November - 202119ADDRESSING SYSTEMIC RACISM IN HEALTHCARE THROUGH SHARED DECISION MAKINGMary I. O'Connor, M.D., Chair, Movement is Life, andTravelle Ellis, M.D., Ph.D., Member of Steering Committee, Movement is Life, Yale School of Medicine ByCOVID-19 has laid bare the inequities that plague our healthcare system. Although we know that the virus disproportionately affects African Americans, Latinos and the economically disadvantaged, the virus itself is not the root cause of these inequities. Why is it that people of color and poor people are much more likely to be hospitalized or die from the virus than white and/or wealthy people? The answer is systemic and structural racism within our healthcare system. The recent Black Lives Matter (BLM) demonstrations have thrust systemic racism back into the national dialogue. While demonstrations are largely focused on systemic racism within our criminal justice system, they have sparked a much needed broader conversation about systemic racism in other parts of our society such as healthcare. Dr. Martin Luther King Jr. said "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." With that quote, Dr. King is describing systemic racism. As long as systemic racism exists within our healthcare system, patients will needlessly suffer. Systemic racism, also referred to as institutional or structural racism, refers to the ways in which society reinforces discriminatory beliefs and distribution of resources through systems such as housing, education, healthcare and criminal justice. Three common examples of structural racism within our healthcare system are unconscious bias, health illiteracy, and cultural barriers. Unconscious bias is perhaps the most egregious example. Though often unintentional, unconscious bias reinforces inaccurate assumptions about different groups of people. A study from 2013 demonstrates unconscious bias relative to gender. The study had a male and female patient describe identical knee pain symptoms to the same set of physicians. The study found that the male patient received significantly different information and advice than the female patient. The physicians provided less medical information and less encouragement to undergo knee replacement surgery to the female patient than to the male patient. If the patients described the exact same symptoms shouldn't they have received the same medical advice?Health literacy refers to the ability of patients to understand medical information and make informed decisions about their health. Studies have shown prevalent racial disparities due to lack of health literacy. Mary I. O'Connor
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