As an African American and a certified registered nurse anesthetist (CRNA), Dr. Edwin Aroke has always been committed to equitable care for racial and ethnic minority patients. However, following years of providing anesthesia care in hospitals and teaching student registered nurse anesthetists (SRNAs) at the University of Alabama at Birmingham, Aroke realized that even the most conscious healthcare providers can have biased impulses.
“One day, I received a report of a 21-year-old African American male with a gunshot wound coming to my room,” said Aroke. “My immediate thought was that he must be a ‘gangster.’ I had to stop and consider that I knew nothing about this individual and he could have been a bystander, a suicide victim, anyone. Despite being an African American, the neurocircuits in my brain made a potentially harmful judgment.”
Disparities in treatment for racial and ethnic minority patients stemming from implicit biases are distinctly present in pain care. Studies show that compared to white women, racial and ethnic minority women are less likely to receive an epidural for childbirth, and Black patients are less likely to receive pain medicines in emergency rooms than white patients. Unfortunately, research suggests that these treatment disparities may be a result of false beliefs about biological differences in pain tolerance between Black and white patients.
This issue is particularly important to Aroke, and the subject of his research program. He is also educating his students and colleagues, as well as moderating webinars alongside the American Association of Nurse Anesthetists, to educate CRNAs and SRNAs across the country.
“As a CRNA, I provide multimodal, opioid-sparing and opioid-free anesthesia and pain management services, as well as safe opioid administration to prevent the risk of addiction,” said Aroke. “Additionally, CRNAs are more likely than physician anesthesiologists to work in counties with lower median incomes and denser unemployed, uninsured and Medicaid-eligible populations.”
Aroke shares advice with patients to help ensure they receive equitable treatment. “The best care experience starts with good communication between the patient and their provider,” he said. “You know your body best. Don’t be afraid to ask for a second opinion on diagnoses and treatment plans and express any concerns with the quality of care you are receiving.”
For healthcare providers like CRNAs, Aroke has additional recommended actions:
- Learn more about minority community needs. “I encourage all of my colleagues to better understand the communities they serve and whether resources are available to address their needs,” said Aroke.
- Address health literacy and linguistic barriers. Racial and ethnic minority patients are more likely to have less health literacy and English proficiency, which can impact their ability to obtain and understand health information and services.
- Incorporate training on implicit bias into practice. “This education should be evidence-based and include recommendations on how to empower patients from disadvantaged backgrounds to understand their options for care and financial and social support,” said Aroke.
Most importantly, healthcare providers and patients must advocate for systemic changes. “We cannot address healthcare disparities without understanding systemic racism and the structures that hold these biases in place,” said Aroke. “‘Not being a racist’ isn’t good enough — CRNAs and other providers must fight discrimination and take active steps to promote health equity.”