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evidence that race is not a reliable proxy for genetic variation, and some algorithms and guidelines may be based on outdated data or unsound science.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 such behavior targeted at colleagues. Some patients may even refuse care from people of certain races, ethnicities, or religions. If health workers feel imminently threatened, prioritizing safety without immediately addressing the discrimination may be the best course of action. But, whenever possible, they should call out the behavior and make clear the expectation for a safe, respectful environment. Here are some potential responses to discriminatory comments, adapted from anti-discrimination policies at my institution, University of Wisconsin Health.

  • “Our institution is committed to being a diverse and inclusive environment for all.”

  • “My role is to take the very best care of you. We are here to help you as a team. We do not change physicians or staff because of their race (or ethnicity, religion, etc.).”

  • “Our institution does not tolerate bigotry. Patients must treat people respectfully here. Let's refocus on how I can help you today.”

Members of marginalized groups may routinely face discrimination. As a result, they may feel that calling out each instance of mistreatment and providing education is unduly burdensome. That's why it's critical that bystanders speak up when they witness discriminatory behavior. Instances of discrimination should also be reported to supervisors or institutional leaders.

ADDRESS INEQUITY BY SUPPORTING BLACK-OWNED BUSINESSES

Health equity is intertwined with economic equity. A simple step physicians can take to help reduce health disparities is to buy supplies or lunches from Black-owned businesses, or use Black-owned banks. Here are some ways to find them:

  1. We Buy Black: An online marketplace of products sold by Black-owned businesses, including hand sanitizer and cleaning supplies,

  2. The Official Black Wall Street app: The most popular app (available for Apple or Android devices) for finding Black-owned businesses,

  3. EatOkra app: An app for finding Black-owned restaurants,

  4. The Blackout Coalition: An organization that keeps a map of Black-owned banks and credit unions on its website,

  5. U.S. Black Chambers Inc.: A national federation that can tell you if there's a chamber in your area with a list of local members.

Reference

How to find Black owned businesses. OneUnited Bank. Accessed Oct.9, 2020. https://www.oneunited.com/how-to-find-black-owned-businesses/

WE WANT TO HEAR FROM YOU

Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to fpmedit@aafp.org, or add your comments below.

 
 

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