#California hospitals ignored training about bias in care

[reasoningdaily]

More than two and a half years after a law took effect requiring maternity care staff to complete racism in medicine training, only 17% of hospitals were in compliance, according to an investigation recently published by the state Department of Justice.

The training matters, Attorney General Rob Bonta and others said during a press conference, because of the state’s persistently high death rates among Black mothers.

Though California is often looked at as a national model for improving maternal outcomes, Black women are still far more likely than others to die during pregnancy. They account for only 5% of pregnancies in the state but make up 21% of pregnancy-related deaths, according to the California Department of Public Health.

The mortality rate for Black infants is also three times higher than for white infants and nearly 1.5 times higher than for Pacific Islander babies, the second highest mortality rate, state data shows.

Investigations into the cause of all pregnancy-related deaths by the California Department of Public Health determined that more than half are preventable.

“We need to listen to this data. It’s screaming at us to do something,” Bonta said. “Listen to these women and make substantial transformative change before another patient is hurt, or worse.”

No hospitals were in compliance when the department began its investigation in 2021, and not a single employee had completed training.

Lawmakers passed the California Dignity in Pregnancy and Childbirth Act four years ago in an effort to reverse the vast disparities in maternal deaths among Black women, who are three times more likely than any other race to die during or immediately after pregnancy. The law requires hospitals and other facilities to train perinatal care providers on unconscious bias in medicine and racial disparities in maternal deaths. It took effect in January 2020.

Bonta recommended lawmakers adopt additional regulations to strengthen the law, including setting clear deadlines for compliance, designating a state agency to enforce the law and introducing penalties for noncompliance.

Former state Sen. Holly Mitchell, the Los Angeles Democrat who authored the bill, said “clearly more must be done” to implement the policy.

"It is my full expectation that every hospital across L.A. County and across the state join in making sure that their staff take the training,” said Mitchell, who is now a Los Angeles County supervisor. “We are simply asking them to follow the law.”

According to the department’s investigation report, about 76% of more than 200 hospitals surveyed had begun training employees by August 2022 but had not completed training. Two hospitals had not fully trained any staff, and 13 did not provide the department with any information.

“Nearly a third of facilities to which DOJ reached out began training only after DOJ contacted them, suggesting that DOJ’s outreach caused compliance in many cases,” the report states.

Black women report mistreatment at hospitals

It is well-documented that racism in health care settings contributes to poor outcomes. Black women in California consistently report poor experiences with medical professionals during pregnancy, including mistreatment because of their “race, age, socioeconomic class, sexuality, and assumed or actual marital status,” according to a recent research review and report by the California Department of Public health.

They also struggle to convince providers that they are in pain and report mistreatment when advocating for their health during pregnancy. A national survey from 2016 revealed half of white medical students and residents believed false and debunked myths about the biological differences between white and Black patients. Those who endorsed the beliefs were more likely to dismiss patients’ pain and make inaccurate treatment decisions.

“What is so deeply offensive about that is it is within our power to change,” Mitchell said.

Implicit bias training is the “bare minimum” of what health professionals can do to improve outcomes, said Assemblymember Akilah Weber, a Democrat from La Mesa and a medical doctor.

Research also shows maternal and infant health disparities among Black women and babies persist regardless of patients’ education or income levels. Celebrities like Serena Williams and Beyoncé have spoken out about their near-death experiences during childbirth.

Recent maternal deaths in Los Angeles

Earlier this year, the deaths of two Black women, Bridgette Cromer and April Valentine, in childbirth shook Los Angeles. Valentine’s death led to a state investigation and a $75,000 fine levied against Centinela Hospital Medical Center where her daughter was delivered via C-section. The investigation stated the hospital “failed to prevent the deficiencies…that caused, or are likely to cause, serious injury or death” to Valentine,, including repeated failure to take steps to prevent blood clots, a common pregnancy risk, even when Valentine complained of feeling heaviness in her leg, numbness and leg swelling.

The Los Angeles County Medical Examiner determined she died from a blood clot that traveled from her leg into her lungs.

Centinela announced its intent to close the maternity ward permanently days after Valentine’s family filed a wrongful death lawsuit. The maternity ward, which delivered more than 700 babies last year, closed last week.

In a GoFundMe post, Cromer’s family said they did not have autopsy results yet but noted that she was readmitted into the operating room after birth with major bleeding before dying.

Gabrielle Brown, an advocate with Black Women for Wellness, said Centinela’s maternity ward closure is “a stark reminder of how healthcare disparities persist in our society.”

“It reminds us of the implicit biases that have subtly influenced healthcare decisions, ultimately leading to an immense reduction in the accessibility and quality of care for many members of our community,” Brown said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

[kathleenseiber]

5 tips for coping with COVID-19 stat overload

Experts have a few important tips to help you handle the flood of COVID-19 statistics.

We’re confronted around the clock with troubling data as reporters, public health experts, and elected officials seek to understand and describe the path and impact of COVID-19. Rates of infection, hospital admission, and death are just a few key indicators.

“…we need statistics—good statistics—to talk sensibly about social problems.”

With so many numbers to digest, it can be challenging to separate COVID-19 statistics that may mislead from those that illuminate—something that has complicated the decision-making of government officials, according to recent news accounts.

In addition, while the widespread suspicion that numbers can be manipulated to support almost any conclusion predates the pandemic, partisanship around the response to the virus has further undermined Americans’ trust in COVID-19 data, according to a recent Pew Research Center survey.

But statistics are, of course, vital to understanding the current COVID-19 crisis, as well as other complex problems such as poverty, economic downturns, and climate change, and so researchers stress the importance of learning to distinguish what’s useful from what may be junk.

“We suspect that statistics may be wrong, that people who use statistics may be ‘lying’—trying to manipulate us by using numbers to somehow distort the truth,” writes sociologist Joel Best in his book Damned Lies and Statistics (University of California Press, 2012). But, he explains, “[t]he solution to the problem of bad statistics is not to ignore all statistics, or to assume that every number is false. Some statistics are bad, but others are pretty good, and we need statistics—good statistics—to talk sensibly about social problems.”

To help enhance our own statistical literacy as the pandemic continues, Andrew Gordon Wilson and Jonathan Niles-Weed, assistant professors at New York University’s Center for Data Science and the Courant Institute of Mathematical Sciences, outline some principles to keep in mind when evaluating figures cited in the news.

Wilson’s and Niles-Weed’s tips appear below, but both caution that training in data science alone isn’t enough to equip leaders to make perfect decisions.

“Many people—statisticians included—think that every problem can be solved by getting better data,” says Niles-Weed. “But even with perfect information, beating COVID will require politicians and public health experts to weigh very different considerations and make hard choices despite uncertainty. Data can help, but setting good policy also requires incorporating values and goals.”

1. Be certain about uncertainty in COVID-19 stats

“Many of the facts and figures we see come with big unstated error bars,” warns Wilson. “Suppose the only person in a village tested for coronavirus tests positive. It could be reported that the incidence rate in that region is 100%. You might say, ‘Surely they need to test more people?’ But how many people should we test for an accurate incidence estimate? Ten people, 100 people, 10,000 people? What’s a reasonable sample size? And do we only test symptomatic people? What fraction of the population is asymptomatic? What constitutes ‘accurate’?

“Similarly, models predicting quantities such as incidence rate take many variables as input, such as case fatality rate. These inputs similarly have big uncertainty attached to them. We should be conscious of uncertainty in parsing numbers we see in the media—the point predictions, without reasonable estimates of the error bars, are often meaningless.”

2. Separate trends and random occurrences

“Random variation in data can easily be mistaken for a genuine trend,” says Niles-Weed. “Even if the underlying situation is static, data may change from day to day because of random noise.

“For example, if a state’s newly confirmed cases are particularly high during a given week and lower the next, it’s easy to interpret this as meaningful: perhaps the high caseload in one week made citizens more cautious, leading to a drop in cases the next week after behaviors changed. But it’s just as likely that the first week was just a random outlier, and that nothing at all changed. By contrast, sustained day-over-day increases or decreases can indicate real trends.”

3. Interpret probabilities carefully

“It’s easy to confuse conditional probabilities, which is significant during a pandemic because it can lead to a misreading of testing data,” notes Wilson. “For example, in taking a test for coronavirus, we care about the probability that we have coronavirus given that we test positive—and not the probability that we test positive given that we have coronavirus.

“We have to carefully interpret what a probability is telling us. For example, the sensitivity of a test tells us the probability that we test positive, given that we have the condition. Similarly, another measure—the specificity—is the probability of a negative result if we don’t have the condition,” he says.

“If a test has a high sensitivity, and is thus reported as highly accurate, it does not mean testing positive means we are likely to have coronavirus, especially if the general rate of coronavirus in the population is low. Similarly, if the general rate of coronavirus is high, a negative test result may have high probability of being a false negative, even when the test has high specificity.”

4. Check for sample bias

“While a truly random sample can give precise information about the whole population, bias can arise if some people are more likely to be included than others,” explains Niles-Weed.

“For example, if a research team performs antibody tests on a random set of people walking down a city street, they will invariably miss those too sick to leave their beds. Data collected in this way can fail to be representative when extended to the whole population.”

5. Beware of missing information in COVID-19 statistics

“Many claims are factually correct but misleading due to crucial missing information,” says Wilson. “For example, it may be correct to report that a majority of confirmed cases in a region are Asian, but if only a very small number had tested positive, that may not be a meaningful finding. Similarly, there are many correlations that can easily be explained away by missing causal factors.

“It was reported at one time that health care workers in New York have a slightly lower incidence of coronavirus than the general population. Does that mean social distancing is ineffective, since these workers will be more exposed to infected people? If we condition on the fact that health care workers are trained to be vigilant in mask wearing, hand-washing, distancing, and sanitization, it likely means the exact opposite!”

Source: NYU

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[kristinsimmons]

The Dilemma of the Black Patient

By YOLONDA Y. WILSON, PhD

Last week a nurse posted a video of herself on Twitter mocking patients with the caption “We know when y’all are faking” followed by laughing emojis. Twitter responded with the hashtag #patientsarenotfaking, created by Imani Barbarin, and a slew of testimonials of negligent medical care. While the nurse’s video was not explicitly racialized, plenty in the black community felt a particular sting: there is clear evidence that this attitude contributes to the problem of black patients receiving substandard care, and that negative behavioral traits like faking or exaggerating symptoms are more likely to be attributed to black patients. The problem is so bad that it turns out racial bias is built right into an algorithm widely used by hospitals to determine patient need. 

Since we can’t rely on the system or algorithms, many health organizations and the popular media encourage patients to advocate for themselves and their loved ones by, for example, asking questions, asking for second (or more) opinions, “trusting [their] guts,” and not being afraid to speak up for themselves or their loved ones. But this ubiquitous advice to “be your own advocate” doesn’t take into account that not all “advocacy” is interpreted in the same way—especially when the advocacy comes from a black person. Sometimes a patient’s self-advocacy is dismissed as “faking;” sometimes it is regarded as anger or hostility.

Black male faces showing neutral expressions are more likely than white faces to be interpreted as angry, violent, or hostile, while black women are often perceived as ill-tempered and angry. These stereotypes can have a chilling effect on a person’s decision to advocate for themselves, or it can prompt violent reaction.       

This past August, LeeAnn Bienaime delivered her firstborn child, with the assistance of her husband, in the couple’s bathtub. No, the couple had not planned a home birth. Instead, they were turned away from Naval Medical Center in Portsmouth, VA even though Bienaime was in active labor. Thankfully, she and her baby were healthy. In discussing her ordeal, Ms. Bienaime said, “In hindsight I would have stood my ground and not left.” 

Consider what happened to Barbara Dawson when she stood her ground. Ms. Dawson was having trouble breathing and went to Calhoun Liberty Hospital in Blountstown, Florida. The emergency room docs determined that she was stable and discharged her. However, Ms. Dawson, knowing that something was not right with her body, refused to leave and pled to be examined further. Hospital staff responded by calling the police, who promptly arrested her for trespassing and disorderly conduct. Even after she collapsed outside of the arresting officer’s patrol vehicle, the officer assumed she was faking and can be heard on the dashcam video telling an unresponsive Dawson, “Falling down like this, laying down, that’s not going to stop you from going to jail.” Within hours, Ms. Dawson was dead from a pulmonary embolism, a blood clot in her lungs.

It’s an open secret in US hospitals that some patients and families are “good” and others are labeled “difficult.” “Good” patients and families are (or are perceived to be) compliant: they refrain from complaining or pushing back against medical advice or evaluations and abide by social norms of manners and politeness. “Difficult” patients and families challenge hospital staff.They may not easily acquiesce to hospital directives, they may ask questions, or they may have feelings.

But many patients and families who are regarded as “difficult” are merely trying to understand and advocate for themselves or their loved ones the best way they know how. Patients who speak up tend to be more satisfied with their medical encounter and gain better information about their medical conditions. Additionally, patient self-advocacy is thought to be on element in the prevention of medical mistakes. As Dr. Louise Aronson writes in defense of difficult patients in The New England Journal of Medicine, “There will always be patients and families who are considered high maintenance, challenging, or both by health care providers. Among them are a few with evident mental illness, but most are simply trying their best to understand and manage their own or their loved ones’ illness.” Dr. Aronson found herself reluctant to speak up for her father, who was a hospital patient, out of worry of being labeled “difficult” by the hospital staff. She spoke up anyway and likely saved her father’s life.   

For black patients, the consequence of being “difficult” can be as deadly as any disease, injury, or illness, while the consequence of notstanding firmly for oneself can also be dangerous. It has been well-documented that black patients don’t get adequate pain relief: a 2016 study of 418 medical students and residents found that approximately 50 percent believed that black patients have “thicker skin,”and are, therefore, unable to feel pain to the extent that white patients do. Black women are three times more likely to die during and shortly after pregnancy than white women—research has connected this disparity directly to institutional racism. Even wealthy, high-profile pregnant black women, like Beyoncé Knowles-Carter and Serena Williams, had their symptoms minimized or ignored, leading to critical complications. 

So what is a black patient to do?  Despite medical personnel’s insistence that she was simply “confused” as a result of her pain medications, Serena Williams could afford to not back down. Not everyone can. And the consequences can linger long past the medical encounter. Black patients who find themselves with biased providers tend to have shorter medical encounters. And those who pick up on a physician’s bias tend to have greater difficulty recalling the treatment plan, further contributing to worsened health outcomes.         

Medical personnel do not leave their biases at the door when they enter healthcare spaces and don their scrubs. In fact, data show that medical professionals exhibit similar levels of implicit bias as the general population, and that these biases seem to have at least some effect on treatment and care decisions.

There is some recognition that it is not black patients’ responsibility to effectively respond to bias. In September, the California State Legislature passed a bill that would require implicit bias training for healthcare workers. Ideally, such training would make healthcare workers cognizant of the racialized dynamics that can shape the medical encounter, including whether patients advocate for themselves and how their advocacy is perceived. While not a panacea and at minimum requires a long-term commitment to change, more states should take this first step. It could save lives. 

Yolonda Willson, PhD, is currently a fellow at the National Humanities Center and an Encore Public Voices fellow with the OpEd Project.

The post The Dilemma of the Black Patient appeared first on The Health Care Blog.

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[lauramalchowblog]

The Dilemma of the Black Patient

By YOLONDA Y. WILSON, PhD

Last week a nurse posted a video of herself on Twitter mocking patients with the caption “We know when y’all are faking” followed by laughing emojis. Twitter responded with the hashtag #patientsarenotfaking, created by Imani Barbarin, and a slew of testimonials of negligent medical care. While the nurse’s video was not explicitly racialized, plenty in the black community felt a particular sting: there is clear evidence that this attitude contributes to the problem of black patients receiving substandard care, and that negative behavioral traits like faking or exaggerating symptoms are more likely to be attributed to black patients. The problem is so bad that it turns out racial bias is built right into an algorithm widely used by hospitals to determine patient need. 

Since we can’t rely on the system or algorithms, many health organizations and the popular media encourage patients to advocate for themselves and their loved ones by, for example, asking questions, asking for second (or more) opinions, “trusting [their] guts,” and not being afraid to speak up for themselves or their loved ones. But this ubiquitous advice to “be your own advocate” doesn’t take into account that not all “advocacy” is interpreted in the same way—especially when the advocacy comes from a black person. Sometimes a patient’s self-advocacy is dismissed as “faking;” sometimes it is regarded as anger or hostility.

Black male faces showing neutral expressions are more likely than white faces to be interpreted as angry, violent, or hostile, while black women are often perceived as ill-tempered and angry. These stereotypes can have a chilling effect on a person’s decision to advocate for themselves, or it can prompt violent reaction.       

This past August, LeeAnn Bienaime delivered her firstborn child, with the assistance of her husband, in the couple’s bathtub. No, the couple had not planned a home birth. Instead, they were turned away from Naval Medical Center in Portsmouth, VA even though Bienaime was in active labor. Thankfully, she and her baby were healthy. In discussing her ordeal, Ms. Bienaime said, “In hindsight I would have stood my ground and not left.” 

Consider what happened to Barbara Dawson when she stood her ground. Ms. Dawson was having trouble breathing and went to Calhoun Liberty Hospital in Blountstown, Florida. The emergency room docs determined that she was stable and discharged her. However, Ms. Dawson, knowing that something was not right with her body, refused to leave and pled to be examined further. Hospital staff responded by calling the police, who promptly arrested her for trespassing and disorderly conduct. Even after she collapsed outside of the arresting officer’s patrol vehicle, the officer assumed she was faking and can be heard on the dashcam video telling an unresponsive Dawson, “Falling down like this, laying down, that’s not going to stop you from going to jail.” Within hours, Ms. Dawson was dead from a pulmonary embolism, a blood clot in her lungs.

It’s an open secret in US hospitals that some patients and families are “good” and others are labeled “difficult.” “Good” patients and families are (or are perceived to be) compliant: they refrain from complaining or pushing back against medical advice or evaluations and abide by social norms of manners and politeness. “Difficult” patients and families challenge hospital staff.They may not easily acquiesce to hospital directives, they may ask questions, or they may have feelings.

But many patients and families who are regarded as “difficult” are merely trying to understand and advocate for themselves or their loved ones the best way they know how. Patients who speak up tend to be more satisfied with their medical encounter and gain better information about their medical conditions. Additionally, patient self-advocacy is thought to be on element in the prevention of medical mistakes. As Dr. Louise Aronson writes in defense of difficult patients in The New England Journal of Medicine, “There will always be patients and families who are considered high maintenance, challenging, or both by health care providers. Among them are a few with evident mental illness, but most are simply trying their best to understand and manage their own or their loved ones’ illness.” Dr. Aronson found herself reluctant to speak up for her father, who was a hospital patient, out of worry of being labeled “difficult” by the hospital staff. She spoke up anyway and likely saved her father’s life.   

For black patients, the consequence of being “difficult” can be as deadly as any disease, injury, or illness, while the consequence of notstanding firmly for oneself can also be dangerous. It has been well-documented that black patients don’t get adequate pain relief: a 2016 study of 418 medical students and residents found that approximately 50 percent believed that black patients have “thicker skin,”and are, therefore, unable to feel pain to the extent that white patients do. Black women are three times more likely to die during and shortly after pregnancy than white women—research has connected this disparity directly to institutional racism. Even wealthy, high-profile pregnant black women, like Beyoncé Knowles-Carter and Serena Williams, had their symptoms minimized or ignored, leading to critical complications. 

So what is a black patient to do?  Despite medical personnel’s insistence that she was simply “confused” as a result of her pain medications, Serena Williams could afford to not back down. Not everyone can. And the consequences can linger long past the medical encounter. Black patients who find themselves with biased providers tend to have shorter medical encounters. And those who pick up on a physician’s bias tend to have greater difficulty recalling the treatment plan, further contributing to worsened health outcomes.         

Medical personnel do not leave their biases at the door when they enter healthcare spaces and don their scrubs. In fact, data show that medical professionals exhibit similar levels of implicit bias as the general population, and that these biases seem to have at least some effect on treatment and care decisions.

There is some recognition that it is not black patients’ responsibility to effectively respond to bias. In September, the California State Legislature passed a bill that would require implicit bias training for healthcare workers. Ideally, such training would make healthcare workers cognizant of the racialized dynamics that can shape the medical encounter, including whether patients advocate for themselves and how their advocacy is perceived. While not a panacea and at minimum requires a long-term commitment to change, more states should take this first step. It could save lives. 

Yolonda Willson, PhD, is currently a fellow at the National Humanities Center and an Encore Public Voices fellow with the OpEd Project.

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[kristinsimmons]

The Dilemma of the Black Patient

By YOLONDA Y. WILSON, PhD

Last week a nurse posted a video of herself on Twitter mocking patients with the caption “We know when y’all are faking” followed by laughing emojis. Twitter responded with the hashtag #patientsarenotfaking, created by Imani Barbarin, and a slew of testimonials of negligent medical care. While the nurse’s video was not explicitly racialized, plenty in the black community felt a particular sting: there is clear evidence that this attitude contributes to the problem of black patients receiving substandard care, and that negative behavioral traits like faking or exaggerating symptoms are more likely to be attributed to black patients. The problem is so bad that it turns out racial bias is built right into an algorithm widely used by hospitals to determine patient need. 

Since we can’t rely on the system or algorithms, many health organizations and the popular media encourage patients to advocate for themselves and their loved ones by, for example, asking questions, asking for second (or more) opinions, “trusting [their] guts,” and not being afraid to speak up for themselves or their loved ones. But this ubiquitous advice to “be your own advocate” doesn’t take into account that not all “advocacy” is interpreted in the same way—especially when the advocacy comes from a black person. Sometimes a patient’s self-advocacy is dismissed as “faking;” sometimes it is regarded as anger or hostility.

Black male faces showing neutral expressions are more likely than white faces to be interpreted as angry, violent, or hostile, while black women are often perceived as ill-tempered and angry. These stereotypes can have a chilling effect on a person’s decision to advocate for themselves, or it can prompt violent reaction.       

This past August, LeeAnn Bienaime delivered her firstborn child, with the assistance of her husband, in the couple’s bathtub. No, the couple had not planned a home birth. Instead, they were turned away from Naval Medical Center in Portsmouth, VA even though Bienaime was in active labor. Thankfully, she and her baby were healthy. In discussing her ordeal, Ms. Bienaime said, “In hindsight I would have stood my ground and not left.” 

Consider what happened to Barbara Dawson when she stood her ground. Ms. Dawson was having trouble breathing and went to Calhoun Liberty Hospital in Blountstown, Florida. The emergency room docs determined that she was stable and discharged her. However, Ms. Dawson, knowing that something was not right with her body, refused to leave and pled to be examined further. Hospital staff responded by calling the police, who promptly arrested her for trespassing and disorderly conduct. Even after she collapsed outside of the arresting officer’s patrol vehicle, the officer assumed she was faking and can be heard on the dashcam video telling an unresponsive Dawson, “Falling down like this, laying down, that’s not going to stop you from going to jail.” Within hours, Ms. Dawson was dead from a pulmonary embolism, a blood clot in her lungs.

It’s an open secret in US hospitals that some patients and families are “good” and others are labeled “difficult.” “Good” patients and families are (or are perceived to be) compliant: they refrain from complaining or pushing back against medical advice or evaluations and abide by social norms of manners and politeness. “Difficult” patients and families challenge hospital staff.They may not easily acquiesce to hospital directives, they may ask questions, or they may have feelings.

But many patients and families who are regarded as “difficult” are merely trying to understand and advocate for themselves or their loved ones the best way they know how. Patients who speak up tend to be more satisfied with their medical encounter and gain better information about their medical conditions. Additionally, patient self-advocacy is thought to be on element in the prevention of medical mistakes. As Dr. Louise Aronson writes in defense of difficult patients in The New England Journal of Medicine, “There will always be patients and families who are considered high maintenance, challenging, or both by health care providers. Among them are a few with evident mental illness, but most are simply trying their best to understand and manage their own or their loved ones’ illness.” Dr. Aronson found herself reluctant to speak up for her father, who was a hospital patient, out of worry of being labeled “difficult” by the hospital staff. She spoke up anyway and likely saved her father’s life.   

For black patients, the consequence of being “difficult” can be as deadly as any disease, injury, or illness, while the consequence of notstanding firmly for oneself can also be dangerous. It has been well-documented that black patients don’t get adequate pain relief: a 2016 study of 418 medical students and residents found that approximately 50 percent believed that black patients have “thicker skin,”and are, therefore, unable to feel pain to the extent that white patients do. Black women are three times more likely to die during and shortly after pregnancy than white women—research has connected this disparity directly to institutional racism. Even wealthy, high-profile pregnant black women, like Beyoncé Knowles-Carter and Serena Williams, had their symptoms minimized or ignored, leading to critical complications. 

So what is a black patient to do?  Despite medical personnel’s insistence that she was simply “confused” as a result of her pain medications, Serena Williams could afford to not back down. Not everyone can. And the consequences can linger long past the medical encounter. Black patients who find themselves with biased providers tend to have shorter medical encounters. And those who pick up on a physician’s bias tend to have greater difficulty recalling the treatment plan, further contributing to worsened health outcomes.         

Medical personnel do not leave their biases at the door when they enter healthcare spaces and don their scrubs. In fact, data show that medical professionals exhibit similar levels of implicit bias as the general population, and that these biases seem to have at least some effect on treatment and care decisions.

There is some recognition that it is not black patients’ responsibility to effectively respond to bias. In September, the California State Legislature passed a bill that would require implicit bias training for healthcare workers. Ideally, such training would make healthcare workers cognizant of the racialized dynamics that can shape the medical encounter, including whether patients advocate for themselves and how their advocacy is perceived. While not a panacea and at minimum requires a long-term commitment to change, more states should take this first step. It could save lives. 

Yolonda Willson, PhD, is currently a fellow at the National Humanities Center and an Encore Public Voices fellow with the OpEd Project.

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