Implicit Bias and Unequal EMS Services
During the last leg of training, PCC students at Cascade campus sat in on a presentation about racial disparities in treatment by EMS providers on Friday November 16th at the Cascade Public Safety Education Building. The presentation was given by Jamie Kennel, an associate professor working toward his PhD in medical sociology. His area of focus is studying the racial disparities in EMS care.
A study like this is a rarity since EMS is typically categorized under public safety and not under the medical field. However, there have been various medical studies that show minorities receive a lower quality of care in almost every area of medicine. These studies aimed to seek out clinically relevant factors, like Kennel’s study, and had controls in place to weed out any clinically relevant explanations for disparities. Thousands of medical charts looking at pain treatment were reviewed during these studies. In the presentation, Kennel explained that prescribing pain medication is always at the discretion of the medical provider. The perception of pain is very subjective. It requires some level of empathy toward a patient. Thus, opening the door of possibilities to include biases as the potential explanation.
In most medical charting, pain is documented on a scale of 1 to 10 and is based on the patient’s response. A good medical practice is to take the patients perceived pain before during and after pain therapy is given. Although that is not always the case and studies have found patient charts without any documented pain perception.
Kennel who is also a paramedic said, “this study found evidence that when controlling for many of the clinically relevant factors that should affect the decision to administer pain medications to a patient, the non-medically relevant factor of race had significant impact on patients receiving pain medications or not.” Kennel found evidence that black patients and Asian patients are 40% and 36% less likely, respectively, to be treated with pain medication compared to white patients with comparable levels of pain and injuries. He also took socioeconomic factors into account and looked only at patients with private insurance. Disparity not only remained but increased to 56% for black patients with private insurance.
Included in his presentation was a review of studies done in other parts of the country. A study in San Francisco found little to no disparities while not too far south in UCLA, disparities were found in the treatment of Hispanic patients, and in Atlanta disparities were found with Black patients.
Students attempted to rationalize Kennel’s findings by asking, “what was the race of the providers?” To which Kennel responded that these studies didn’t account for the providers’ races, but cited other studies that have shown that even when race is comparable between patient and provider, disparities did not significantly diminish. Another student asked if his study included rural versus urban areas. “Oregon’s rural population does not include a sufficient amount of minority population to study racial disparities,” says Kennel.
The final few slides of Kennel’s presentation attempted to answer a question that the media asks most and what everyone in the room was wondering: “Why?” One possibility could be a language barrier. This could explain a large part of the disparities experienced by Asian and Hispanic patients, but is not likely to factor into most of the Black patients disparities. Incorrect beliefs about race, aversive racism and cognitive load could also be players in the equation.
Before introducing a slide with mistaken beliefs about Black patients’ physiology that a percentage of 1st and 2nd year medical students thought to be true, Kennel said “There has been no scientific proof to show truth behind any of these.” Some of those beliefs included: thinking black patients age slower, that their skin is thicker, and that their blood coagulates more quickly. Kennel describes another potential mechanism: a feeling of uncomfortableness around different races, known as aversive racism, which is often fueled by implicit biases. Implicit biases can be subconscious and unwanted at times but, nevertheless present in social interactions. He adds that cognitive load and stress tend to activate racial biases and may very well explain some of the findings.
Students in this class are only 3 weeks away from finishing their Capstone phase, and graduate on December 7th. All are aware of the stress and high demand of their career choice and have now become aware of how their biases might affect their performance. Of course every paramedic wants to do right by their patient but medical care isn’t always provided under good conditions.Medical and public safety providers are constantly in high stress environments. Kennel expressed his intentions not to be accusatory but instead to inspire personal reflection in order to mitigate malpractices.
Click the link below for more info on Jamie Kennel’s study
To learn more about racial disparities in health care check out the following links: