I know this is a big question, but what can we do moving forward? What seeds can be planted today to identify and overcome racial inequities in our health care system that would improve patients’ lives 1, 5, or 10 years from now on a system and on an individual level?

Dr Konadu: It is a big question, but I believe it has a simple answer. On an individual level, mandatory cultural sensitivity training is imperative in all fields of health care. In its absence, implicit bias is inevitable and will remain an anchor of health care in America and there should be a national ZERO tolerance policy for racism in the workplace.

On a systemwide level, a consensus and direct acceptance that racism is the driving force behind health disparities and inequities is of vital importance. Without taking this step, there is no moving forward.

Black patients are often undertreated for pain and some “dress up” before seeking emergency care so that health care providers won’t think they’re seeking drugs. What do you want to tell your colleagues about how people of color experience the health care system?


Continue Reading

Dr Konadu: It is intimidating. The forced inferiority complex is an illness in its own right. On top of battling whatever underlying medical issue ails patients, they must also worry about how they’re perceived simply so they can receive basic appropriate and equitable care.

A few anecdotes: I have had family and friends call me after being sent home from the ED. My urging for them to return to the ED and ultimate discussions with ED staff has led to diagnoses such as acute pulmonary embolism and even rectal abscess. Both are reasonable causes for admission from the ED to the hospital. I constantly must serve as the “go to” advocate and assert my credentials simply so basic levels of care and attention are granted. No one should have to experience this.

You are a gastroenterologist. How have you seen COVID-19 impact your patients? What precautions are you taking for your own physical and mental health?

Dr Konadu: I am typically consulted for feeding tube placement due to the need for tracheostomy or the long-term effects of encephalopathy from prolonged intubation and sedation.

In the beginning, I will admit I was constantly hyper-anxious about potential exposure and passing the virus on to my newborn because I was breastfeeding. That fear is slowly subsiding now that the vaccine has been rolled out and appropriate personal protective equipment and other measures are given the highest priority. At the end of it all, I always consider it an honor to take care of the sick.

Tell us about your experiences in China and Ghana and your role on the West Africa Institute for Liver and Digestive Diseases (WAILD). How has this experience changed your perspective and exposure?

Dr Konadu: My times abroad gave me the sorely needed perspective of how health care is managed outside of the United States. The practice of conservative medicine is an art all on its own.

Once you are in a situation where you can only rely heavily on your inherent fund of knowledge and physical exam skills, professional and personal growth is unavoidable. What I valued most was the exposure to the rich cultures both in China and Ghana. I spent time learning about Chinese traditional medicine and West African tropical medicine, opportunities that would have been very difficult to attain in the United States.

My time in Ghana fueled my involvement with WAILD. As an institution, we offer educational, preventive, and interventional general gastrointestinal and liver services to West Africa, with a broader goal of serving as a training hub for physicians interested in gastroenterology.

It’s enlightening when you are exposed to a world outside of your own but rewarding when granted the opportunity to make an impact even in those foreign spaces.

References

  1. Titowsky K. Phrenology and “scientific racism” in the 19th century. Vassar College blog. Real Archaeology. Spring 2017. Accessed March 15, 2021.
  2. National Museum of African American History and Culture. Historical foundations of race. Accessed March 15, 2021.
  3. Library of Congress. Immigration and relocation in US history. A journey in chains. Accessed March 15, 2021.
  4. Brooks W. African-American contributions to medicine – part 1 of 7. University of Nebraska Medical Center. 2002. Accessed March 15, 2021.
  5. Villarosa L. Myths about physical racial differences were used to justify slavery – and are still believed by doctors today. The 1619 Project. NY Times Magazine. August 14, 2019. Accessed March 15, 2021.
  6. Skloot R. The Immortal Life of Henrietta Lacks. New York: Crown Publishers; 2010. Accessed March 15, 2021.
  7. Corbie-Smith G. The continuing legacy of the Tuskegee Syphilis Study: considerations for clinical investigation. Am J Med Sci. 1999;317(1):5-8. doi:10.1097/00000441-199901000-00002. Accessed March 15, 2021.
  8. Melillo G. Racial disparities persist in maternal morbidity, mortality and infant health. American Diabetes Association conference, June 13, 2020. Accessed March 15, 2021.
  9. Fernandez ME. Why black women are less likely to survive pregnancy, and what’s being done about it. American Heart Association. February 10, 2021. Accessed March 15, 2021.
  10. Centers for Disease Control and Prevention. COVID-19. Disparities in deaths from COVID-19. Updated December 10, 2020. Accessed March 15, 2021.
  11. Ndugga N, Pham O, Hill L, Artiga S, Alam R, Parker N. Latest data on COVID-19 vaccinations race/ethnicity. KFF (Kaiser Family Foundation). March 17, 2021. Accessed March 15, 2021.
  12. Grubbs V. The health care system has the black community in a choke hold. CHCF Blog (California Health Care Foundation). August 4, 2020. Accessed March 15, 2021.
  13. Bridges KM. Implicit bias and racial disparities in health care. ABA. Human Rights Magazine. 2021;43(3). Accessed March 15, 2021.
  14. Hoffman KM, Sophie Trawalter S, Axt JR, Oliver MN. Undertreatment of pain: racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS. 2016;113(16):4296-4301. doi:10.1073/pnas.1516047113. Accessed March 15, 2021.
  15. Wyatt R. Pain and ethnicity. Virtual Mentor. 2013;15(5):449-454. doi:10.1001/virtualmentor.2013.15.5.pfor1-1305. Accessed March 15, 2021.
  16. Lee P, Le Saux M, Siegel R,et al. Racial and ethnic disparities in the management of acute pain in US emergency departments: meta-analysis and systematic review. Am J Emerg Med. 2019;37(9):1770-1777. doi:10.1016/j.ajem.2019.06.014. Accessed March 15, 2021.
  17. Johnson A. Understanding why black patients have worse coronary heart disease outcomes: does the answer lie in knowing where patients seek care? J Am Heart Assoc. 2019;8(23):e014706. doi:10.1161/JAHA.119.014706. Accessed March 15, 2021.

This article originally appeared on Clinical Pain Advisor