Three years ago, I sat with my family in an intensive care unit, watching over my sister for what we knew would be her last hours.
When the attending physician entered this room full of beeping monitors, blinking LED screens, and quiet desperation, I did not expect him to try a new drug or procedure, or even offer words of hope. As a physician myself, I knew the realities of the circumstance.
But as a family member, I wanted him to stop a moment at the bedside, hold my sister’s hand, share our pain. Instead, he spoke with the family remotely, standing closer to the exit than the bed.
This was not my home institution, where I would have been surrounded by caring colleagues. Yet as an African American physician, this interaction, or lack thereof, was not a surprise.
In 2016, researchers from the University of Pittsburgh published findings in the Journal of Pain and Symptom Management after observing that generally, black patients are more likely than white patients to die in critical care units. They also noted something that may have escaped the physicians’ notice: The doctors stood farther from the bedside of patients who were of a different race or ethnicity than their own.
Unfortunately, my family lived this experience.
Recently, the news has been full of articles about black women facing three to four times the risk of dying after giving birth, compared with white women. Why now? Likely because tennis great Serena Williams and pop star Beyoncé have shared their own stories of life-threatening pregnancy complications.
This news raises critical questions that have been long noted in the practice of medicine.
In an American Heart Association article published last month, Ana Langer, director of the Women and Health Initiative at the Harvard T.H. Chan School of Public Health in Boston, noted there are many complex reasons behind this stunning statistic. But a major issue concerns the practice of medicine.
“Basically, black women are undervalued,” she said. “They are not monitored as carefully as white women are. When they do present with symptoms, they are often dismissed.”
Judging a patient’s health status based on physical characteristics goes against a fundamental principle in the medical profession, “To Do No Harm.” This phrase, part of the Hippocratic oath, is either recited verbatim or paraphrased at every medical school’s white coat ceremony, initiating a new group of students as they enter their studies, and at graduation, as newly minted physicians. This is a bedrock principle linked to high quality, ethical, compassionate care.
Despite this affirmation of ethical responsibility, despite the awareness that articles such as the American Heart Association’s exemplifies, differential treatment across patient populations continues.
The trend is so deeply rooted in American culture that many younger physicians are practicing in similarly biased ways as their elders, who were trained at a time of more overt discrimination. When will this nation realize that this pervasive bias literally is destroying lives?
As individuals, we can recognize our own biases and determine ways to mitigate how they influence our own choices and behavior.
Systemically, there needs to be a focus on building self-awareness, through conducting unconscious bias workshops, building a more transparent culture to enhance trust, and learning from patient experiences and research. Patients and their families should be aware of their rights as receivers of care and ask critical questions. Nationally, there is hope that as medicine moves toward payment models that reward quality of care over quantity of care, and keeping people healthy rather than just treating illness, our motivation will be more patient-centered and less bottom-line centered. We must recognize that the treatment of a patient’s disease does not begin with our own assumptions, but must be initiated by the responses, symptoms, and signs of the patient.
But first we must recognize that we all have biases, and we must pause before considering the next steps in any critical decision process.
Locally, we are addressing the root causes of disparate care through a series of unconscious bias workshops, invited speaker series, and cultural competence training, among many other initiatives. These are opportunities to not only raise individual self-awareness but transform organizational culture. This first step is critical.