Long Covid highlights racism in medicine and the need for high-reliability hospital operations
The Covid-19 pandemic has shed light on the reality of medical racism. Research from Johns Hopkins University has found that Covid-19, as well as its long-term effects, are magnified by structural racism and discrimination. First, black, Hispanic, and Native American workers were most likely to be employed in industries such as restaurants, travel, retail, and manufacturing that have been disproportionately impacted by the pandemic. Due to existing health inequalities in the medical system, minority patients were also more reluctant to seek care. Additionally, when members of the Black, Hispanic, and Native American populations developed Covid-19 infection, they were at higher risk of morbidity and mortality.
Even though the patients experienced a mild case of Covid-19, they were still at risk of developing symptoms that linger long after their initial diagnosis. This group of people is known as the long-haul Covid, and their condition is often referred to as Long Covid. At the start of the pandemic, Long Covid was poorly understood, and many physicians did not believe it existed, nor did they have the proper resources to formally diagnose it. To complicate matters, experts believe that minority patients could be most at risk of Long Covid. Without a Long Covid diagnosis, it is difficult for patients to obtain appropriate care, participate in Long Covid research studies, take sick leave between work and rest – the primary recommended treatment – or get disability benefits.
It wasn’t until June 14, 2021 that the US Centers for Disease Control and Prevention finally released their guidance for diagnosing this condition. Without concrete guidance on how to diagnose and treat this condition, the symptoms of many minority patients were dismissed and this further marginalized patients who already faced barriers to receiving health care.
The Role of Racism in Health Care
Racism in medicine is not a new subject. In fact, research reveals that medical diagnoses and doctors’ perceptions are steeped in racism. Medical diagnoses may seem “objective”, but they may include ingrained racism. For example, race plays a role in measuring kidney function, so black patients are less likely to receive kidney transplants than white patients. As a result, while black Americans make up more than a third of dialysis patients, they receive only one in five kidney transplants.
In addition, physician biases can unintentionally harm marginalized patients. False beliefs about pain tolerance mean some doctors prescribe painkillers to black patients. In fact, Dr. Susan Moore, a black doctor hospitalized in December 2020 with Covid-19, took to Facebook with a video recorded on her smartphone that went viral. In the video, she detailed her doctor’s reluctance to prescribe medication for her Covid-related pain. After asking to be moved to another hospital, she was eventually discharged – and was quickly readmitted to another intensive care unit, where she died.
Understanding a patient’s background and culture – known as cultural competence – plays an important role in healthcare. For example, when black patients see black doctors, they are more likely to follow their doctor’s recommendations for lifesaving preventive care. One can also see the historical importance of cultural competence in health care: In the 17th century, community midwives served pregnant Black, Indigenous and immigrant women. Midwives learned informally and understood the culture and traditions of their patients. In the 1920s, the new midwifery license eliminated apprentice midwives. Pregnant black women today often choose to escape at least one aspect of racism in their obstetrical care by choosing black doctors.
Model hospitals after high-reliability organizations
One way to reduce discrimination in medicine is for hospitals, clinics, and other medical groups to cultivate the attributes of a High Reliability Organization, or HRO, loosely defined as “organizations that operate in complex, high-risk areas for long periods without serious accidents. or catastrophic failures.
A classic example of HRO can be found in the airline industry. Airplane pilots, for example, are tasked with lengthy checklists to make sure everything goes smoothly during their flight, because failure to follow the rules can lead to disaster. A doctor’s office that operates as an HRO operates the same way. In the pandemic, that would mean maintaining cleanliness, washing hands and wearing masks. A medical practice operating as an HRO knows exactly what to say to patients to help them receive the highest quality of care. Medical HROs do not ignore patients, instead they speak directly with the patient and center them in the care process. The opinions and views of everyone, regardless of status, are valued in an HRO.
Functioning as an HRO can help break down traditional hospital hierarchies that typically value seniority over experience. At the clinic, an attending physician supervises doctors in training: residents, interns and medical students. Participants are decision makers, and historically, input from junior colleagues, including medical residents, is often overlooked. Patient concerns can go unnoticed, whether they are intimidated by medical staff or rejected by caregivers. This means that valuable information from junior colleagues is often ignored in healthcare settings, undermining the standard of care for everyone – not just marginalized patients.
In addition, HROs are aware of their actions and are characterized by a high level of transparency and accountability. Just as an airline can rely on data to make safety decisions, medical companies can also harness 21st century data collection and analytics to learn more about the drivers of health care outcomes. health in marginalized patients.
Modeling health care after HROs can help reduce harm by normalizing the way care is delivered and identifying and mitigating sources of bias that can disenfranchise marginalized patients. These sources of bias are often ignored, or complainants may even experience backlash. Unfortunately, such a culture of fear and silence has catastrophic consequences.
Adopting an HRO model can seem overwhelming, but Actionable Patient Safety Solutions (APSS), a free comprehensive patient safety program, makes it possible. These checklist-like protocols for hospital procedures resemble airline pilot procedures. APSS also addresses the cultural aspects of patient care and discusses the importance of a culture of communication, in which patients and healthcare workers can voice their concerns and emerge from a toxic culture of silence and of fear.
Without efforts to make hospitals function more like HROs, the healthcare system will continue to harm minorities.
Photo: Irina Chatilova, Getty Images