Question

Melanie Funchess described how her husband’s doctors wasted 4 weeks seeking the diagnosis that they expected him to have due to his race and preconceived perceptions of his race. Once they opened their eyes (at the strong request of his wife) to the possibilities of diseases/diagnosis a “white man” would have, they were finally able to correctly diagnose and help him. There are certain genetic conditions that have been reported to be more common in particular ethnic groups (e.g., sickle cell disease), although this was not the case in the aforementioned scenario. Dorothy Roberts decribes the underlying social conditions that cause medical disparities in different racial groups and the problems with race-based medicine. Is it ever okay to use race-based medicine to guide or inform your medical practices? Why or why not? Give an example of an implicit bias a healthcare professional may hold that could be detrimental to the care of their patient. How can practitioners avoid implicit biases in their practice?

Answer 1

Decision aids that U.S physicians use to guide patient care on everything from who receives heart surgery to who needs kidney care and who should try to give birth vaginally are racially biased.

Is it never ever okay to use race-based medicine to guide or inform your medical practices. The algorithms used by hospitals and physicians to guide the health care given to tens of millions of Americans are shot through with implicit racism that their creators are often unaware of, but which nevertheless often result in Black people receiving inferior care..

  As a medical community, we have not fully embraced the notion that race is a social construct and not based in biology.” Algorithms used for medical decisions from cardiology to obstetrics are similarly tainted by implicit racial bias and adversely affect the quality of care Black patients receive. Presumably unintentionally, made Black and, in some cases, Latinx patients less likely to receive appropriate care.

Algorithms used for medical decisions from cardiology to obstetrics are similarly tainted by implicit racial bias and adversely affect the quality of care Black patients receive. Some of the examples for implicit bias are:

Heart Failure Risk Score:Developed by the American Heart Association to determine which hospitalized patients are at risk of dying from heart disease, the algorithm assigns three points to any “nonblack” patient; more points mean higher risk of death. Those deemed at higher risk (non-Black patients) are more likely to be referred to specialized care, said David Shumway Jones of Harvard Medical School, the study’s senior author.

Chest surgery: In a risk calculator used by thoracic surgeons, being Black increases the supposed likelihood of post-operative complications such as kidney failure, stroke, and death. “That could make surgeons steer Black patients away from bypass surgery, mitral valve repair and replacement,” and other life-saving operations.

Kidney failure: It’s very difficult to measure kidney function directly, so physicians use creatinine levels in the blood as a proxy: less creatinine, better kidney function. A “race adjustment” in a widely used algorithm lowers Black patients’ supposed creatinine levels below what’s actually measured. That makes their kidney function appear better, potentially keeping them from receiving appropriate specialty care. The rationale for “adjusting” creatinine levels by race is that Black people are supposedly more muscular, which can increase the release of creatinine into the blood. As it is, Black people have higher rates of end-stage renal disease than whites.

Kidney donation: An algorithm used by transplant surgeons says that kidneys from Black donors are more likely to fail than kidneys from donors of other races. Because Black patients are more likely to receive an organ from a Black donor, the algorithm reduces the number of kidneys available to them.

Giving birth: The algorithm used to determine whether a woman faces too high a risk from vaginal birth automatically says that Black and Latinx women face a higher risk.

Breast Cancer:  Risk of developing the disease calculates a lower risk for a Black or Latinx woman than a white one even when every other risk factor (such as age at menarche, close relatives with breast cancer, and a history of benign biopsies) is identical. That could deter minority woman from undergoing screening.

Kidney stones: When patients come to an emergency department with pain in the back or side, doctors use an algorithm with a 13-point scale to assess whether the cause is kidney stones. A higher score means less likelihood of that. Being Black automatically adds three points to the score.

Practitioners can avoid implicit biases in their practice By perpetuating the use of race in the decision-making, that can further exacerbate inequities, make it longer to get needed treatments or procedures, or referrals to specialists. For the medical community, this is an example of structural racism and is one area that has to be addressed quickly and decisively. Instead of assuming race is directly the cause for poor medical outcome, practitioners can also consider factors that typically go along with race in the U.S., such as access to primary care or socioeconomic status or discrimination, might be the true drivers of the correlation. This could lead to better patient care or even be a tool for addressing inequities. Physicians should finally come to terms that race is just biology and not a social construct.