Medical Bias? There’s a Bill Brewing That Could Help Stem It.
Rep. Ayanna Pressley introduces legislation that formally identifies systemic racism as a public health crisis
Most physicians think they treat all patients the same, but we know that is a lie.
Just like there is a stark disparity in Covid-19 deaths in Black patients (two times higher) and Latinx patients (one times higher) compared with White patients, there are similar life-or-death outcomes in Black and Latinx newborns. Tiffani Johnson, MD, at Children’s Hospital in Philadelphia discovered that implicit bias occurs in Black and Latinx babies and children, even more so than Black and Latinx adults.
Most physicians enter medicine to help people and make a difference. Many doctors are really trying, but reproducible data shows all people are biased, no matter their education level. Physicians are all unintentionally biased, especially against Black and Latinx patients. This unfortunately means Black and Latinx patients, including babies, become ill and die at higher rates than White babies. These patients and their parents are spoken to with less compassion and report feeling as if they were treated differently than other patients.
In my 14-year career, I’ve seen physicians and nurses assume parents of newborns are uncaring for not being with their baby at their bedside all day. Far from being universal, they do not consider that some parents may not have maternity leave or the financial ability to take unpaid leave. It is impossible to treat these parents with compassion if this is how you view them when you do not see them around.
I’ve heard physicians and nurses joke and make fun of patients’ names. Specifically culturally unique names with apostrophes, hyphens, or loads of abundant creativity. It is impossible to treat these parents with compassion if you feel they made a silly choice in naming their child.
I’ve seen patients who do not speak English not receive frequent medical updates from physicians and nurses because the extra step of grabbing an interpreter for the second or third time is too inconvenient. It is impossible to treat these patients with compassion if you are annoyed by having to update them. And they can feel it.
I’ve seen physicians and nurses “talk down” to some patients, usually the Black and Latinx ones, often assuming less education and less understanding of their baby’s medical issues and health care in general. I have had family members in the hospital, and when the outcome is death or significant illness, I cannot help but wonder if their outcome would be different if they were White. I often pray to a higher power because I am not confident they will be seen as an individual by their medical team. If it happens at my wonderful institution, with my awesome colleagues, it can and does happen anywhere.
For the past three years, I have facilitated over 50 small-group, closed-door talking sessions to over 350 pediatric trainees and nurses. They have been largely very welcoming to this conversation and have become aware of their own bias about patients which comes from jumping in and contributing honest feelings and patient stories. I have witnessed residents apply their learnings by pursuing specific and tangible requests: This involves creating an advocacy portion to their reports to discuss health care disparities, including current conditions such as Covid-19.
Since the police killing of George Floyd in Minneapolis in May, many hospital administrators and physicians have interrogated the ways racial and ethnic bias operates in medicine. Knowing that physician bias contributes to patient harm and disparate outcomes in the communities we serve means we cannot ignore this problem. Racism and bias work against everything good we’re trying to do.
These differences prompted one legislator, Rep. Ayanna Pressley (D-Massachusetts), to introduce the Anti-Racism in Public Health Act, on September 3. This bill would formally identify systemic racism as a public health crisis in the United States.
Admittedly, there are numerous structural biases in medicine, starting with too few Black and Latinx physicians, stemming from fewer educational opportunities and mentors in Black and Latinx neighborhoods, and in health care in general, including stark differences between private insurance vs. Medicaid, to name a few.
The good news is that bringing awareness to their own biases, physicians and nurses can make immediate improvements in their care for Black and Latinx newborns at the bedside during patient care. These conversations also give tools for physicians and nurses to call out bias in their colleagues in a way that centers the patient and our collective inherent need to do good.