Different people get different health care, and that can vary by race, gender and more. And it can make a big difference in outcomes.
How does that play out in everyday life?
Dr. Quinn Capers, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, has long studied racial disparities and bias, especially among doctors and nurses. He likes to explain the concepts by starting with his own specialty.
When two men of different races show up in the emergency room with chest pains, the most common symptom in cardiology, “the white man is more likely to be admitted to the hospital, the Black man turned away,” Capers said.
If both are hospitalized, the white man is more likely to have a cardiac catheterization to unblock arteries, he said. When both get the procedures, the white man is more likely to get state-of-the-art stents.
If both are smokers, the white man is more likely to get a formal program to quit the habit. He’s also more likely to be referred to cardiac rehab, a supervised exercise program to help heart patients live longer.
“At almost every step, from having severe chest discomfort until the time you’re discharged, we see this racial disparity,” Capers said. “Partly as a consequence of that, survival after a heart attack is lower in Blacks than among whites.”
In Dallas County, the age-adjusted death rate from heart disease was 32% higher for Blacks compared with whites, according to a 2019 report on community health.
The pandemic has shone a spotlight on racial disparities, in part because people of color have faced a much higher risk of hospitalization and death from COVID-19. Age-adjusted data show that Blacks and Hispanics are at least twice as likely to die from COVID than whites, according to an October report from the Kaiser Family Foundation.
Blacks and Hispanics were slower to get vaccinated early and remained less likely than whites to have been inoculated by early October, Kaiser reported. Those gaps are narrowing over time, particularly among Hispanics, Kaiser said.
Capers said it’s natural for some people in underserved, vulnerable communities to be hesitant about the COVID vaccine: “If you grew up hearing your grandmother talk about how the health care system has mistreated her and her people,” he said. “Tragically, that’s translated into lives lost.”
Capers joined UT Southwestern last December after 10 years as associate dean for admissions at Ohio State University’s College of Medicine. In Columbus, he helped the school achieve high marks in diversity, including recruiting 26% of the student body from groups traditionally under-represented in medicine, according to his biography.
He speaks and writes frequently about reducing bias in patient care and in the selection of medical students and residents. He has trained over 2,000 doctors in such strategies.
At UT Southwestern, Capers is associate dean for faculty diversity and vice chair for diversity and inclusion. The Dallas medical school has a higher share of minorities compared with national levels, roughly 22% at UT Southwestern vs. 14% nationwide, he said. But there’s much work ahead to increase their representation on the medical school faculty, which is a weakness throughout the country, he added.
In a paper published last year, Capers and co-authors proposed strategies to reduce bias in hospitals, including removing photos from the decision-making process because they can “trigger explicit and implicit biases.”
They called for adding “bias and racism rounds” so providers could regularly discuss incidents that may have caused patient harm.
“There should be nothing punitive about this exercise,” they wrote, and it could become “a powerful teaching tool.”
The article includes two case studies in which clinical outcomes were negatively affected by bias. Similar examples “are likely playing out in hospitals across this nation,” they wrote.
Capers and his colleagues often debate the role of social determinants on health outcomes. He acknowledges that what happens to people before entering the hospital — from family upbringing to education to a community’s air quality — has a big impact on reducing life expectancy, too.
Still, he warns against putting too much weight on those factors because that tells doctors and nurses it’s not their fault. “You leave them blameless,” Capers said. “But our hands are not clean.”