The issue of racial equity in healthcare is becoming more and more prevalent. Much of the way medical care is handled in the United States is to the detriment of Black patients, who not only face the threat of physician bias, but also the systematic bias built in to the very foundations of medicine – from what our medical students learn in school to the algorithms experienced physicians use to diagnose patients.
The Washington Post recently highlighted the story of Alphonso Harried, a 46-year-old St. Louis resident living with kidney disease. He’s currently undergoing regular dialysis as he awaits a kidney transplant. The article notes that, in the United States, Black patients are four times more likely than White patients to have kidney failure, but are also much less likely to make it on the wait list for a transplant or receive a transplant once they get on the list.
The answer may lie in a medical algorithm doctors use to evaluate the stages of kidney disease care, which include diagnosis, dialysis, and transplantation. This algorithm uses race as a factor when making treatment recommendations, which, according to the Post, “has recently come under fire for being imprecise, leading to potentially worse outcomes for Black patients and less chance of receiving a new kidney.”
(It’s important to note that this is not the first time a medical algorithm was tied to negative outcomes for Black patients.)
About the algorithm
A recent statement from the National Kidney Foundation asserts that race modifiers should not be included in equations used to estimate kidney function. The leaders also stated that “current race-based equations should be replaced by a substitute that is accurate, representative, unbiased, and provides a standardized approach to diagnosing kidney diseases.”
Currently, the primary diagnostic method for detecting and treating kidney disease is estimated glomerular filtration rate (eGFR). This equation uses age, sex, body weight, and race to determine and measure kidney function. However, as we are learning, race is more of a social than biological construct – meaning, in part, that the factors and issues that may cause Black patients to have different outcomes than White patients may have more to do with socio-economic causes rather than biological race.
In a letter to colleagues, the National Kidney Foundation in partnership with the American Society of Nephrology agreed that:
1) “race modifiers should not be included in equations to estimate kidney function and
2) current race-based equations should be replaced by a suitable approach that is accurate, inclusive, and standardized in every laboratory in the United States. Any such approach must not differentially introduce bias, inaccuracy, or inequalities.”
In short, this call for change in diagnosis and management of kidney disease in Black patients is a welcome step in addressing racial inequity in our healthcare system – an inequity many patients are unaware exists.
As Alphonso Harried continues to wait for a kidney, he told the Washington Post, “I really wish someone would have mentioned it…knowing that this one little test that I didn’t know anything about could keep me from — or prolong me — getting a kidney.”
Systematic racism in healthcare
Racism in healthcare is, unfortunately, nothing new. All of us have implicit and unconscious bias, whether we are aware of them or not. This doesn’t mean we or the entire healthcare system is racist; it simply means that we have certain cultural biases built in to our experiences as people, and sometimes those implicit biases can have a negative impact on others.
In healthcare, implicit bias can affect patient outcomes in a variety of ways. The American College of Cardiology discusses some of these disparities:
- Black and Hispanic patients are less likely than White patients to receive pain medication – even for traumatic injuries like broken bones. Those who do receive pain management receive medication at lower doses than other patients, even when reporting higher levels of pain.
- In 2018, only 4 percent of cardiology residents here in the U.S. were Black, and only 4.8 percent were Hispanic.
- Black patients are less likely than White patients to receive evidence-based care for things like stroke, myocardial infarction, and heart failure.
When systemic racism or bias leads to medical malpractice and harm, consult with an experienced attorney about your next steps. You are not alone.
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At McGowan, Hood, Felder & Phillips, LLC, we hold the right people accountable when you or a loved one are harmed by a physician’s negligence or discrimination. We want to help and we will fight for your rights. Contact us today to tell us your story. To schedule a free consultation with one of our South Carolina attorneys, call 803-327-7800, or we invite you to reach out to us through our contact page.
Randy is the former President of the South Carolina Association for Justice. He has been certified by the American Board of Professional Liability as a specialist in Medical Malpractice Law which is recognized by the South Carolina Bar. Randy has also been awarded the distinction of being a “Super Lawyer” 10 times in the last decade. He has over 25 years of experience helping injured people fight back against corporations, hospitals and wrong-doers.
Read more about S. Randall Hood