my concerns seriously until I got myself a biracial Black doctor who actually listened to me! It shouldn’t have taken so long to get diagnosed or treated, but racism is so pervasive everywhere! Even in the medical community & you denying this is an issue shows your privilege!
Just because you don’t experience this yourself doesn’t mean it doesn’t exist & real people are suffering because of ignorance!
#279😤I'm fed up with racism and the topic!!
Risk factors are not clinical evidence of disease. It is basically crap!! But it is a rediculous problem too!! 🎭⚡🗯