By Mary Kate Brogan

Adapting to changing practices in health care is central to ensuring safe, top-quality, equitable care for all patients. As researchers discover more information about biases in health care, health systems, including VCU Health, are educating current and future health care providers on how to reduce these biases.

New research published Monday in JAMA Internal Medicine and based on VCU Medical Center data suggests that removing race from the first line of a patient’s history of present illness can help make patient care more equitable. A patient’s history of present illness explains why the patient was admitted to a hospital or has come in for a doctor’s visit, and the first line often offers a summary of why the patient is requesting care.

“Whether race is referenced in the first line of someone’s chart is something that can be easily studied and something that we believed may be biased,” said Dr. Jessica Balderston Gertz, the study’s lead author and an emergency medicine physician at VCU Health. “Evidence already exists that demonstrates racial bias in medicine related to factors such as outcomes and treatments. What is unique about this project is it explores individual providers' racial bias in a core part of medical practice: documentation.”

Gertz and her co-authors suggest that removing race from a patient’s history of present illness is one way to reduce racial bias in physician practice. Other means include additional training to help physicians identify instances of racial bias and rectify those practices. Such efforts are already underway at VCU Health.

We spoke to Marcelle Wilson Davis, DSL, VCU Health’s director of diversity, equity and inclusion, about the importance of understanding racial bias in health care, educating providers on the impacts of biases and why health systems must address bias head-on through changing practices to improve outcomes for all patients.

Why is understanding racial bias in health care so important?

Racial bias in health care could mean life or death for our patients. This is because bias causes providers to make unconscious assumptions about their patients and their patients’ needs that could lead to inappropriate treatment decisions. As an industry, it’s important that we tackle this.

What is VCU Health doing to educate providers about racial bias in health care and how they can address any biases they may have?

As I enter my third month as the inaugural director of diversity, equity and inclusion, I can speak to several efforts we have underway:

• We developed a formal VCU Health Diversity, Equity and Inclusion governance structure, which is comprised of clinicians from across the health system who focus on addressing racial biases and other important topics.
  
  
• We host numerous virtual learning modules to educate our clinicians on the impacts of racial biases, and we regularly create and add courses to the curriculum.
  
  
• We also host regular panel discussions to raise awareness of health disparities and share how our providers can address them in patient care.

What can clinicians do now to tackle implicit or explicit biases? 

This is such an important question given the current climate we are living in. We are in the middle of a global pandemic and continue to see blatant examples of systemic racism.

The very first thing clinicians can do to tackle bias is to find out what their individual biases are.  We do better when we know better, so we have to first identify our biases in order to intentionally work to mitigate against them. There are many free tools online that serve this purpose.  

Second, let’s all remember that we never stop learning. Our communities are global. We must take the time to learn about other races, ethnicities and cultures so that we can provide all our patients with the best medical care possible.

Third, we have to hold ourselves and each other accountable when we see bias at work. Call it out for what it is. It’s the only way we can intentionally interrupt the cycle.

What else should we know so we can better tackle racial biases in health care?

Racial bias in health care is not a problem that we created, but we can all choose to be a part of the solution to ensure biases are removed.

Patients can advocate for themselves by not only communicating openly with their clinicians, but also ensuring that key information is included in their medical records so that their doctors can recommend appropriate care based on those facts.

Clinicians should also do the work to educate themselves and interrupt the cycle. The bottom line is, we must first listen to one another so we can learn from one another. We can then determine what course of action we need to take.