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The subtle knife

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Subtle knife

Bias in healthcare, and what we can do about it.

Three things in life are certain: death, taxes, and prejudice.

The first one cannot be avoided. The second is when the Cayman Islands have good accountants and property. But third? That is, we can do something.

My name is Jamil Rivers. I do a lot, but for the purposes of this conversation, two of them are the most important. I am a breast cancer survivor and prosperous. And I’m a black woman.

I was diagnosed with breast cancer at the age of 39. Having a husband and three children who depend on me as the main earners, I couldn’t afford to be the best defender possible for myself on that patient’s journey. So I connected with many breast cancer advocacy groups and learned as much as I could about my illness and how to get the best possible treatment. I was a patient in the chemotherapy room who visited when another patient asked a question.

One of the things I learned while armed for this fight was that black women died of breast cancer at a 40 percent higher rate than white women. We’ve heard all sorts of explanations about this, including poverty, social determinants of health, access to care, and lack of insurance. However, when I tried to advise and support all the other patients who brought me questions, the black women among them had access to care, good work and income, and good insurance, but they were still Understanding what the standard of care, or even the quality of care, was.

Why not?


Now let’s talk a little about bias. Bias is not a moral position. It’s usually not even a conscious choice. It is a function of how the human brain works. If our brain does not develop shortcuts, we will be overwhelmed by finding the basis for all decisions and will not be able to get out of bed in the morning. If you have a few hours to burn, check out “heuristics”. Then you can see what I mean.

In most cases, these mental shortcuts we build are harmless. But not always. Sometimes they come at very high prices.

for example? In fact, it is true that black women are diagnosed with breast cancer at a slightly lower rate than the general population. Based on that, some HCPs (medical professionals) think that this is a black female patient and is unlikely to get breast cancer, and perhaps I don’t have to be very aggressive about ordering tests. Someone else. But she has it, and I miss it, and she dies.

Or, black women are more likely to have dense breasts. Therefore, the HCP sees something blurry on the mammogram, and his or her brain is just a dense breast, so no additional testing is needed.

Or, black women may not have the resources to pay for a high level of care. Therefore, the HCP finds suspicious things, but his or her brain takes the shortcut that, well, she can’t afford all of this, hopefully nothing. This does not happen consciously. But it still happens.

Even after being diagnosed, black women with breast cancer often end up at the wrong end of prejudice. A complete diagnostic workup may not be done. Genetic or genomic testing may not be actively provided. Information about clinical trials may not be shared. HCPs and care providers unknowingly speculate on economic, socio-economic, insurance, transportation, and poverty issues, and their brains, in the case of a typical white man, “she doesn’t need it” or Just click “She can’t use it”. Not surprisingly, the patient gets it all.

Or pain management. HCPs and care providers may be unknowingly convinced of black women and substance abuse, so their brains click “don’t give it to her.” And the patient is suffering. Alternatively, resources for home nursing after breast reconstruction are not provided, or you can stay in the hospital for a sufficient number of days. It’s like death from a thousand cuts, a series of omissions or imperfections in many elements of what a quality standard of care should look like, and in fact looks like a typical Caucasian patient. increase.

Of course, this all happens while black female patients are already very traumatized and already experiencing life-changing experiences in dealing with potentially deadly illnesses.

Isn’t it heavy enough to withstand?

Therefore, it is necessary to attack the prejudice of breast cancer treatment. My organization, the Chrysalis Initiative, does just that.

We do it in two ways. The first is to educate the provider. We have created a menu on the fairness assessment of care facilities and what standard and impartial care should look like. We partner with the Care Center to discuss prejudice with our employees. Since we are analyzing actual patient data, we can show providers inconsistencies in their care. In our experience, most cancer centers and healthcare providers can unknowingly lead to substandard treatment, how much information and influence bias can make in patient diagnosis and treatment decisions. I’m surprised to see the data showing if there is. It’s not easy to talk to the facility manager, tell them that the facility may not be working as well as you think, and show and back up your data. But in reality, most people in healthcare have the best intentions. They do not consciously choose to underestimate or abuse black women. They are shocked when they find out that it may be happening. And they most often want to learn how to fix it.

Another way is to empower the patient himself. Too many patients, not just black women, take care of everything given to them without any questions or complaints. In fact, this trend itself is a bit biased. One of the most common mental shortcuts we all take is authority bias, which tends to believe whatever the “expert” says to us. Should I believe in HCP in general? of course. They attended medical school, but we probably didn’t. They are based on clinical data and we probably aren’t. But that doesn’t mean that they should accept what they say without a doubt, or without being aware of what standard of care should be. That’s why Chrysalis connects patients with personal coaches to manage their specific concerns and challenges and assess their access to quality standard of care. In partnership with Intouch Group and KT CATL, we have launched a new BC Navi (Breast Cancer Navigation) website and patient portal. It also provides a variety of educational resources on personalized dashboards for tracking many components of breast cancer, connections with other patients, checklists of what to expect and demand, and – BC Navi. – Created patient travel, and information and access to clinical trials. More importantly, BC Navi provides patients with the opportunity to review and evaluate providers, focusing on potential biases or their lack. This is a type of Yelp that helps patients find and hold caregivers who deserve treatment. To some degree of cultural ability. In short, BC Navi provides black women with breast cancer with the tools they need to recognize, share, and address health care gaps and manage their patient care. We help patients break down artificial barriers on their way to survival. And, of course, all the patient data generated by the app will help build a better case to attack the bias and return to the first path to educate HCP. I was frankly shocked by the bad reviews of many prominent institutions from BCNavi’s black and brown patients, both as a patient and as an advocate. We believe that these assessments will be the beginning of positive conversations and partnerships with these institutions.

To raise awareness of all these efforts, the Intouch Group has developed a social media campaign, Erase the Line, to highlight disparities in outcomes and encourage engagement and action. Every time you register for BC Navi, download the app, or sign up, the pixels will be erased from the inequality lines drawn in the campaign’s digital graphics.

We black women with breast cancer rely on equal treatment, begging, and begging. Equal treatment is our right and we must demand it. Differences of more than 40% in mortality exceed coincidence, genetic factors, or socio-economic factors. It’s an unacceptable end. The causes of substandard care can be unintentional, careless, or unconscious, but the results are very realistic. Prejudice may be as inevitable as death and tax, but substandard care is not.

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