Understanding Bias in Healthcare: A Road to Equity (Spring 2024)

Understanding Bias in Health Care: The Road to Equity K R I S T I N F LY N N P E T E R S , P H D S C H O O L O F H E A LT H P R O F E SS I O N S GUEST LECTURE – SPRING 2024  Lean into your discomfort It’s how you learn & how you grow  Cognitive bias Learnin Social bias...

Understanding Bias in Health Care: The Road to Equity K R I S T I N F LY N N P E T E R S , P H D S C H O O L O F H E A LT H P R O F E SS I O N S GUEST LECTURE – SPRING 2024  Lean into your discomfort It’s how you learn & how you grow  Cognitive bias Learnin Social bias g Race as a social construct Objectiv Examples of how racism negatively impacts es health outcomes How to move toward equity What the eyes see. What the brain understands. What the ears hear. What the brain understands. This can be uncomfortable, and even cause anxiety to listen to, so feel free to cover your ears. We’ll only play for about 30 seconds. What do we really KNOW for sure? https://www.youtube.com/watch?v=scTRg5AmBPU iClicker Question Do you think that you have a bias? A) Yes B) No C) Maybe What is a cognitive bias? A mental shortcut our brain takes to deal with a lot of information quickly If you have a brain, you have a bias. What is a cognitive bias? A pattern of “thinking” errors that are SYSTEMATIC, not random. The biases are commonplace, and not usually committed intentionally. People tend not to be aware of their cognitive biases until they are taught to recognize them. You can practice catching the errors and challenging them, even in the face of still experiencing the bias. Cognitive biases affect health care Availability Bias When we decide something based on the first thing that comes to our minds – the idea that is most “available.” A very recent or very memorable experience has too much influence on our patient- centered decision making. Availability Bias in Health Care Physicians who saw really bad side effects with a drug in one patient, were then less likely to prescribe that same drug for another patient regardless of whether the second patient was likely to experience risks or benefits from the drug (Choudry, et al, 2005) When doctors had a patient with a negative birth outcome, they were more likely to increase in C-sections in the next patients’ births, regardless of appropriateness to the next patient (Singh, M. , 2019)  Who is at greater risk for biased treatment that negatively impacts health outcomes? Research shows Disabilities Rural evidence LGBTQ for People of Color (e.g., Black, Latinx, Native American, Pacific Islander people) systematic Heavier weights (diagnosed as overweight or obese) Lower socioeconomic status biased Older adults or teens, young adults treatment Recent immigrants Limited English Proficiency based on Religious minorities Certain diagnoses social Women…. identities And men… as well Gender norms: Men should be strong and stoic, so not seeking help Women are viewed as “emotional, hysterical or too sensitive.” Research shows biases occur systematically for certain social groups… That doesn’t mean every single person in a minoritized social group in every single situation experiences worse treatment. It does mean that on average, the research shows a pattern of certain social groups receiving worse health care as compared to other groups. The biases are not always intentional. These biases are sometimes unconscious. Regardless of the intent, the impact of that bias and discrimination is associated with negative health outcomes.  Risk of wrong diagnosis increases ◦ Patients get inadequate or inadequate treatment ◦ Patients get delayed referrals for screenings, tests IMPACT ◦ Increased mortality and morbidity for patients of People are disrespected, not believed, BIASES? misunderstood & hurt ◦ Health care experience is stressful ◦ Decreased trust of provider ◦ Less likely to come back for more care ◦ Health professional has effectively decreased access to health care Today, we will focus on the problem of racialized medicine and racism in medicine. SCIENTIFIC EVIDENCE White patients were more likely to receive better quality care than: Black patients Native American patients Alaska Native patients Hispanic patients Native Hawaiian/Pacific Islander patients Disparity in Positive Affect (Cooper, et al, 2003) Study Subjects 252 adult patients -> 142 African-American & 110 White Saw 31 physicians -> 18 African-American & 13 White Measurements Audiotapes of Visits – Ratings of Patient-Centeredness Patient Ratings – of Shared Decision Making Patient Ratings – of Satisfaction with Care Racism in Medicine Example: eGFR race “corrections” Glomerular filtration rate (GFR) is the best way to measure how well your kidneys are working The actual GFR test is complicated and cannot be easily done in a doctor’s office. Laboratories use math equations based on creatinine instead to estimate the GFR instead of measuring it. This is how we get the eGFR. A race correction has been made until 2022 based on the belief that black people have higher muscle mass than white people BUT…  False-Muscle-Mass-Assumption is a bias rooted in dehumanizing justifications for slavery Wrong Assumption leads to the “normal range” eGFR for African Americans to be in the higher numbers to “account” for the so-called muscle mass difference A “muscle mass” correction has not existed for women compared to men, just Black people compared to White people Dangerous Result: African Americans have not been referred for needed interventions because they were incorrectly assumed to be okay. Not getting medical treatment when they need it Not getting put on transplant list when they should Good News The National Kidney Foundation changed their recommendations in 2021. Race is a social construct Since the Human Genome Project of the There is much more Genetic diversity that early 1990s, it has genetic diversity exists across humans been confirmed that within any “race” than is extremely small the idea of biologically between “races” meaningful races is flawed. The “races” emerged out of the effort to categorize people Prior to 1700s and 1800s, race was used to describe kinship. During the foundation of the US, ideas of race, based on skin color, became a way to justify and reinforce enslavement of black people by law. Ideas that white people had about black people during slavery perpetuated in medicine and health care in general. Racialized Diseases What about sickle cell? It’s not “race,” It’s place… Racial Disparities in Referrals Schulman, et al. 1999 720 physicians were given scenarios of patients with symptoms of heart attack 8 different “actor” patients describing their symptoms Physicians were randomly assigned to the videos Physicians who watched the women and Black people were much less likely to refer a them for cardiac catheterization than men and White people. Black women were the least likely to receive referral for this procedure. A review of literature published in 2016 One finding was that physicians were significantly more likely to recommend white patients for bypass surgery than Black patients. Physicians in the study explained a belief that their Black patients were not as well educated and so would not take part in the necessary physical activity after surgery. What? This would be an EXPLICIT BIAS Stereotypes that health professionals ADMIT to having about African Americans prone to anger poorly educated thick-skinned able to tolerate high levels of pain less trustworthy sexually promiscuous drug seeking unable to pay Maternal & Infant Mortality Rates Racism in society is stressful contributing to “weathering” in African American women Racism in health care settings leading to not listening to Black women’s pain, to their concerns Disparity in Positive Affect (Cooper, et al, 2003) When race of patient / physician matched Appointments were longer (2.15 minutes [95% CI, 0.60 to 3.71]) Had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) Were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). *Satisfaction and positive affect linked to continuity of care measures in other studies. *Roughly 6% of MDs are Black while 13.4% of Americans are Black *Roughly 5.8% of MDs are Latinx, while 18.5% of Americans are Latinx iClicker Question Which is a positive disparity affect? A) Physicians rated as more participatory B) Longer appointments C) Increased patient positive affect D) All of the above Infant Mortality Rates by Race Maternal Mortality Rates by Race Disparities cannot be explained by we HTTPS://WWW.TIKTOK.COM/@JOELBERVELL/VIDEO/7182 978020037102890?L ANG=EN alth, income, insur ance What can health professionals do to improve equity? Make sure that our textbooks are not reinforcing biases because they are using outdated scientific methods or stereotypes about groups of people. Watch out for racialized medical tools and medical findings – they are often based on false ideas that race is a biological construct (THE HUMAN GENOME PROJECT TAUGHT US THIS) What can health professionals do to improve equity? Cue health professionals to watch out for biases, avoid making assumptions, and be methodical about asking questions to formulate a good diagnosis based on data, not on hunches. Listen to and believe your patients, regardless of their background. Open doors for more people from across social groups to become health professionals; better representation leads to better educated health professionals all around and better care for all of our patients What can I do now as an undergraduate? Know that what you see on the outside may be different that what people are experiencing on the inside. Get involved, spend time with, listen to people who are different from you. Listen for understanding (not to respond). Don’t try to explain someone else’s experience to them – listen, believe. Keep learning.  Keep learning HLTH_SCI 2850 Inclusion and Equity in Health Care HLTH_SCI 4400 Culture and Health literacy HLTH_SCI 4410 Humanism and Health literacy SOC-WK 2000 Exploration in Social and Economic Justice Nutrition Sciences Obesity course Park & Rec Disability course Women & Gender Studies Gender & Public Health; Transgender Studies; Queer Theories/Identities; Disability certificate Gender, Race & Sexuality; Social Inequalities Want to learn more about providing better patient-centered care to all? Let’s Meet! KRISTIN FLYNN PETERS, PHD DONAL BUCKNER, SENIOR STUDENT SERVICES COORDINATORSENIOR STUDENT SERVICES COORDINATORVV [email protected] [email protected] DU Donal Buckner Dr. Flynn Peters and other faculty hosts office hours in the Department around campus. of Health Sciences He is also available want to work on to meet in Lewis improving Hall. Health Inclusion and Sciences students Equity in Health may Care. Contact her schedule an appoi ntment in MU Conn via email to set up ect time to meet. or contact Donal directly