Addressing racial bias in wards

Abstract

Health disparities fall along racial lines, in part, due to structural inequalities limiting health care access. The concept of race is often taught in health professions education with a clear biologic underpinning despite the significant debate in the literature as to whether race is a social or biologic construct. The teaching of race as a biologic construct, however, allows for the simplification of race as a risk factor for disease. As health care providers, it is part of our professional responsibility and duty to patients to think and talk about race in a way that is cognizant of broader historical, political, and cultural literature and context. Openly discussing the topic of race in medicine is not only uncomfortable but also difficult given its controversies and complicated context. In response, we provide several evidence-based steps to guide discussions around race in clinical settings, while also hopefully limiting the use of bias and racism in the practice of medicine.

Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short

“…Lenses warp light. But biomedicine's insistence that it relies on pure empiricism-that it sees the world without an intervening theoretical frame-means it cannot evaluate the process, construction, and ensuing flaws of its understanding of bodies, disease, and racial difference (36)(37)(38)(39)(40)(41). The field is left without the scholarly articulation and rhetorical defenses that help identify and combat racism embedded in hospitals and professional medical culture (32).…”

“…This emphasizes targeted behavioral and biomedical interventions rather than considering structural solutions to structural obstacles. Consider, for example, how terms such as “non-compliant” ( 39 , 40 ) ignore institutional inequities in insurance, transportation, and access that limit ability to adhere to prescribed treatments. This underscoring of individual culpability implicitly casts social justice efforts as philanthropic enterprises (needed to help people make better decisions or overcome genetic predisposition) rather than justified, reparative endeavors necessary to rectify historical wrongs ( 4 ).…”

From race-based to race-conscious medicine: how anti-racist uprisings call us to act

“… 35 , 36 On the wards, students learn that race is relevant to treatment decisions and have inadequate power to question the racialised assumptions of their supervisors. 37 , 38 , 39 , 40 In this way, race-based medicine is quickly propagated.…”

Evidence-Based Practice in Clinical Social Work

“…Social worker's professional values include an explicit focus on the needs of diverse and vulnerable populations. Several areas need further research to be optimally useful in practice: Cristofalo (2013) calls for more attention to vulnerable populations using "safety net" services who are disproportionately persons of color; Hemsing, Greaves, and Poole (2015) note that underserved women are routinely not offered basic health services such as smoking cessation help; Caputo and Mason (2009) note how family composition impacts client's use of services; Tsai et al (2018) note racial bias on medical wards; Wang, Wong, and Humbyrd (2018) point out that payer eligibility requirements may limit medical services to people with other preexisting conditions who are disproportionately people of color. The list goes on.…”