Combating Racism and Place-ism in Medicine | J. Nwando Olayiwola | TEDxKingLincolnBronzeville

[brigettebroxton]

This was a powerful and very informative speech by Dr. Olaywiola. As an African American woman I've been a victim of the negligence of the medical profession not having sensitivity to my pain when I was in the emergency room with a broken ankle early this year. My daughter is a veterinarian and was upset that when my ankle was set in the emergency room I was not given strong enough pain meds. I yelled really loud and the white male nurse made a statement along the lines, "Ma'am it's not that bad!" I was in so much pain I buried my head in my husband's shoulder and cried. When I shared my experience with my daughter she shared some of the statistics with me that Dr. Olaywiola shared in this Ted Talk. I hope this type of awareness will be about a change. It's needed.

[amarismohammed]

"It's going to take patients, institutions and doctors to play their part... and together we can do no harm". Loved this talk. Thank you for sharing your wisdom and truth, Dr. Olayiwola.

[LaxM-cn]

Dr. Olayiwola addresses 2 very crucial topics with regards to medicine and that is racism and place-ism. She discusses about distributive justice and non-maleficence. Distributive justice in ethics is fairness in what people receive. Non-maleficence is the “do no harm” aspect that she was discussing, but I would like to discuss more on beneficence which is promoting good for the patient. Dr. Olayiwola does a phenomenal job intertwining these two. I was definitely shocked seeing the life expectancy differences that she displayed. I also commend her for bringing up that physicians do not take into account where someone lives. This is where better education is very crucial in healthcare especially for healthcare professionals. Better education of healthcare providers will assist with increasing distributive justice and decreasing poor health outcomes. I would like to further Dr. Olayiwola’s point by adding that increased health education for patients would also assist with this. Part of the duty of a healthcare professional is the educate patients about their health and the options that they have for treatments. This can be achieved by teaching healthcare professionals on how to properly educate their patients. Understanding one’s diagnoses and understanding what kind of options one has is so important because at the end of the day, it is the patient’s own health and body that is being treated. There is a shared-decision making with the patient and healthcare provider. The healthcare professional’s duty is to inform and have the patient decide on what path they would like to go this is where beneficence comes into play. To further this, paternalism is often a difficult aspect of medicine and needs to be balanced with beneficence. Paternalism runs on a scale, but to simplify it, it basically is interfering with a healthcare decision believing it is in the patient’s best interest. I would like to note that paternalism is not always bad. However some examples that Dr. Olayiwola discussed does disrupt the balance of beneficence and paternalism. When patients are more educated then they can have more control over their own treatment and health. This is why patient education and education of healthcare professionals to take the time to educate patients is so important.

[abby]

Dr. Olayiwola did a fantastic job at highlighting how our zip code affects our health. The discussion of her two friends, Wendy and Sara, was a great addition. By using the narratives of Wendy and Sara, Dr. Olayiwola was able to make this research more personable and relatable to the listeners. I thought it was really moving how she started the talk with how medical students start their medical journey with the hippocratic oath. From the beginning, we promise to do no harm to our future patients. However, how is medical training and the healthcare system going against this ethical principle?
While education reform plays an important role in this as well, something also needs to change within the current healthcare system. Technology has improved so much even within the two years since this talk was given. The use of technology and the pop ups in the patient chart to check physician’s implicit bias can be a great tool. While this could make the care that patients receive more equal, I believe that this would also help reveal implicit biases that provider’s have. My hope would be that as time goes on, healthcare providers would be seeing these pop up reminders less and less. Meaning they are becoming aware of their biases and more likely to act in an equitable way without the reminder. I would also hope that as providers see these reminders come up, they would reflect on what potential bias they had in the first place. I believe that reflecting on our implicit biases when we do become aware of them is extremely beneficial in changing the way we think.
These pop up reminders also serve as a way to promote distributive justice. In the research article, Exploring distributive justice in healthcare, Capp and colleagues define distributive justice as “The allocation of resources to providers and the way in which the resources are then prioritized to specific service areas and patients remain the critical ethical decisions which determine the type of health system a community receives.” The reminders that providers would receive in the patient portal would be one way to help ensure distributive justice. One way it would do this would be asking the provider why a patient is receiving the first line medication for a diagnosis. While there may be good reasons as to why another treatment has been chosen for a patient, at least the provider has been reminded to think about equality in the medication prescribed.
Dr. Olayiwola then ends her with a reminder that together we can work on the ethical principle of doing no harm to our future patients. This highlights how healthcare is a team effort and that we all need to work together to make it a more just system. Using technology for good is one way that healthcare providers can all contribute to the cause of promoting health equity.

[rygy]

This was a great speech, Dr. Olayiwola! I think the most striking thing is the local disparities you can graphically show on a map. Your use of real-life friends who live close to one another and have huge health disparities is a perfect illustration of this.

[letsgetethical-urtm]

This was a great talk from Dr. Nwando Olayiwola. In the beginning of her talk, she mentions taking an oath as a first year medical student, along with thousands of other medical students: to do no harm. This is one of the four fundamental principles of ethics called “Non-maleficence.” Under this ethical principle, we, as future healthcare providers, make it our duty to avoid causing harm and to minimize harm to our patients. I have always known that racism and inequality took place in healthcare, but it never really occurred to me that place-ism existed. I was shocked when I saw the stark difference in life expectancy between those living in poor and wealthy zip codes, all within a few miles of each other. This brings up another important fundamental principle of ethics, which is “justice”, the duty of treating patients fairly and equitably. It is so upsetting to see such health disparities exist based on the color of someone’s skin or based on the location of where they live. It’s even more upsetting that healthcare professionals are taught to dis-credit someone’s pain based on the color of their skin. I never understood that logic or reasoning and I question how those in healthcare, those that are educated in medicine, could believe such “facts.” It completely goes against the ethical principles of beneficence, non-maleficence, and justice. In no way are patients being treated equally and fairly. These harmful beliefs don’t enhance the patient’s well-being, but actually minimizes it. We are in the year 2023. Things need to change. Our healthcare system needs to change. We need to do better, and Dr. Olayiwola is right. In order for things to change, patients, institutions, and doctors all need to play their part. I 100% agree that patients should advocate for themselves and inquire more about their pain and about the management of their health. Most importantly, I think healthcare providers should educate themselves, and their peers, about the possible implicit racial biases that they may harbor.

[AnsleySmith-un]

What a powerful and informative session! As a current osteopathic medical student, I am being trained to look at each patient as their own human and addressing their health in all components: body, mind, and spirit. My school has been working tirelessly to raise a new generation of physicians who are aware of these implicit biases and to directly combat them. I agree with you that this will take time. Likely a lot of it. The main proponent of how to move forward is the education. I am hopeful that with this next generation of physicians, we will hold more power in our voice as we actively fight against racism and place-ism.
The AI that you talked about is one that seems very realistic to integrate into current medical practices. As more data is gathered on the inequities of our healthcare system, there could be more screenings that hold physicians accountable for their beliefs and medical practices. Perhaps many of the physicians and other healthcare professionals in our system are not aware of the implicit biases they hold. In no way does that dismiss their actions, but it encourages me to see that there could be systems that allow us to constantly be checking those biases and actively working against them.
As you mentioned, this will be a long process that demands the attention from all involved in order to truly produce change in our system. However much energy it requires, our patients have the right to evidence-based medicine that truly works for their beneficence.

[Simply_hollyraee]

This was a great presentation! Lately, as a woman of color, I am scared to have children because of the fear of myself or my child being treated unfairly by providers. Im terrified actually.

[SaintTrinasTorch]

A brilliant and beautiful human being. Thank you. 🙏🏼

[JourneyNNERPEACE]

What a great presentation! I love your vision of using technology to create empathy and a comprehensive experience between patients and medical professionals. Keep up the awesome work!

[AlpineMeadow-bq]

As a medical student, her talk really touched me and how we can all utilize this in our practice. The do no harm principle she was talking about is the main ethical principle called nonmalificence, to do no harm. It is crazy how people thought pain was different amongst races and how much that effected our treatment of care. I do think that race should be taking into consideration such as if certain populations were more prone to certain predisposing health conditions, but if anyone knows pain, it is the firing of pain receptors at a biomolecular level which race or the color of someone's skin should NOT effect this. I love her ideas of ensuring non-maleficence. I think that more hospitals and healthcare facilities should integrate this, because it also encourages new information, research, and education to healthcare providers. I do think education is very powerful, and this is education through action. It creates an environment where Justice is practice, which is the ethical principle of treating everyone equally. I like how her solutions are focused on prevention and advancing technology. Technology is advancing so quick so why not use it to help fix current problems within the healthcare system. My question is why is this not currently being implemented? What is preventing this solution from happening? I really like how the app would give more information on where someone lives according to their zipcode. This is a great way to determine social determinants of health before speaking to the patient and allowing them to elaborate afterwards. I hope to get something like this integrated nin my future practice to combat racism and place-ism.

[Kewlzz]

I’m shocked to see how placism affected the life expectancy but life expectancy did not change due to racism! That’s huge! Loved your talk! Thanks 🙏

[royalbrooks]

Thank you Dr. Olayiwola! I and my Veteran Opioid Prevention group are working on an NIH STTR project "Addressing Health Inequities in Clinical Diagnostics, " we would love to talk to you.

[FungaiNdemeraYoutube]

I totally agree with this. We are fighting this demon and it will take time.

[CharTheStarMeetsLadyBleak]

Absolutely brilliant, I hope she is connected to Harriet A. Washington who wrote Medical Apartheid

[tomover]

Thank you fir for this talk. I'm glad you're here in Central Ohio.

[ifeifesi]

I'm in the UK and since learning that white doctors are taught that blacks feel less pain than other races, the first thing I tell them is I have a low pain threshold.

[georgeduncan]

😫😫😫 this practice started back in the beginning of racism & experimenting. Medical Apartheid....a real book ☝🏾☝🏾☝🏾☝🏾

[ayaokoe]

Thank you for bringing this to the fore.

[jaimelevy]

thank you so much! Devastating to know these truths and important to know this. These are brilliant ideas, I wish we could have started to use them Yesterday!