© 2010 American Academy of Physician Assistants. All rights reserved.
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Heads Up!
| A Health Disparities Reduction Project of the American Academy of Physician Assistants, the Physician Assistant Foundation, and Physician Assistants for Health Equity |
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issues of racial health care disparities, unconscious racial stereotyping, and implicit racial bias by clinicians was placed on
partner institution, Harborview Medical Center.
The campaign consisted of three bus signs, each of which addressed a different health disparities issue. The signs were
worked with AAPA to develop this CME module, with an assessment available at no charge to AAPA members on the AAPA
website. One hour of Category I CME credit may be earned by reading this introduction, three additional articles and completing
a post-test with a minimum score of 70% correct.
The project is among the first to address new evidence about the role of unconscious racial stereotyping in racial health
disparities. In 2007, Alexander Green, MD, of the Disparities Solutions Center at Massachusetts General Hospital, released a
study that connected implicit and unconscious stereotyping with unequal treatment of patients. It is one of the first studies to
connect these two issues. Green and the Disparities Solutions Center provided consultation and input on the Heads Up!"
campaign.
One "Heads Up!" sign featured photos of two males, one Caucasian and one African American, with the words: "Chest Pain,
Identical Symptoms, Matching Histories: Which Patient Doesn't Get the Appropriate Tests?" This refers to Green's study,
published in the Journal of General Internal Medicine, which had resident physicians direct treatment for hypothetical patients.
The residents based treatment decisions on a picture of the patient's face, accompanied by a written description of the
patient's chest pain. All of the hypothetical descriptions were identical, differing only in the race of the patients. Results revealed
more physicians prescribing thrombolysis for the white patients than for the black patients.
The study used an assessment tool from Project Implicit at Harvard University, measuring unconscious bias against black
patients on the part of providers. As the study clinician's unconscious biases against blacks increased, their likelihood of giving
thrombolysis treatment decreased. Green noted in an interview, "It's not a matter of you being a racist. It's really a matter of the
way your brain processes information is influenced by things you've seen, things you've experienced, the way media has
presented things." Green recommends that the best way to combat those impulses is by acknowledging them, and suggests
that medical personnel take an assessment measuring unconscious bias, which can be found at implicit.harvard.edu.
Recent research about the issue of stereotyping and disparities in care offer some novel suggestions for ways to address and
decrease these problems. Diana Burgess and Michelle Van Ryn of the University of Minnesota have proposed an intervention
called "priming," putting basic information about unequal treatment and implicit/unconscious bias and stereotyping in front of
clinicians and allied health providers. This technique presupposes that racial gaps in care are based on unconscious
stereotyping, not on conscious efforts, as echoed by Green.
Van Ryn and Burgess describe the mechanism of using unconscious stereotyping to allow clinicians to "fill in the gaps" to
facilitate making complex decisions in a short period of time. They note that unconscious stereotyping, while helping clinicians
arrive at decisions quickly, can lead to unequal treatment.
Pain care persists as an area with well-studied and documented disparities in care. Todd's work has indicated evidence of
unequal treatment of pain, focusing on disparities in pain care for trauma and emergency departments.
It is widely and inaccurately believed by many clinicians that unequal treatment based on race and ethnicity is a matter of
unequal access. While access to care is known to impact a variety of populations, data indicates that even when access is
factored out of studies, treatment of pain and other problems frequently varies simply based on the race of patients, even when
patients present to the same facilities with similar injuries.
The federal government's Institute of Medicine released the congressionally mandated book Unequal Treatment in 2003.
Widely acclaimed for its comprehensive look at data related to racial disparities to care, Unequal Treatment made several
recommendations to health professionals. One of the foremost recommendations directs health professionals to share
information about racial disparities in care with colleagues, increasing awareness within the medical community about this
ongoing problem. The AAPA "Heads Up!" project was a response to this recommendation, as well as an effort to integrate the
Burgess and Van Ryn "priming" concept. This effort promotes awareness about racial disparities to PAs and other colleagues,
while framing the issue by describing the shared human tendency to use implicit and unconscious stereotyping in daily
practice.
Green and the Disparities Solutions Center also recommend developing "equity reports" in practice sites. These reports are
ways to examine specific practices for disparities in care, and creating specific action plans to address these disparities. Their
guide to creating equity reports is available at www.massgeneral.org/disparitiessolutions.
The AAPA is the only national organization to represent physician assistants in all medical and surgical specialties. Founded in
1968, the Academy works to promote quality, cost-effective health care and the professional and personal growth of PAs. For
more information about the Academy and the PA profession, visit AAPA’s Web site, www.aapa.org.
partner institution, Harborview Medical Center.
The campaign consisted of three bus signs, each of which addressed a different health disparities issue. The signs were
worked with AAPA to develop this CME module, with an assessment available at no charge to AAPA members on the AAPA
website. One hour of Category I CME credit may be earned by reading this introduction, three additional articles and completing
a post-test with a minimum score of 70% correct.
The project is among the first to address new evidence about the role of unconscious racial stereotyping in racial health
disparities. In 2007, Alexander Green, MD, of the Disparities Solutions Center at Massachusetts General Hospital, released a
study that connected implicit and unconscious stereotyping with unequal treatment of patients. It is one of the first studies to
connect these two issues. Green and the Disparities Solutions Center provided consultation and input on the Heads Up!"
campaign.
One "Heads Up!" sign featured photos of two males, one Caucasian and one African American, with the words: "Chest Pain,
Identical Symptoms, Matching Histories: Which Patient Doesn't Get the Appropriate Tests?" This refers to Green's study,
published in the Journal of General Internal Medicine, which had resident physicians direct treatment for hypothetical patients.
The residents based treatment decisions on a picture of the patient's face, accompanied by a written description of the
patient's chest pain. All of the hypothetical descriptions were identical, differing only in the race of the patients. Results revealed
more physicians prescribing thrombolysis for the white patients than for the black patients.
The study used an assessment tool from Project Implicit at Harvard University, measuring unconscious bias against black
patients on the part of providers. As the study clinician's unconscious biases against blacks increased, their likelihood of giving
thrombolysis treatment decreased. Green noted in an interview, "It's not a matter of you being a racist. It's really a matter of the
way your brain processes information is influenced by things you've seen, things you've experienced, the way media has
presented things." Green recommends that the best way to combat those impulses is by acknowledging them, and suggests
that medical personnel take an assessment measuring unconscious bias, which can be found at implicit.harvard.edu.
Recent research about the issue of stereotyping and disparities in care offer some novel suggestions for ways to address and
decrease these problems. Diana Burgess and Michelle Van Ryn of the University of Minnesota have proposed an intervention
called "priming," putting basic information about unequal treatment and implicit/unconscious bias and stereotyping in front of
clinicians and allied health providers. This technique presupposes that racial gaps in care are based on unconscious
stereotyping, not on conscious efforts, as echoed by Green.
Van Ryn and Burgess describe the mechanism of using unconscious stereotyping to allow clinicians to "fill in the gaps" to
facilitate making complex decisions in a short period of time. They note that unconscious stereotyping, while helping clinicians
arrive at decisions quickly, can lead to unequal treatment.
Pain care persists as an area with well-studied and documented disparities in care. Todd's work has indicated evidence of
unequal treatment of pain, focusing on disparities in pain care for trauma and emergency departments.
It is widely and inaccurately believed by many clinicians that unequal treatment based on race and ethnicity is a matter of
unequal access. While access to care is known to impact a variety of populations, data indicates that even when access is
factored out of studies, treatment of pain and other problems frequently varies simply based on the race of patients, even when
patients present to the same facilities with similar injuries.
The federal government's Institute of Medicine released the congressionally mandated book Unequal Treatment in 2003.
Widely acclaimed for its comprehensive look at data related to racial disparities to care, Unequal Treatment made several
recommendations to health professionals. One of the foremost recommendations directs health professionals to share
information about racial disparities in care with colleagues, increasing awareness within the medical community about this
ongoing problem. The AAPA "Heads Up!" project was a response to this recommendation, as well as an effort to integrate the
Burgess and Van Ryn "priming" concept. This effort promotes awareness about racial disparities to PAs and other colleagues,
while framing the issue by describing the shared human tendency to use implicit and unconscious stereotyping in daily
practice.
Green and the Disparities Solutions Center also recommend developing "equity reports" in practice sites. These reports are
ways to examine specific practices for disparities in care, and creating specific action plans to address these disparities. Their
guide to creating equity reports is available at www.massgeneral.org/disparitiessolutions.
The AAPA is the only national organization to represent physician assistants in all medical and surgical specialties. Founded in
1968, the Academy works to promote quality, cost-effective health care and the professional and personal growth of PAs. For
more information about the Academy and the PA profession, visit AAPA’s Web site, www.aapa.org.
| JOIN PHYSICIAN ASSISTANTS FOR AAPA CONFERENCE |
| next May. Here are the talks we presented JAAPA Ethics Column co-editors Gino JAAPA Board member Diane Bruessow in presenting: Eyes Wide Shut: How Selective Use of Medical Evidence Violates Ethical Principles and Hurts Patients Howard Straker and Susan LeLacheur of George Washington University, Washington Academy of PAs Committee on Diversity chair Jim Anderson and AAPA Appointed Representative to the Gay and Lesbian Medical Association Diane Bruessow presented: It Ain't Me! Bias, Stereotyping and the Patient Sitting in My Exam Room Jim Anderson lead a discussion about treating patients facing addiction with Fear and Loathing in the Exam Room: Your Addicted Patient is Waiting in Room 4 PHYSICIAN ASSISTANTS FOR HEALTH EQUITY HOSTED OUR FIRST ANNUAL RECEPTION, THANKS FOR ALL WHO CAME BY! |
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