Racism

[Khaled Janom]

Very interesting discussion this week with Dr. Weinberger and Dr. Nnodim. The discussion explored how racial profiling in medicine can be a manifestation of the current social disparities through their epigentic role. We also discussed how migration patterns and geography affects health as a better model than the generalization of racial medicine.

[Michal Serafin]

The thing that surprised me most about the discussion was that race and genetics are not necessarily as connected as we were taught in medical school. In some cases, such as sickle cell disease, I think that the genetic component is highly correlated with the genesis of the genetic mutation, i.e. in Africa. Therefore, today it is more likely to find African Americans with this genetic mutation today. If we look at hypertension, the AHA states that African Americans have the highest prevalence of hypertension in the world. So there have to be some other factor/s such as environmental or epigenetic that drive these numbers, and not necessarily be based on the race of the population. As physicians we should be cognizant genetics and race are not 100% correlated and not to motivate our studies, treatments, or other therapies based on race alone.

[Brett Trzcinski]

Very productive discussion yesterday at SDH with Dr. Nnodim and Dr. Weinberger. I particularly liked Khaled’s suggestion that society guidelines need to be updated to acknowledge the negative health impacts of institutional racism. Such guidelines are important in clinicians’ ability to address this cause of health disparity in their daily practice. It was also refreshing to hear that the ABIM is beginning to identify the board questions that use race as a “buzzword” and revise these or eliminate them. As many of my cohort mentioned during our discussion that because these racial terms are imbedded in our medical education thru heuristics and licensing questions, they will continue to persist in our medical practice to the detriment of patient care.

[Said El Zein]

Very interesting discussion yesterday; I never questioned link between race and disease before as this was something we had been taught since medschool. The discussion had opened my mind about how little we really know especially when it comes to the effect of society, racism, stress etc.. on epigenetics. The idea that external stressors might (over time) affect a certain population’s genotype/phenotype is very interesting and this would be a very exciting topic for future genetic/ molecular / clinical research

[Aamer Javed]

This discussion was very eye opening to me as we are all taught from beginning of medical school to pay attention to certain races as they are predisposed to medical conditions. I was unaware of the biases that have been engrained from my training. Although, I avoid denoting races during case presentations and writing notes I can’t help but picture an African American when I hear “Sickle Cell disease.” This discussion inspired me to be aware of these biases and to not let it alter how I would treat patients subconsciously.

[Hibah Ismail]

It was interesting interesting to think about how diseases can be linked to migration patterns and geographical locations as opposed to race. The video about the elevated cortisol level was especially eye-opening, especially to know that whole populations were subject to increased stress levels as opposed to others and how that can directly affect their healthcare. Dr Weinberger’s analogy was very relatable, when he compared stress levels before and after exams to the stress levels that certain populations are subject to chronically.

[Raja Rabadi]

The articles and the videos were an eye-opener to how we can further help our patients. It was interesting to know that women of color would have a higher cortisol level than the rest of women. The reason was mainly because of their struggles are not related to socioeconomic reasons or lack of educations or lack health care access, but because of the experience of racism on a daily basis. To be honest, I don’t see my patients as black and white. When my patients come into the room, I try my best to help them with their medical issues and any other issues that might arise. I tend to get to know my patients better and see what kind of struggles they go through on a daily basis. From the ones I have spoken to, the main issues seem to arise from lack of money and financial stress that comes with it. In those situations, I speak to them and I try to refer them to a psychologist for ways to help them cope with stress.
I wanted to bring one thing up, During the SDH sessions, we always talk about how we should be open-minded and investigate further and dig deeper. However, we have 20min to do everything before the next patient comes. On Wed, I only had only 2 patients show up that day luckily and each one of them took 2hrs. Out in the world that is not plausible, we are expected to see at least 8-10 in 4-5hrs. I think there should be some sort of a screening tool, that would help the physician to have a focused and efficient sessions with patient that really do need the help

[Ali Saker]

It was surprising and striking to know that AA women have a higher cortisol level from other women . That influences my role to be aware of health iniquity between races, and to avoid unnecessary mentioning of race during case presentations.

[Nadine Abdallah]

I thought the videos were very interesting, and it was striking to learn that in 2019, African Americans are still subjected to various forms of racism. I can only imagine the stress, despair and even fear than individuals experience as a result of these racist acts. This also alerted me that as residents, we may inadvertently practice racism ourselves during our patient encounters in clinic and in the patient setting. We often order tests and formulate diagnoses based on race, and the stereotypes associated with that race. I started to think of the factors that contributed to this, and felt that race is integrated in internal medicine books, and board questions, and I started to wonder whether these associations were validated. I think that omitting race from case presentations, and documentation is a good first step to shed these biases.

[Hamza Salam]

Had a very interesting discussion on institutionalized racism and how it affects our patients. We have been taught several buzz words since medical school which co-relate with how some pathologies are more common in people of different races. The idea that these pathologies might be more related to geographical and social factors and not race is a valid counter argument and one that has not been thoroughly studied. In a world with multicultarism and a future generation which becomes more and more inter-racial in their genetics, the concept of race being linked to any sort of pathology has become more questionable. Even if racial factors make the presentation of a pathology atypical, does the low incidence of such a presentation change our clinical assessment or management? If not, then should race ever be brought up when dealing with patients? This discussion has influenced me in a way that I believe race is an insignificant factor when dealing with certain pathologies and the mentioning of race to any patient’s medical history is a practice of institutionalized racism and efforts should be made to avoid it.

[Hussam Tabaja]

I found this week’s discussion to be the most interesting topic by far. It showed how important it is to pay attention to labels that we commonly use to identify patients with. As mentioned during the discussion, most of us identify patients with their race while presenting their history. This is due to the way medicine has always been taught. Revealing the impact that such approach could and would have on our patients was shocking specially that our intentions are only to present our cases rather than to actively partake in racial profiling.

[Omar Chehab]

The videos were very interesting, and it was striking to learn that even African American women of high social economic status were subjected to racism which was shown from the high cortisol levels even after immigration of african women to the united states, the number of premature births increased. That influences my role to be aware of health iniquity between races, and to avoid unnecessary mentioning of race during case presentations.

[Arslan Mahmood]

We had a very interesting discussion this week during our SDH meeting. One thing that I learned was the fact the cortisol affect can affect people from every walking life. Even people who well off and do not have any financial restraints are subject to stress which leads to excessive cortisol and negative outcomes in life. I will pay special attention to this affect during my practical training

[M Rauf]

I was late and missed the session, but I heard it was great. I agree with the above reflections and would have probably felt the same way.

[Emilia Khalil]

As I was going through the videos and the articles, I was shocked to learn that people from different races had different health outcomes based only on the fact of racial differences due to environmental factors rather than genetic predisposition to illness. As women at this time are still being affected by socioeconomic status and environmental modifiers, where future generations suffer the consequences.

The Gardner story was an eye opener for me, as a practical example had a deep illustration of our daily interactions and assumptions. During my presentations or medical management of patients, I have found myself to unintentionally attribute multiple medical problems to racial differences without giving the real causative nature any further thought. I believe that this will change, as I have learned to question what I have took for granted before.

[Scott smith]

Interesting that health outcomes for minorities is worse than whites even when adjusted for similar care. I had typically assumed that discrepancies in outcomes was due to less access to care and implicit bias of providers. I would be interested to know how outcomes would be for minorities if the results were stratified by stress levels in some objective manner

[Nabeel Rizvi]

This SDH was an excellent discussion on institutionalized racism. It was surprising to see how little we really know especially when it comes to the effect it has on patients and its larger effect on society. The discussion on the idea that external stressors might over time affect a certain population’s genotype/phenotype and how migration patterns and geography affects health was an enlightening topic. The article on “Going public” took an excellent approach to understand racism on 3 levels: institutionalized, personally mediated, and internalized. We must all work hard to mitigate, and ultimately eliminate, institutional racism and racial discrimination not only in medicine, but in all areas of our society. My role as a physician is to be that gardener who will implement changes in my clinical practice.

[wsumed]

A is for America by Devin Scillian : 9781585360154

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