Diversity and Equity in Medicine and Anesthesia

Diversity and inclusiveness in health care leadership: three key steps

Leadership roles and initiatives for diversity and inclusion in academic anesthesiology departments

Medical racism from 1619 to the present: history matters

Science and storytelling: health disparities and equity

Patient Care

Association of patient characteristics with the receipt of regional anesthesia

Association of race and ethnicity in the receipt of regional anesthesia following mastectomy

Evaluation of nitrous oxide in the gas mixture for anesthesia II (ENIGMA II) revisited: patients still vomiting

Use of neural machine translation software for patient with limited English proficiency to assess postoperative pain and nausea

Diversity and inclusiveness in health care leadership: three key steps
Suggested by: Eman Nada, MD, PhD

Lack of trust in the US healthcare system among communities of color is inextricably linked to the history of systemic racism in this country. With fewer than half of Black American adults indicating that they will definitely or probably get vaccinated against COVID-19, understanding the roots of this hesitancy—which dates back centuries—is critical to battling the disease. Speakers on this panel examine the roots in slavery of contemporary African American mistrust of the healthcare system, the lack of trust in medical providers fostered by experiences of everyday racism, and the African American community’s long dependence, born of necessity, on care from within the community.

Reference: Lee TH, Volpp KG, Cheung VG, et al. Diversity and inclusiveness in health care leadership; three key steps. NEJM Catalyst 2021. https://doi.org/10.1056/CAT.21.0166 

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Leadership roles and initiatives for diversity and inclusion in academic anesthesiology departments
Suggested by: Kethy Jules-Elysee, MD

We have made strides in admission rates to medical school, where 50% of students are women. Although ethnic diversity and underrepresentation, when compared to the general population remains a problem. In anesthesia, males make up 63.4%, and females 36.6% of anesthesiologists. Only 9.8% belong to different racial/ethnic groups, as stated in the article. In academic anesthesia, less than 20% of women are full professors, and about 10% are department chairs. (Anesth Analg 2019).

It has been well acknowledged that diversity in medicine leads not only to an improvement in health care disparities, but also to increased creativity and better decision making. Women definitely should have a stronger representation in medicine and should play a major leadership role. Lack of support and mentorship, family circumstances, and biases against women have all been cited as factors preventing women from achieving leadership roles.

Steps to overcome these issues include the following:

1. Develop leadership structure from the top focused on diversity and inclusion
2. Appoint faculty members who are focused on diversity and inclusion roles
3. Establish clear leadership roles while enhancing diversity
4. Provide proper support with career development
5. Create a mentoring system
6. Most of all, have women support each other, take the lead as needed, and stay motivated to reach the top

Reference: Brooks AK, Lians Y, Brooks M, et al. Leadership roles and initiatives for diversity and inclusion in academic anesthesiology departments. J Natl Med Assoc 2022;114(2): 147-55. https://doi.org/10.1016/j.jnma.2021.12.014 

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Medical racism from 1619 to the present: history matters | Harvard Radcliffe Institute
Suggested by: Niyant Jain, MD

Video description:

Lack of trust in the US healthcare system among communities of color is inextricably linked to the history of systemic racism in this country. With fewer than half of Black American adults indicating that they will definitely or probably get vaccinated against COVID-19, understanding the roots of this hesitancy—which dates back centuries—is critical to battling the disease. Speakers on this panel examine the roots in slavery of contemporary African American mistrust of the healthcare system, the lack of trust in medical providers fostered by experiences of everyday racism, and the African American community’s long dependence, born of necessity, on care from within the community.

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Science and storytelling: health disparities and equity
Suggested by: Niyant Jain, MD

Podcast description:

Many people assume that pain is a normal part of getting older. Although pain is not inevitable, it is a serious concern for those who experience it. Yet older adults with pain are likely to receive different qualities of treatment depending on their race and/or ethnicity. Dr. Tamara Baker talks to host Brenda Olmos about disparities in treatment for pain management and why it is critical to acknowledge the realities of pain in older adults without equating pain with aging. Along the way, they discuss how personal histories can guide professional work, bridging the gap between research and practice, and the power of diverse representation in leadership at The Gerontological Society of America. 

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Association of patient characteristics with the receipt of regional anesthesia
Suggested by: Kethy Jules-Elysee, MD

The abstract discussion was presented at the 2022 Anesthesiology Annual Meeting.

This study of 56,000 patients revealed that women, minorities, and Medicaid recipients are less likely to receive regional anesthesia, which is known to improve outcomes after surgery. Possible reasons for this disparity might be a lack of knowledge regarding possible benefits and a misconception regarding needle insertion in their spine, or practice trends in their hospital. We should also ask ourselves whether we take the time to discuss anesthesia choices with the risks and benefits with all patients.

Reference: Beletsky A, Currie M, Shen J, et al. Association of patient characteristics with the receipt of regional anesthesia. Reg Anesth Pain Med 2023;48:217-23. https://doi.org/10.1136/rapm-2022-103916 

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Association of race and ethnicity in the receipt of regional anesthesia following mastectomy
Suggested by: Johnny Lee, MD

Imagine undergoing a mastectomy. Now imagine that there is an intervention readily available to significantly improve your postoperative pain, but you aren't offered it. Imagine that a different patient undergoing the same procedure in the hospital across the street is offered the intervention. Why, you ask? The answer to that is nuanced and not totally straight forward. However, awareness of the problem highlights the need to standardize protocols in a community that is increasingly more diverse with every generation. I urge the community to read the interesting 2021 article in the link above. While it isn't the solution, but helps point in the direction of things we can do about it.

Reference: Beletsky A, Burton BN, Finneran IV JJ, et al. Association of race and ethnicity in the receipt of regional anesthesia following mastectomy. Reg Anesth Pain Med 2021;46:118-23. https://dx.doi.org/10.1136/rapm-2020-101818 

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Evaluation of nitrous oxide in the gas mixture for anesthesia II (ENIGMA II) revisited: patients still vomiting

Suggested by: Johnny Lee, MD

 

There is a 2016 article that I discuss with my residents, but oddly I feel like it did not get enough attention. It discussed the high risk of severe PONV in people of Asian descent when using Nitrous Oxide. Asian patients are also less likely to receive PONV prophylaxis. I would encourage this forum to spread this knowledge. Additionally, I would argue that regional anesthesia is an effective way to avoid Nitrous and narcotics in this population.

Reference: Li ECK, Balbuena LD, Gamble JJ. Evaluation of nitrous oxide in the gas mixture for anesthesia II (ENIGMA II) revisited: patients still vomiting. Anesthesiology 2017;127:204-05. https://doi.org/10.1097/ALN.0000000000001657 

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Use of neural machine translation software for patient with limited English proficiency to assess postoperative pain and nausea
Suggested by: Vikram Bhasin, MD

This article discusses the use of Google Translate for non-English speaking patients. This technology is certainly relevant to my job and practice at Montefiore Medical Center in Bronx, NY, where we have a large Spanish-speaking population, as well as a large number of patients who speak many other languages. While we have overall excellent access to language translation services, using Google Translate is also an interesting option worth considering. I don't know that it can completely replace a translator for obtaining a complete history or obtaining consent for a procedure, but perhaps it does have a place for quick questions and more focused assessments. 

Reference: Kapoor R, Corrales G, Flores MP, et al. Use of neural machine translation software for patients with limited English proficiency to assess postoperative pain and nausea. JAMA Netw Open. 2022;5(3):e221485. https://doi.org/10.1001/jamanetworkopen.2022.1485 

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