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Race, Ethnicity, and Culture in the Medical Record: Implicit Bias or Patient Advocacy?

  • Matthew C. FadusEmail author
  • Oluwatobiloba T. Odunsi
  • Lindsay M. Squeglia
In Depth Article: Commentary
First Online:
On morning rounds, before meeting newly admitted patients from overnight, an inpatient team listens to the medical students present the patients’ histories:

Medical student 1: “A 32-year-old male presented to the emergency room by police escort for erratic behavior. Collateral from law enforcement reported that the patient was hostile and aggressive toward others in the facility at which he lives, and the patient reported experiencing auditory hallucinations to harm others.”

Medical student 2: “A 25-year-old African American male presented to the emergency room for making homicidal threats toward others. He was brought in by emergency medical services, and overnight there was concern that he was experiencing auditory hallucinations and responding to internal stimuli.”

The clinical vignettes reported from the medical students identify two patients with similar presentations: hostility, aggression, and homicidality in the context of psychosis. However, subtle differences occur between...

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Notes

Compliance with Ethical Standards

Disclosures

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Croskerry P. From mindless to mindful practice — cognitive bias and clinical decision making. N Engl J Med. 2013;368(26):2445–8.CrossRefGoogle Scholar
  2. 2.
    Cognitive Biases in Healthcare. The Joint Commission-Quick Safety (28) 1–3. 2016. Retrieved from https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_28_Oct_2016.pdf. Accessed 1/20/19.
  3. 3.
    Feisthamel KP, Schwartz RC. Differences in mental health counselors’ diagnoses based on client race: an investigation of adjustment, childhood, and substance-related disorders. J Ment Health Couns. 2009;31:47–59.CrossRefGoogle Scholar
  4. 4.
    Greenwald AG, Banaji MR. Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychol Rev. 1995;102:4–27.CrossRefGoogle Scholar
  5. 5.
    Devine PG, Forscher PS, Austin AJ, Cox WTL. Long-term reduction in implicit race bias: a prejudice habit-breaking intervention. J Exp Soc Psychol. 2012;48(6):1267–78.CrossRefGoogle Scholar
  6. 6.
    Fitzgerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18:1–18.CrossRefGoogle Scholar
  7. 7.
    Zestcott CA, Blair IV, Stone J. Examining the presence, consequences, and reduction of implicit bias in health care: a narrative review. Group Process Intergroup Relat. 2016;19:528–42.CrossRefGoogle Scholar
  8. 8.
    Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105:60–76.CrossRefGoogle Scholar
  9. 9.
    Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolyisis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.CrossRefGoogle Scholar
  10. 10.
    van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic health disparities in health? Am J Public Health. 2003;93(2):248–55.CrossRefGoogle Scholar
  11. 11.
    Cohn JN. The use of race and ethnicity in medicine: lessons from the African American heart failure trial. J Law Med Ethics. 2006;34(3):552–4.CrossRefGoogle Scholar
  12. 12.
    Ellison GT, Smart A, Tutton R, Outram S, Ashcroft R, Martin P. Racial categories in medicine: a failure of evidence-based practice? PLoS Med. 2007;4(9):e287.CrossRefGoogle Scholar
  13. 13.
    Coleman KJ, Stewart C, Waitzfelder BE, Zeber JE, Morales LS, Ahmed AT, et al. Racial/ethnic differences in diagnoses and treatment of mental health conditions across healthcare systems participating in the mental health research network. Psychiatr Serv (Washington, DC). 2016;67(7):749–57.CrossRefGoogle Scholar
  14. 14.
    Braun L, Fausto-Sterling A, Fulwiley D, Hammonds EM, Nelson A, Quivers W, et al. Racial categories in medical practice: how useful are they? PLoS Med. 2007;4(9):e271.CrossRefGoogle Scholar
  15. 15.
    Snipes SA, Sellers SL, Tafawa AO, Cooper LA, Fields JC, Bonham VL. Is race medically relevant? A qualitative study of physicians’ attitudes about the role of race in treatment decision-making. BMC Health Serv Res. 2011;11:183.CrossRefGoogle Scholar
  16. 16.
    Loue S, Wilson-Delfosse A, Limbach K. Identifying gaps in the cultural competence/sensitivity components of an undergraduate medical school curriculum: a needs assessment. J Immigr Minor Health. 2015;17:1412–9.CrossRefGoogle Scholar
  17. 17.
    Ladson G, Lin J, Flores A, Magrane D. An assessment of cultural competence of first- and second-year medical school students at a historically diverse medical school. Am J Obstet Gynecol. 2006;195:1457–62.CrossRefGoogle Scholar
  18. 18.
    Genao I, Bussey-Jones J, St. George DM, Corbie-Smith G. Empowering students with cultural competence knowledge: randomized controlled trial of a cultural competence curriculum for third-year medical students. J Natl Med Assoc. 2009;101(12):1241–6.CrossRefGoogle Scholar
  19. 19.
    Teal CR, Gill AC, Green AR, Crandall S. Helping medical learners recognise and manage unconscious bias toward certain patient groups. Med Educ. 2012;46:80–8.CrossRefGoogle Scholar
  20. 20.
    Sukhera J, Chahine S. Reducing mental illness stigma through unconscious bias-informed education. MedEdPublish. 2016;5(2):16.CrossRefGoogle Scholar
  21. 21.
    Dao DK, Goss AL, Hoekzema AS, Kelly LA, Logan AA, Mehta SD, et al. Integrating theory, content, and method to foster critical consciousness in medical students: a comprehensive model for cultural competence training. Acad Med. 2017;92:335–44.CrossRefGoogle Scholar
  22. 22.
    Chun MB, Young KG, Honda AF, Belcher GF, Maskarinec GG. The development of a cultural standardized patient examination for a general surgery residency program. J Surg Educ. 2012;69:650–8.CrossRefGoogle Scholar
  23. 23.
    Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33.CrossRefGoogle Scholar
  24. 24.
    Kramer EJ, Kwong K, Lee E, Chung H. Cultural factors influencing the mental health of Asian Americans. West J Med. 2002;176(4):227–31.Google Scholar
  25. 25.
    Mandell DS, Ittenbach RF, Levy SE, Pinto-Martin JA. Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder. J Autism Dev Dis. 2007;37(9):1795–802.CrossRefGoogle Scholar
  26. 26.
    Walkup JT, McAlpine DD, Olfson M, Labay LE, Boyer C, Hansell S. Patients with schizophrenia at risk for excessive antipsychotic dosing. J Clin Psychiatry. 2000;61:344–8.CrossRefGoogle Scholar
  27. 27.
    Goff PA, Jackson MC, Di Leone BA, Culotta CM, DiTomasso NA. The essence of innocence: consequences of dehumanizing black children. J Pers Soc Psychol. 2014;106(4):526–45.CrossRefGoogle Scholar
  28. 28.
    Stevens T, Morash M. Racial/ethnic disparities in boys’ probability of arrest and court actions in 1980 and 2000: the disproportionate impact of “getting tough” on crime. Youth Violence Juvenile Justice. 2015;13:77–95.CrossRefGoogle Scholar
  29. 29.
    Wu J. Racial/ethnic discrimination and prosecution. Crim Justice Behav. 2016;43:437–58.CrossRefGoogle Scholar
  30. 30.
    Multi-racial in America: Proud, Diverse, and Growing in Numbers. Pew Research Center. 2015. Retrieved from: http://www.pewsocialtrends.org/2015/06/11/multiracial-in-america/. Accessed 1/20/19.
  31. 31.
    Lackland DT. Racial differences in hypertension: implications for high blood pressure management. Am J Med Sci. 2014;348(2):135–8.CrossRefGoogle Scholar
  32. 32.
    Cooper RS, Wolf-Maier K, Luke A, Adeyemo A, Banegas JR, Forrester T, et al. An international comparative study of blood pressure in populations of European vs. African descent. BMC Med. 2005;3:2.CrossRefGoogle Scholar
  33. 33.
    Gibson MA. Immigrant adaptation and patterns of acculturation. Hum Dev. 2001;44:19–23.CrossRefGoogle Scholar
  34. 34.
    Njenga FG, Kang'ethe RK. Anorexia nervosa in Kenya. East Afr Med J. 2004;81:188–93.CrossRefGoogle Scholar
  35. 35.
    Njenga F. The concept of mental disorder: an African perspective. World Psychiatry. 2007;6(3):166–7.Google Scholar
  36. 36.
    ProjectImplicit. Retrieved from https://implicit.harvard.edu/implicit/education.html. Accessed 1/20/19.
  37. 37.
    Teal CR, Shada RE, Gill AC, et al. When best intentions aren't enough: helping medical students develop strategies for managing bias about patients. J Gen Intern Med. 2010;25(suppl 2):S115–8.CrossRefGoogle Scholar
  38. 38.
    Littleford LN, Wright MO, Sayoc-Parial M. White student's intergroup anxiety during same-race and interracial interactions: a multimethod approach. Basic Appl Soc Psychol. 2005;27(1):85–94.CrossRefGoogle Scholar
  39. 39.
    Dalton RF, Evans LJ, Cruise KR, Feinstein RA, Kendrick RF. Race differences in mental health service access in a secure male juvenile justice facility. J Offender Rehabil. 2009;48(3):194–209.CrossRefGoogle Scholar
  40. 40.
    Lieberman JA, Yunis J, Egea E, Canoso RT, Kane JM, Yunis EJ. HLA-B38, DR4, DQw3 and clozapine-induced agranulocytosis in Jewish patients with schizophrenia. Arch Gen Psychiatry. 1990;47:945–8.CrossRefGoogle Scholar

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© Academic Psychiatry 2019

Authors and Affiliations

  1. 1.Medical University of South CarolinaCharlestonUSA

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