Anesthesia

Cardiovascular Surgery

Anesthesia

Understand and interrogate disparities in acute and chronic pain treatment, and unceremoniously dismiss the idea that Black people feel less pain than White people
- Pain in BIPOC patients is often underestimated or attributed to drug seeking behaviour

Cardiology

Cardiovascular Surgery

Anesthesia

Find out if students at your institution are taught that beta-blockers don't work in Black people
- Eliminate that race-based medicine
There is a Black amputation epidemic.
- What are you doing to improve treatment access for peripheral vascular disease?
Black patients are more likely to develop hypertension and heart disease compared to Caucasian patients
Black patients respond less to ACE inhibitors compared to Caucasian patients
- Beta-blockers and diuretics have demonstrated better efficacy in Black patients
- These differences in treatment guidelines should be taught in more detail during the cardiology block
Students should be advised on how to examine discoloration in melanated patients in response to critical ischemia
An element of chronic disease management and lifestyle changes for racialized/low-income populations should be incorporated into the curriculum

Cardiovascular Surgery

There is a Black amputation epidemic.
- What are you doing to improve treatment access for peripheral vascular disease?

dermatology

Emergency medicine

Cardiovascular Surgery

Sample images of skin conditions in darker skinned individuals should be included in case presentations
Malignant melanoma is learned in the context of fair-skinned individuals
- Emphasis should be placed on the increased likelihood of acral lentiginous melanoma in darker-skinned individuals and where it presents
  - i.e. fingernails, soles of hands and feet
Ask your program director/faculty to increase the representation of skin of colour in your lectures
- Can extend this to all medical students for under-graduate dermatology teaching

Emergency medicine

Understand and interrogate disparities in acute and chronic pain treatment, and unceremoniously dismiss the idea that Black people feel less pain than White people
- Pain in BIPOC patients is often underestimated or attributed to drug seeking behaviour
Encourage your department to not allow special entrance privileges to law enforcement
- Ensure that they're required to check in through the main desk and not be there when unnecessary to avoid intimidation patients/ deterring seeking treatment

Endocrinology

Emergency medicine

Does your institution fund work on obesity that explores EXCLUSIVELY genetic bases for racial disparities in obesity?
- If so, write a letter which delves into the many conceptual flaws in this framework, which locates pathology not in our societies, but in the bodies of individual Black people. A reminder: no one has ever found an allele that is found in all Black people and no White people
- Read Naomi Zack's Philosophy of Science and Race and dig deeper
Find out how many Black girls are harmed by the differential diagnostic standard for early puberty at YOUR institution
- Advocate for the elimination of that race-based medicine

Family Medicine

Internal Medicine

Family Medicine

Check your roster for how many Black and Indigenous clients you have
- Ensure this is higher than the numbers in your community to correct access inequities
Dedicate time to seek out and hear stories of the impact of racism on your patients’ lives
- Make sure they know you know this is a core health issue and treat it as such
Question ANY behavioural health diagnosis (ADHD, conduct disorder, etc) in children of colour
- Autism spectrum disorders are woefully underdiagnosed in non-white children
Use the strength of long-term relationships to advocate for patients and “check up” on their specialists to make sure that they receive equitable care and treatment

Hematology

Internal Medicine

Family Medicine

Hematologic reference ranges do not apply to all ethnic groups and differ in Black patients
Jaundice can be harder to notice in darker skinned individuals.
- Students should be instructed to examine the hard palate of the mouth and inner canthus of the eyes if jaundice is suspected in a darker skinned individual
Emphasis should continue to be placed on the possibility of sickle cell anemia or thalassemia trait in darker skinned patients with hematologic abnormalities

Internal Medicine

Medical microbiology and Infectious disease

Advocate for the creation of a ICD-10 code for experiences of chronic racis

Medical microbiology and Infectious disease

Find out what the local environmental racism issues are in your community
- What are you doing to address the pollution which inequitably damages the lungs of Black people?
- Will you push for this issue to be taught in your medical school?
Address the scourge of tuberculosis that almost exclusively affects Black people and other minorities
- We are trained to look for it in people caged in our inequitable criminal legal system
  - Go deeper
  - Ask why

Nephrology

Medical microbiology and Infectious disease

Obstetrics and Gynecology

Find out how many Black people are denied kidney transplants by the race-adjusted eGFR at YOUR institution
- Advocate for the elimination of that race-based medicine
Find out if students at your institution are taught that ACE inhibitors are not safe for Black people due to hereditary angioedema or are simply inefficacious
- ACE inhibitors are renoprotective, lifesaving medicine

Obstetrics and Gynecology

Medical microbiology and Infectious disease

Obstetrics and Gynecology

Black women experience higher rates of morbidity and mortality during pregnancy, and receive inadequate care compared to Caucasian women
Black women have higher rates of preterm births compared to White women
- Be aware of the socioeconomic factors that lead to these disparities
- Advocate for pregnant Black women during their care
Ask what your institution is doing to save Black mothers
- The answer should not be implicit bias training
- Read the wealth of work done by Black women and push for it to be taught and discussed at every meeting and seminar

Oncology

Pediatrics

Pathology

Do not let social disparities affect your decision to treat aggressively
- Find ways to offer help with transportation and assistance for patients who are from underprivileged neighbourhoods

Pathology

Pediatrics

Pathology

Advocate for the addition of a box on the standard death certificate which marks death in custody
- We don't actually know how many people the police kill every year because we have to rely on police to report

Pediatrics

Pharmacology

Question ANY behavioural health diagnosis (ADHD, conduct disorder, etc) in children of colour
- Autism spectrum disorders are woefully underdiagnosed in non-white children
Find out how many Black girls are harmed by the differential diagnostic standard for early puberty at YOUR institution
- Advocate for the elimination of that race-based medicine

Pharmacology

Are the students you matriculate learning to treat the whole individual? Or are they taught myths of Black biological uniformity and pathology that reflexively deny life-saving drugs?

Psychiatry

Pharmacology

Pulmonology

Recognize and question the chronic underdiagnosis of depression, bipolar, and ASD and overdiagnosis of schizophrenia in Black patients; as well as the frequent criminalization of psychiatric symptoms in Black individuals
Question ANY behavioural health diagnosis (ADHD, conduct disorder, etc) in children of colour
- Autism spectrum disorders are woefully underdiagnosed in non-white children
Black patients with mental health issues are considered to be more violent than their Caucuasian counterparts and are more likely to be involuntarily admitted
Black patients with mental illness are less likely to be offered psychotherapy and more likely to be offered pharmacotherapy
Every student should be aware that Black patients presenting with delirium are more likely to be turned away and accused of malingering or drug usage
Find out the rates of chemical and physical restraint use in your hospital in White and non-White patients
Look at the rates of antipsychotic prescriptions and psychosis diagnoses across race
- Notice a trend?

Pulmonology

Pharmacology

Pulmonology

Find out how many Black people are harmed by differential spirometry standards at YOUR institution
- Does it delay time to treatment? Access to transplant?
- Be the expert that answers those questions
Find out what the local environmental racism issues are in your community
- What are you doing to address the pollution which inequitably damages the lungs of Black people?
- Will you push for this issue to be taught in your medical school?
Address the scourge of tuberculosis that almost exclusively affects Black people and other minorities
- We are trained to look for it in people caged in our inequitable criminal legal system
  - Go deeper
  - Ask why

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