ACOFP Diversity, Equity and Inclusion Task Force member Sabrina Rocke, DO, discusses race-based medicine, the role it plays in medical schools and how changing this approach would help eliminate bias, stigma and structural racism when treating patients.
By Sabrina Rocke, DO; Member, ACOFP Diversity, Equity and Inclusion Task Force
Think back to the first year of medical school; remember how we were trained to formulate an opening one-liner to present to our attending physician? The template goes something like, “30-year-old African American male presents with hypertension.” This format of discussing race at the beginning of a patient presentation mostly felt odd and uncomfortable for me. In the short time a student gets with a patient, I wonder, how is there enough trust or time to get into a person’s race and still get into the details of the patient’s presenting concern? What if there is more than one race with which a patient identifies?
My solution was to skip the patient’s race and present the patient’s age, identified gender and chief complaint, but that did not go over well with many attending physicians. I soon reverted to the traditional method I had been taught. In my mind, I received an excellent education and did not see this as a knock on my medical training.
Now as an attending physician, I still see medical students presenting in this format to me. The difference is that I ask them not to tell me the patient’s race to minimize the risk of race-based bias in our patient care. Let’s dive deeper into the discussion of race-based medicine in medical practice and education.
The patient example used above highlights a common race-based practice in medicine that we still see daily. The Eighth Joint National Committee (JNC 8) released evidence-based guidelines for blood pressure management that were published in 2014 and differentiated treatment approaches for non-Black and Black patients. The full discussion of the controversy of this recommendation is too great to discuss in detail here, but in summary, it used a secondary endpoint (stroke risk) to make a recommendation for blood pressure management that placed Black patients at risk of not getting equitable treatment compared to non-Black patients to prevent renal complications.
Raced-based medicine induces stereotypical and often antiquated theories and does not truly address social determinants of health that are more important factors to understand how to improve our patients’ health. In the example of hypertension, it is more important to know about diet, access to healthy food, tobacco use, and other modifiable lifestyle interventions than it is to know the patient’s race.
There are numerous other examples of how using race in medicine creates stigma and bias leading to misdiagnosis, inadequate treatment plans and, ultimately, undesired outcomes for our patients. A few examples include glomerular filtration rate (GFR) race differentiation, spirometry corrected for race; pain management treatment; diagnostic criteria for mental illness; screening pregnant women for drug use; and how physicians view non-adherence.
For these reasons, we should be skeptical of race-based medicine that is not based on high-quality evidence. In addition, we should work to minimize stigma and bias by learning about our individual patient’s risk factors and lifestyle, while addressing needs surrounding their social determinants of health.
The culture of medicine starts with day one of medical school training—maybe even earlier in the pipeline. With the start of the new academic year, it is a good time to acknowledge that each of us is a teacher, role model or mentor at some point. I encourage you to start and be part of a culture change in medicine.
Avoid teaching race-based medicine that is not based on high-quality evidence to your students. If your students have already been taught to use race in medicine, explain how it harms our patients and continues a culture of stigma, bias and structural racism in medicine. Not only can we change our culture in medicine, but we can improve our patient outcomes by eliminating race-based biases in medicine.