PRACTICE PEARLS

Special Edition: Advancing Health Equity

 

Fam Pract Manag. 2020 Nov-Dec;27(6):47.

ASK THREE QUESTIONS BEFORE USING RACE-BASED CLINICAL ALGORITHMS

Over the years medical groups have adopted diagnostic algorithms and practice guidelines that include race-based differences. For example, the Vaginal Birth After Cesarean algorithm endorsed by The Society for Maternal-Fetal Medicine predicts a lower likelihood of successful vaginal birth for patients who have had a cesarean section if they are Black or Hispanic.

These “race corrections” are intended to control for biological differences. But there is mounting evidence that race is not a reliable proxy for genetic variation, and some algorithms and guidelines may be based on outdated data or unsound science. Given the persistent racial disparities in health outcomes, it's worth re-evaluating race-based algorithms and practice guidelines to determine whether they exacerbate those disparities, rather than ameliorate them.

When developing or applying algorithms and practice guidelines with a racial component, physicians should ask these three questions:

  1. Is the need for race correction based on robust evidence and statistical analyses (with consideration of internal and external validity, potential confounders, and bias)?

  2. Is there a plausible causal mechanism for the racial difference that justifies the race correction?

  3. Would implementing this race correction relieve or exacerbate health inequities?

Reference

Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. N Engl J Med. 2020;383(9):874–882.

WHAT TO DO WHEN A PATIENT MAKES A DISCRIMINATORY REMARK

Health care workers are sometimes subjected to discriminatory behavior by patients or their families, and sometimes witness

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