Central PA Medicine Summer2020 - 7

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* Gender and race biases: women are
undertreated for pain; African Americans
are treated less aggressively for pain than
any other group.
* Socioeconomic bias: there's evidence
that those of lower socioeconomic
class receive less aggressive treatment,
are given less information, etc. It was
assumed this patient was of a lower socioeconomic class probably attributable
to her race and diagnosis of Sickle Cell
Disease (SCD).
* Diagnosis bias: it is well documented
that clinicians and other health
care professionals have significant
biases towards patients with SCD
and as a result undertreat their pain.
Diagnostic delay of life-threatening
events such as acute chest syndrome
also is well documented.
How can physicians support their
African American colleagues and help
ensure the same level of care for all patients,
especially African Americans in whom
health care disparities are unacceptable
and evident in poor health outcomes/
quality of life measures?
* Take down your guard and educate
yourself on the uncomfortable issue of
racism by reading some of the references
in Ms. Christina La Gamma's article
* Consistently verbalize to those using
racially insensitive language in closed
circles your intolerance of that language
* Actively advocate for and demand
diversity in system/office leadership
* Help restructure the admission process
and committee composition in medical
schools to facilitate the recruitment
of more diverse classes - minority or
rural low-income students cannot do
research while trying to pay for education, support themselves and family, e.g.
Those of disadvantaged backgrounds on
admissions committees bring a different
and much needed perspective to the
admission/decision-making process.
* If you are involved in teaching reconsider
how the curriculum is structured and
taught; who are the decision makers?

"The ultimate tragedy
is not the oppression
and cruelty by the
bad people but the
silence over that by
the good people."
MLK, Jr.
"The ultimate
measure of a man
is not where he
stands in moments
of comfort and
convenience, but
where he stands at
times of challenge
and controversy."
MLK, Jr.
"He who passively
accepts evil is as
much involved in it
as he who helps to
perpetrate it. He who
accepts evil without
protesting against it
is really cooperating
with it."
MLK, Jr.

Is the evaluation process unbiased? Are
faculty trained and evaluated on cultural
competency, diversity and inclusion? Is
faculty diverse?
* E ngage with local school boards,
county commissioners, and state and
federal legislators to ensure equal
educational opportunities
* Write/call your legislators about policies
that do not support equality for all
whether in health care services delivery
or public health matters (e.g. are your
patients "non-adherent" due to the
cost of care/meds; are your pediatric
patients' blood lead levels elevated due
to their community's tap water; is there
access to affordable, healthy foods in
the community you serve?)
Now that the nation (and the world) can
no longer ignore the impact of structural
and institutionalized racism, physicians
must do major soul searching combined
with actively addressing the structures and
systems which allow the casual taking of a
life by law enforcement on camera or allowing implicit biases to negatively impact the
care rendered. Maintaining the status quo
must be rejected. Colleagues, the team we
lead and the systems within which we work
must be held accountable. Physicians must
not be afraid to say "Black Lives Matter"
not because they are "more important" but
because as Reverend Dr. Martin Luther
King, Jr. said in his famous 1963 "I Have
a Dream" speech, "America has given the
Negro people a bad check"..."we've come
to cash this check."
Case reference: Poles G. (2019) Sickle Cell
Disease Patient. In: Martin M., Heron S.,
Moreno-Walton L., Strickland M. (eds)
Diversity and Inclusion in Quality Patient
Care. Springer, Cham (Diversity and
Inclusion in Quality Patient Care - Your
Story/Our Story - A Case-Based Compendium; 2nd ed. 2019; pg. 181-87)

Central PA Medicine Summer 2020 7
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Central PA Medicine Summer2020

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