Pearls from 2/9/21 Medicine LEADS

Wednesday, February 10, 2021

The Feb. 9, 2021 session of Duke Medicine LEADS featured a discussion led by John Duronville, MD, and Dinushika Mohottige, MD, MPH, "Case Dissection: Confronting Structural Racism and Implicit Bias."

Panelist included, Manesh Patel, MD; George Yankey, MD; Andy Mumm, MD; Yolanda Guzman, MD; and Jon Reichstein, MD, who weighed in for the health equities and disparities in medicine discussion.

Here are pearls and takeaways from the session:

  1. Racial disparities in cardiovascular care delivery are extensive and persistent including less receipt of PCI among Black vs. White patients on dialysis.

  2. Stigmatizing language in the chart may convey harmful narratives about a patient, which can then be transferred and perpetuated among other providers. Strive for objectivity and structural contextualization; avoid casting doubt on pain, remove irrelevant data that encourages stereotyping, avoid implications of irresponsibility, and choose words carefully (such as opiate rather than narcotic).

  3. Black and other ​minoritized patients often have personal and health narratives that are deeply ​impacted by current and historic experiences of marginalization and inequity, ​inside and outside of health care. The accumulation of these experiences over time may contribute to mistrust of providers and institutions. Providers should strive to demonstrate trustworthiness and earn trust; these processes require time, empathy, cultural humility, and continued investment in relationship building.

  4. When a patient portrays a behavior that doesn’t initially make sense to you as a provider, stop and ask: “what might be contributing to this individual's behavior, words, or expression?” We as providers are often doing things TO patients rather than FOR them, and patients can perceive this as lack of agency over their own treatment. We should strive to partner with our patients and engage in shared and informed decision making.

  5. We should not only strive to give care that is compassionate, rooted in evidence-based medicine but care that is also equitable. This means understanding factors beyond physiology that can impact care and then making the critical adjustments to our approach necessary to tailor care and achieve equity.

This session was not recorded.

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.