HCPLive Network

Reducing Disparities in the Delivery of Healthcare to Patients with Lupus: A Q&A with Sam Lim, MD, Consortium Chair of the Lupus Initiative

How can conscious and unconscious bias affect treatment? Given the patient population that lupus predominantly strikes, how important is the idea of culturally competent care and what are some of the tools offered by the Lupus Initiative to help physicians practice more culturally competent care?
The whole concept of cultural competency and unconscious bias is very important because I think no clinician would readily admit, or want to admit, or dare to admit that they have an active bias or they’re not culturally sensitive and inclusive. The point of the curriculum is not to point that out; we’re not trying to say that all physicians are biased. We’re really trying to point out the unconscious aspects of it.
 
Unconscious bias is a common part of everyday life. It is another term for the filter or lens through which we view the world, and everybody has experiences that shape who they are, and that’s not anything to back down from. But what we all need to understand is that even under the most well meaning of circumstances and upbringing, there can be opportunities or possibilities that the lens through which we look may impact how we interact with our patients. And, therefore, it may limit the effectiveness that we have in terms of their outcomes. The topics of cultural sensitivity and bias have become more ingrained in the medical education of younger doctors, but physicians who have been practicing for a while haven’t really been exposed all that much to them, certainly not on a consistent continuing basis in terms of ongoing medical education. Given that lupus disproportionately affects young, female, ethnic minority patients, the Lupus Initiative curriculum is wonderful vehicle in which to bring up these issues in order to help us all treat patients across all chronic conditions better.
 
Is this an ongoing program? Are there opportunities for interested physicians to still get involved in the Lupus Initiative?
The initiative is complete in terms of developing its curriculum, but the initiative is more than just the curriculum. It really is an ongoing community that values this wealth of medical knowledge and the concepts that we’ve been talking about: better chronic disease care, health disparities, cultural competency, and the evaluation of bias. There aren’t currently any specific opportunities for additional involvement, but the initiative is still developing ways to sustain these efforts. I would say the specifics are not there yet, but the concepts are certainly there that indicate that we’re committed to keeping these initiatives alive and ongoing. And there will certainly be opportunities down to the road to continue to improve on the materials we offer, as well as to sustain the types of topics that we’ve been presenting. So I would ask your audience to just stay tuned on that.

Further Reading
This 71 year old woman presented with an itchy raised erythematous leg lesion that had been present for 10 months. She has a history of significant sun exposure in the past and was prescribed topical triamcinolone 4 months ago which she believes has made it slightly smaller and less itchy.
This cohort study looked at the influence of maintaining a Mediterranean diet on telomere length, which is commonly used as a surrogate marker for longevity.
It has been more than a decade since the findings of the Women's Health Initiative and even since that time the question of estrogen treatment remains contentious for the medical community
More Reading