A recent Oregon study suggests that emergency physicians – paramedics and paramedics – treat minority patients differently than white patients.
The researchers found that black patients in their study were 40 percent less likely to receive painkillers than their white counterparts.
Jamie Kennel, Head of Rescue Services at Oregon Health and Science University and the Oregon Institute of Technology, led research presented at the Institute for Healthcare Improvement in December Scientific Symposium in Orlando, Florida, USA.
Researchers received a grant to prepare the internal report for Oregon Medical Services and the Oregon Office of Rural Health. Clear discrimination by paramedics is rare and illegal according to researchers; In these cases, unconscious prejudices could be at work.
Several years ago, Leslie Gregory was one of the few black medical emergency technicians working in Lenawee County, Michigan. She said the results of the study are true based on her experience
She recalled a specific phone call ̵
"I think it was something like," Oh my god. It's starting again, "Gregory said. She was worried – both then and now – that her colleague suspected he was taking painkillers for pain because the patient was black.
"I'm absolutely certain that this was unconscious," added Gregory, who now lives and works in Portland, Ore., Where she set up a non-profit organization to raise awareness of racial differences in health care spread. "I remember, at that time my stress increased as we came across this person. Because I thought, "Now I have to work with my colleague for more painkillers, should that happen?"
Unconscious bias may be subtle – but, as this new report shows, this could be one of the factors behind racial health inequalities in the US
The study examined 104,000 medical charts of ambulance patients from 2015 to 2017. It has been shown that minority patients are less frequently given morphine and other pain medications than white patients. Socioeconomic factors such as the status of health insurance.
During a shift change at the American Medical Response headquarters in Portland, paramedics and paramedics discussed the issue with a reporter as they prepared their drill rigs for the next shift.
Jennifer Sanders, who has worked as a paramedic for 30 years, has insisted that her work is not influenced by the breed.
"I have never treated anyone else," Sanders said.
Most emergency workers i According to Jason Dahlke, race does not affect the treatment. But Dahlke also said that he and some of his colleagues are thinking deeply about unconscious bias.
"Historically, this country has been like this," said Dahlke. "In the beginning, we had slavery, Jim Crow and redlining – and all that can be lost on a large macro level. Yes. It is there.
Asked where he thinks that subconscious prejudice could go underground, Dahlke spoke of a patient he had just treated.
The man was black and about 60. Dahlke is white and in his thirties The patient has diabetes and has called the number 911 from home and complained of extreme pain in his hands and feet.
When Dahlke arrived at the patient's home, he followed the standard procedure and gave it to the patient The results showed that the man's blood sugar level was low.
"That's why I decided to treat this blood sugar first, make sure the number is displayed," said Dahlke.
He gave the patient glucose – but no painkillers.
Dahlke said he did not deal with the pain of the man in this case because the patient is stabilizing at this time had arrived at the hospital – there was the responsibility of the emergency room staff.
"When people are acutely ill or injured, painkillers are important," said Dahlke. "But it's not the first thing we have to worry about. We will worry about life threats. You will not necessarily die of pain, and we will do what suits you at the moment to take you to the ambulance, to the hospital and to a higher level of care. "
Dahlke said I do not know if the patient, if he had been white, would have used painkillers even though he does not think so.
"Is it something I think about when I come across a patient who does not look like me? I do not know that my treatment will change as a result, "he said.
He asked if treatment differences are sometimes due to white people asking for more medication more often, Dahlke smiled.
" I wonder if if we In this study, people who refuse color with color or do not get narcotic drugs like white people may overwhelm white people with narcotics. "
Research has found African Americans more likely to be suspicious of the medical community, and that Such a mistrust is understandable and goes back generations, said Gregory.
"How can a colorist not respect a system that constantly studies and discusses these differences, but does nothing to stop them Did she? "she asked.
Gregory wrote an open one Letter to the Centers for Disease Control and Prevention in 2015, calling for racism to be a threat to public health.
Earlier Crisis Declarations – Such as Those Concentrating on Issues Such as Smoking or HIV
However, the CDC told Gregory in his e-mail response that the government supports policies to combat racial discrimination and the role of Recognizes racism in health inequalities. "Racism and racial discrimination in health care is a social and public health that requires a broad-based social strategy to effectively reduce racism and its negative impact in the US. "
Kennel said false stereotypes about racial differences in physiology that date to slavery also play a role in health inequalities. Despite the lack of supportive science, some doctors believe that the blood of African Americans clots faster, so Kennel. He cited a recent study on medical students at the University of Virginia.
Another question in the survey The students, whether they thought African Americans had fewer pain receptors than whites. "An unpleasant percentage of medical students said," Yes, that's right, "said Kennel.
In addition, paramedics and paramedics often work under time pressure, where they are limited to ambivalent clinical situations, information, and scarce resources It's much more likely to make decisions [based] about stereotypes, "he said.
Healthcare differences are well documented, whites tend to care better and get better results, whether in a doctor's office But in Kennel's study, nobody knew if this was also true in the back of an ambulance.
And they almost did not know about it because the ambulance companies had to publish highly sensitive data.
Ready, maybe not so great "said Robert McDonald, Operations Manager, American Medical Response, Portlan d AMR is one of the largest ambulance organizations in the country and has shared Kennel's data from more than 100,000 charts.
Some people explain the differences they have found in terms of demographics and health insurance status, but Kennel said he was in control of this variable.
Now that AMR knows about inequalities in its care, what can the company do?
"My feeling is that we are likely to offer some education and training to our people in this field," McDonald said.
Also, AMR said AMR will hire more people for color.
"We want more ethnic groups to be represented in EMS – which was a white, male-dominated workforce in the past," said McDonald
AMR's policy also needs to change, he added. The company has acquired software that allows patients to read medical permission forms in one of 17 different languages. And the company plans to work for the paint communities to explain the role of EMS workers.
This story is part of a partnership that includes Oregon Public Broadcasting, NPR and Kaiser Health News. [19659002 Kaiser Health News (KHN) is a national intelligence service for health policy. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.