We Can Do Better

So what can we do about this? Increasing health literacy in the African American community is crucial to helping patients understand and manage their hypertension, diabetes, asthma, and other chronic medical conditions. This is challenging in part because of the history of medical distrust in the African American community. From Dr. J. Marion Sims’s gynecological subjects to the Tuskegee Syphilis Study, our history of medical racism enforces patient bias. This discourages some African Americans from seeking and complying with the care they need. Thus, the terrible cycle continues because the lack of appropriate medical care will lead to more disease and death. Training a higher percentage of diverse physicians is one method to build trust within the black community. Currently African Americans make up 4 percent of U.S. physicians, a number that has remained the same since the 1960s. A diverse physician workforce that mirrors the population cared for by physicians will positively affect patient health literacy and medical compliance within minority communities.

Emergency medicine has the perfect platform to engage apathetic patients who eventually seek care due to the severity of disease or lack of access to primary health care. As emergency departments work within accountable care organizations, the emergency visit can serve as the entry point to primary care, case management, and community resources via electronic health records and meaningful use. Health informatics can help clinical care at the emergency department bedside by giving access to the patient’s complete health record. Interoperability of health information can incorporate primary caregivers, specialists, and case managers to better serve patients. Health informatics also gives data that can be analyzed to better serve at-risk health populations via public health initiatives. Public health resources can help address overcrowded housing, access to healthy foods, personal health literacy, and other social determinants of health.

Addressing patient bias may be an obvious method to decrease health disparities; however, practitioner bias may not be so apparent. Practitioner prejudice is based on our personal histories and subconscious preferences that affect our medical decision making. Doctors’ decisions about cardiac catheterization versus thrombolysis, pain management in renal colic, and offering knee replacements are influenced by physician implicit bias against black patients. Uncovering our own physician bias with implicit association testing is critical. However, more research is needed to incorporate implicit bias training in graduate medical education and develop implicit bias CME for physicians in different stages of their careers that is measurable and sustainable.

The COVID-19 pandemic is highlighting the importance of first responders every day. As emergency physicians, we are on the front lines treating and caring for increasing numbers of COVID-19 patients daily. We are also witnessing the effect of health care disparities, one patient at a time. We can be the first responders to health care disparities as well. The National Institute on Minority Health and Health Disparities has issued special notice of the urgent need for research on the impact of the SARS-CoV-2 pandemic within National Institutes of Health–designated health disparity populations. Emergency medicine is uniquely positioned to spearhead health disparity research.

COVID-19 has been the unexpected game changer in 2020. The economy is at a standstill, financial markets are crashing, health care capacity is bursting at its seams, and people across the world are dying. The pandemic is exacerbating health care disparities. How we handle the next pandemic will be determined by many factors, including how we address racial disparities in health care today.