News of George Floyd’s death and the resulting protests have brought up many discussions about race and racism. If you read the protest signs, you’ll see the anger and sadness isn’t only about police brutality directed at black men. The protest signs point out concerns about our legal system, job opportunities, and about our healthcare system. One concern is how and why COVID-19 has had a much greater toll on black people in the United States than on other races (more on the definition of race later).
I often tell prospective clients that our goal is to help our customers deliver better patient care and to reduce the cost of care. Considering this mission statement, it seemed a good idea that I research the topic of quality of care for minorities. The first thing I learned is that this is a very big and very complicated topic. I previously thought the issue was that white doctors don’t work with people of color as they do with whites, and the result is that quality of patient care and outcomes are worse than they should be for African Americans. Without doubt this is a problem but read on for other examples.
I learned that too often the quality of patient outcomes is affected by patients that don’t like being treated by people of another race or sex or even religion. Race is a foundational issue, but so is the fact that patients and doctors often come from very different backgrounds and sometimes they have difficulty communicating effectively with each other or even having a basic sense of trust with each other.
As described in a NY Times article, a young Asian woman ER doctor had an encounter with a “burly patient with the swastika tattoo.” The doctor described the time she spent examining the patient as very threatening and scary. I am guessing, but I feel comfortable suggesting, that the doctor spent as little time as was required in the patient’s presence. The patient wasn’t seriously injured, she did her job, and she moved on to another patient. Nurses and care givers of all kinds deal with similar hostility or worse, and probably far more often than the physician.
I was ignorant of another important fact about race. The following is an excerpt from an article written a few years ago by Keith Norris. He is a nephrologist and the founding principal investigator for the very first NIH founded research network dedicated to reducing health disparities. “The concept of race has been widely propagated since Carl Linnaeus published Systema Naturae in 1735. The father of modern taxonomy proposed four distinct racial groups for human beings – American, European, Asian and African – that encompassed not only physical characteristics and geographic origin, but also personality traits, skills, and abilities. This classification has become institutionalized with little awareness that the variable “race” is not actually a biological phenomenon: there is more genetic variation within these racial groups than across them. Rather, the notion of race is a social construct.”
I had to read that paragraph a couple times. What it means to me is that people from all over the world are biologically very much alike. Differences do exist but those differences can be caused by shared ancestral/family traits. For example, people that identify as black or African American are likely to have a biologic trait that helps protect them from Malaria which is an advantage if one lives in Africa. This trait puts these same people at a disadvantage because they are at higher risk for kidney failure.
In another historical example, Paul Rivet (a medical doctor and anthropologist) was instrumental in setting up the resistance in occupied France in the 1940’s. He saw racism firsthand in Germany’s overt belief in an Arian nation and white supremacy. He also saw it 30 years earlier through his work in anthropology where scientists ranked humanity into race categories based on skull measurements. The prevalent belief was that some races were superior to others. While it is true that anthropologist do not treat live patients, their opinions (as wrong as they were) supported false beliefs that have been perpetuated over and over through hundreds of years.
Physicians have to be in tune with other health related differences in race. In addition to biological traits, drugs can affect races differently and ACE inhibitors (for hypertension and congestive heart failure) are an excellent example for adverse side effects for blacks. In another example, the professionals at the University of Washington found that lower serum vitamin D concentrations were associated with an increased risk of coronary heart disease for white and Chinese study participants.
Clearly, there are race related differences in care and outcomes, but it’s important to not generalize about race when diagnosing and treating patients. Every person should be entitled to the same high standard of care, personalized to their needs. A very bright spot is that the more researchers learn about genetics and the resulting prediction of disease, the less physicians will rely on generalizations. The more accurate and unbiased data that can be collected, the better we’ll be able to treat all patients. Surely this will help reduce the care gap that exists in medicine today.
About the Author: David Rasmussen
David Rasmussen is the President of Extract. With 30 years’ experience leading software companies, David is driven by the challenge to consistently find groundbreaking ways to solve customer problems. David finds it rewarding to hit the customer’s target and create a great team, build a solid infrastructure, and emerge with a strong value proposition.