I imagine many Minnesota physicians were heartened to see the headline “Good sign in health equity report” on the front page of the Star Tribune’s Science and Health section last Sunday, which highlighted the one bright spot in Minnesota Community Measurement’s 2017 health equity report.
I fear the take away might be: “We’re well on the way to healthy equity in Minnesota.”
That’s far from the truth. Despite welcome gains in the rate of doctors counseling overweight children of all racial backgrounds, the report demonstrated that black and American Indian Minnesotans continued to have poorer outcomes on almost every clinical measure, from diabetes and vascular care to asthma control and colorectal cancer screening.
Why is it that one of the healthiest states in the nation for white people continues to be one of the least healthy states for people of color? The Health Disparities Work Group of the Minnesota Medical Association is committed to addressing the persistent health disparities and inequities that are comparable to a chronic disease.
Structural racism in the healthcare system itself — and the unconscious biases of well-intentioned physicians — lead to poorer outcomes for people of color in Minnesota.
A big part of the effort to bring change is physician education. It’s very difficult for many physicians to see how their own implicit biases and human tendencies to stereotype affect their clinical decisions.
Most physicians are not racists or bad people. We’re dedicating our lives to providing the best possible care despite overwhelming patient loads, changing reimbursement models that require extensive documentation, learning new electronic recordkeeping systems and trying to get home to take care of our own families.
Under that load, we tend to default to stereotyping because it’s quicker — a common human reflex.
None of us is immune. In 2008, there was a consensus meeting at the National Institutes of Health (NIH) about the under-utilization of Hydroxyurea — the one FDA-approved drug and only effective treatment for Sickle Cell Disease.
Shortly thereafter, the NIH published a Consensus Statement designed to increase the use of Hydroxyurea — and followed that report with a survey that asked three questions:
1. Did you read the Consensus Statement?
2. Did you agree with the findings?
3. Do you now routinely offer Hydroxyurea to all of your sickle cell patients?
Strikingly, 100 percent of the black physicians surveyed read the report, 100 percent agreed with the findings and 100 percent routinely offered the drug.
Of the white physicians surveyed, 100 percent read the Consensus Statement and virtually 100 percent agreed — but only 40 percent routinely offered Hydroxyurea to their patients.
As a hematologist/oncologist serving patients with Sickle Cell Disease, I can remember standing in the nurse’s station when one of the nurses came up and asked me, “What about Hydroxyurea for so and so?” and I said, “He won’t do it.”
I decided he wouldn’t fill his prescription. I decided he wouldn’t take his medications. I decided he wouldn’t come to the clinic for the blood work that’s needed.
I get a little emotional when I think about it — because that’s not OK.
We as physicians have a lot of power over what we discuss with patients and what therapies we recommend. Maybe this patient wouldn’t have been able to adhere to the plan as prescribed — but I never even gave him the opportunity.
We tend to think that where there’s the presence of racism, there’s the presence of bad people, but that’s not the case. Many times, it’s a lack of awareness combined with a health-care delivery system that systematically favors one race over the others. The evidence of this is undeniable.
The MMA provides proof of these disparities in its Implicit Bias Education Series available online at www.mnmed.org/resources/Education/Online-Education-CME. We are also working to provide tools and resources to support physicians as they work to eradicate disparities in their own practices and throughout the health-care system.
We invite physicians across the state to join us in working to achieve health-care equity in Minnesota — and we encourage physicians to be aware that it’s far too early to claim “Mission Accomplished.”
Martin Luther King Jr. said it perfectly: “Of all the forms of inequity, injustice in health care is the most shocking and inhumane.”
Dr. Stephen C. Nelson is a pediatric hematologist/oncologist in Minneapolis.