Diversity Needs Our Attention
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Misdiagnosis and Diversity
Where I live I have had to face people in positions of authority who are done with Diversity, Equity and Inclusion (DEI). They don’t believe there is a problem, they don’t want it talked about, they don’t want it taught in schools. It’s like the Munch painting, “The Scream” only they seem to be saying “La La La I can’t hear you”
Well, there is a problem and that’s what we will discuss today.
In a study published Jan. 8 in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.
It is estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a study published in July in the BMJ Quality & Safety periodical. Here is a link to KFF news story about it.
Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, according to the lead author of the BMJ study.
Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.
Weakening of the heart muscle is the most common cause of maternal death one week to one year after delivery, and is more common among Black women.
We have reported on studies in the past where med students were asked about people of color and their ability to feel pain. 40% of 1st and 2nd year medical school students thought that Black people have higher threshold to pain. Here is a link to the AMA report.
In another experiment, researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women. If doctors were uncertain, they were less likely to take action such as ordering tests or prescribing treatment.
It’s easy to see why doctors are more confident when diagnosing white men because for more than a century, medical textbooks have illustrated diseases with stereotypical images of white men. Only 4.5% of images in general medical textbooks feature patients with dark skin.
That may help explain why patients with darker complexions are less likely to receive a timely diagnosis with conditions that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more advanced disease, which can cause arthritis and damage the heart. Black people with melanoma are about three times as likely as whites to die within five years.
Remember the issue that COVID-19 showed us? Pulse oximeters were not accurate on darker skin, because when they were developed they were tuned to white skin. The devices work by shining light through the skin; their failures have delayed critical care for many Black patients.
In a report just re-released in the past week by the Pew Center , by and large, Black Americans do not express a widespread preference to see a Black health care provider for routine care: 64% say this makes no difference to them, though 31% say they would prefer to see a Black health care provider for care. 31% is not 0.
In fact, let me quote from one of the focus group participants in the Pew study.
“I had a situation where I had to go through about two different doctors until I was able to get the results that I was requesting, because they did not believe that the issues that I had were valid, or that they were as serious as I made them out to be. It’s kind of been an ongoing thing, so I’m always leery when I’m talking to physicians. I don’t trust them just because they are doctors. I know they have the Hippocratic Oath, but it feels like it’s a little different when they deal with African American patients. And I don’t care if it’s an African American physician or White physicians.” – Black woman, 25-39
Summary:
People of color are not treated the way white people are treated by the medical community. This is an example of systemic racism. The textbook issue we described above is strong evidence. Med students thinking people of color feel pain differently is a systemic issue. They won’t pay the same attentio n
Remember the pulse oximeters? I met the fellow that invented those and he was not aware enough to test his device against a variety of skin colorations. More awareness leads to better and more thorough scientific work and better outcomes for patients.
Women are not well heard by doctors and when you combine that with the inability to take their symptoms seriously, especially cardiac ones after birth, you wind up with maternal mortality for Black women TWICE what is is for White.
Better education is needed that is not white male-centric. More medical professionals are needed of all racial, gender, ethnic types because when you have a diverse population, stereotypes are washed away through personal interaction. More awareness is called for and we won’t get that if we close our eyes to the need for Diversity, Equity, and Inclusion for all of us.
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Organizations to Contact
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Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
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Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
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Link to Chop Wood, Carry Water RESISTBOT write up
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In my recent experience in health care and hospital settings the majority of physicians are neither white nor male. They are from India Pakistan China Indonesia South America Caribbean Islands. PAs and NPs have been mostly white. RNs and MAs are mostly black women working to get their BSN. Interesting though that most of the senior, consulting, and faculty physicians are white males.