During his physician residency training about 15 years ago, Dr. Chris Colbert doesn’t recall health equity ever being acknowledged or discussed.
“There was just African American residency (training) and the thought that this wasn’t right,” said Colbert, who is African American and serves as assistant emergency medicine residency director and director of health disparities at the University of Illinois College of Medicine. “But we didn’t feel like we were in a place where we could say that out loud.”
That sentiment has permeated medical education for generations, and many experts contend that’s part of the reason cultural and racial inequities persist in a nation that is growing more diverse.
“I think for a lot of organizations … they’ve just been able to check a box and then keep going” when it came to cultural competency training, said Dr. James Hildreth, president and CEO of Meharry Medical College, one of three historically Black U.S. medical schools.
Unless medical education moves beyond that mentality, clinicians are likely to continue ignoring the effect of their implicit or unconscious biases on their decisionmaking, which has resulted in:
Perpetuation of assumptions that reinforce racist and culturally insensitive stereotypes, such as the notion that Black patients have a higher pain tolerance than whites, leading to misdiagnosed pain assessments that result in Black patients being less likely to receive pain medication. Or when medical book publisher Pearson in 2017 came under scrutiny for such passages as “Arabs may not request pain medicine but instead thank Allah for pain if it is the result of a healing medical procedure,” in its textbook, Nursing: A Concept-Based Approach to Learning.
Lack of investigation into the root causes for the disparities. Take breast cancer—Black women are 41% more likely to die from the disease than white women despite having a slightly lower incidence rate. And while breast cancer incidence rates are higher among Black women than white women under age 45, leading organizations, including the U.S. Preventive Services Task Force, call for routine mammogram screening once every two years for all women between the ages of 50 and 74 at average risk for the disease.
Less intervention, as the Joint Commission points out that non-white patients receive fewer cardiovascular interventions and fewer kidney transplants. Black men are less likely to receive chemotherapy and radiation therapy for prostate cancer and more likely to have testicle(s) removed.
Patients of color are more likely to be blamed for being too passive about their healthcare and less engaged in shared decisionmaking.