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Hepatic angiomyolipoma is a rare primary liver tumor, with a radiographic appearance very similar to hepatocellular carcinoma. We present the case of a noncirrhotic patient with a liver tumor suspicious for HCC by imaging features. Liver biopsy demonstrated angiomyolipoma, and the patient successfully underwent a laparoscopic liver resection.

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In teaching medical students about the social determinants of health, too often do educators omit discussion of how clinicians themselves contribute to health inequity. It is far easier to shine a critical light on disparities that exist in access to care, safety in neighborhoods, and economic opportunity than it is to interrogate individual clinician's biases that inform his or her views about race, gender, sexuality, and economic class. Yet these are the conversations that all medical students should be having because such biases, conscious or not, contribute to patient health, frequently with negative outcomes. The challenge facing medical educators is how to engage medical students in conversations about bias effectively in order to instill a commitment to social justice and promote action toward the eradication of health disparities in the next generation of physicians. The following is an examination of the ways in which clinician bias against black patients affects health outcomes and how, through both student-driven and curriculum-mandated efforts, the University of Michigan Medical School is engaging its students in dialogue about bias and privilege and their impacts on patient care. Race-Related Bias in MedicineWhen considering the social determinants of health, physician bias is rarely cited as a possible contributor to the health disparities that exist between white and black patients. A growing body of literature suggests that physicians do not treat their patients impartially and that black patients, for example, often receive less aggressive medical treatment, are presented with fewer medical treatment options, and spend less time talking with their physicians during the clinical encounter [1-3]. Studies explicitly examining physician racial bias and disparities in decision making suggest that implicit bias can affect treatment decisions, patient satisfaction, referrals for interventional procedures, physician-patient communication, and the amount of information received from a physician during a clinical encounter [4][5][6]. Of note, Janice Sabin and colleagues found that physicians implicitly associated black patients with noncompliant behavior, despite reporting absence of explicit bias [7]. In a study by John Ayanian, physicians cited patient preference as an important reason why black patients are less likely than white patients to be evaluated for kidney transplantation in the presence of renal failure [6].