“First do no harm”: Clinical practice guidelines, mesolevel structural racism, and medicine's epistemological reckoning

Rondini, Ashley C.; Kowalsky, Rachel H.

doi:10.1016/j.socscimed.2021.113968

Cited by 9 publications

(6 citation statements)

References 52 publications

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“…Nonetheless, we recognize that guidelines are not a panacea. Guidelines have, in some cases, contributed to health disparities when a race adjustment is included, as in the example of pediatric urinary tract infection treatment 41 . Thus, it is critical to develop guidelines with an explicit focus on equity, and while acknowledging bias and racism in medicine.…”

Section: Discussionmentioning

confidence: 99%

Disparities in the provision of perinatal care based on patient race in the United States

Byrn

Buys

Mujahid

et al. 2023

Birth

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BackgroundIn the United States, there are significant health inequities in perinatal care. This study examined differences in perinatal care provided to women based on the birthing person's designated race, within a large and diverse cohort of women.MethodsThis retrospective electronic medical record review identified patients receiving perinatal care within a large hospital system between January 2012 and September 2018 and examined associations between maternal designated race/ethnicity (Hispanic or non‐Hispanic [NH] Black, Asian or White) and various provider treatment decisions.ResultsThe study sample (N = 7056) was comprised of 36% Hispanic, 34% NH White, 21% NH Black, and 4% NH Asian women, aged 29.7 ± 6.3 years; 53% of the sample had private insurance, and 45% had Medicaid. Few differences by race were seen in perinatal care based on guidelines or expert recommendations (nondiscretionary care). Discretionary care, however, varied by race: Compared with NH White women, NH Black women were less likely to receive a prenatal depression screen (OR 0.8 [95% CI: 0.7, 0.9]) and more likely to have a urine drug test when denying drug use (OR 1.6 [95% CI 1.3, 2.0]), whereas Hispanic (OR 0.6 [95% CI: 0.5, 0.8]) and NH Asian (0.4 [95% CI 0.2, 0.9]) women were less likely to have a urine drug test completed when denying drug use.DiscussionPerinatal care differs by maternal race/ethnicity, particularly when guidelines or expert recommendations are absent. Greater efforts need to be made to identify and mitigate providers' implicit and explicit biases; expanded professional guidelines may offer some protections against inequitable, discretionary care.

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Section: Discussionmentioning

confidence: 99%

Disparities in the provision of perinatal care based on patient race in the United States

Byrn

Buys

Mujahid

et al. 2023

Birth

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“…Switching clinics is also important for considering racial disparities. People of color, especially Black people, are more likely to experience negative encounters with medical providers and receive a lower quality of care and therefore might have a greater impetus to switch clinics (Hagiwara et al 2013; Rondini and Kowalsky 2021), although because of a racial capitalist dynamic, they might have less freedom to do so. Future researchers might examine whether Black patients respond to racist or biased medical encounters by switching clinics and how this is mediated by patients’ resources.…”

Section: Discussionmentioning

confidence: 99%

Switching Clinics: Patient Autonomy over the Course of Their Careers in Consumer Medicine

Brown

2023

J Health Soc Behav

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Patient autonomy, or the right to make decisions about medical care, is usually examined either within clinical encounters with medical providers or outside of clinics via social movements to transform care. These perspectives, however, may miss how patients exercise autonomy outside of clinical encounters while remaining in conventional care. Through in-depth interviews with 61 people who pursued fertility treatment in New York City, this article argues that one important way that people exert autonomy in consumer medicine is by switching clinics. This study finds that nearly half of participants switched clinics to reorient their patient careers that were not progressing satisfactorily, attempting to reset, redirect, and escalate them. This article emphasizes that patients exercise autonomy not just over treatment decisions but also over the direction and progress of patient careers themselves. This article suggests that patients’ disparate opportunities to elect to switch medical practices represents an inequity in consumer medicine.

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“…It should be noted that recent scholarship in health sciences research has advocated for a more technically accurate and socially conscious use of the race variable [56,57]. On its own, the race variable has been used as a proxy to represent biological difference, just as income levels are often used as a proxy for social class.…”

Section: Research Aimsmentioning

confidence: 99%

“…Although these supposed biological differences have been thoroughly found to be false, the social impact of the myth is real [58]. The differences between people based on racial category should instead be interpreted as the consequence of racism and the effects of inequitable political, economic, and social treatment [56]. Editorial [59,60] and theoretical [56] scholarship has called for reframing the use of the race variable, with Phelan and Link [61] illustrating how racism itself has a fundamental causal relationship with health, separate from any effect SES may also have.…”

Section: Research Aimsmentioning

confidence: 99%

“…The differences between people based on racial category should instead be interpreted as the consequence of racism and the effects of inequitable political, economic, and social treatment [56]. Editorial [59,60] and theoretical [56] scholarship has called for reframing the use of the race variable, with Phelan and Link [61] illustrating how racism itself has a fundamental causal relationship with health, separate from any effect SES may also have. To capture this difference methodologically, variables that measure levels of discrimination based on racism, controlling for SES measures, are ideal [61].…”

Section: Research Aimsmentioning

confidence: 99%

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Financial Behavioral Health and Investment Risk Willingness: Implications for the Racial Wealth Gap

Anvari-Clark

Rose

2023

IJERPH

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Financial behavioral health (FBH) influences numerous socio-ecological domains, affecting investment risk willingness and consequent wealth levels. The experience of FBH by racial group is unknown, and findings of differences between Black and White investors’ risk willingness are mixed. The study’s aims are to establish an FBH measure and explore its application to risk willingness by racial group. The study used a subset of data from FINRA’s 2018 National Financial Capability Study, including Black (n = 2835) and White (n = 21,289) respondents. Through factor analysis, 19 items were confirmed for the FBH measure; the measure was then applied to investment risk willingness using structural equation modeling (SEM). Invariance analyses showed that the FBH model had an excellent fit for White respondents but not Black respondents. The SEM analysis determined that FBH accounted for 37% of the variance in risk willingness (R2 = 0.368; β = 0.256, p < 0.001). Racial group affiliation was a negligible predictor of risk willingness (β = −0.084, p < 0.001). This project contributes an empirical basis for FBH, emphasizes the importance of FBH for investment risk willingness, and elucidates that racial group differences in risk willingness could be an unlikely contributor to the wealth gap.

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“First do no harm”: Clinical practice guidelines, mesolevel structural racism, and medicine's epistemological reckoning

Cited by 9 publications

References 52 publications

Disparities in the provision of perinatal care based on patient race in the United States

Disparities in the provision of perinatal care based on patient race in the United States

Switching Clinics: Patient Autonomy over the Course of Their Careers in Consumer Medicine

Financial Behavioral Health and Investment Risk Willingness: Implications for the Racial Wealth Gap

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