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joanna_banana's review against another edition
4.0
Took me awhile to get through this one! Definitely academic — in a good way. I felt like it was written for healthcare workers, medical school deans, policy makers, and lawyers. Danya Bowen Matthew does an excellent job of demonstrating the mechanisms that cause healthcare disparities between racial and ethnic groups—all operating at different levels, in particular during those crucial patient-provider interactions when implicit bias takes over, all too often because the provider is not allowed to spend enough time with the patient and relies on statistics and preconceived, racist, unhelpful ideas. The outcomes are deadly.
So what can we do about it? I liked how the author walks through the policy history and case law, explaining why it hasn’t reduced disparities to date. In part, it’s because we aren’t addressing poverty and enacting real universal healthcare. Those structural changes would go a long way to closing the gap. It’s also that there’s a long standing belief that if racial bias is unconscious you can’t control it, which is far from the truth. I like how she used the evidence on how laws have been largely successful at preventing and litigating (treating) discrimination in the workplace, so why not in healthcare where again, the question is one of life and death. The book ends with a specific guide to amending Title VI of the 1964 Civil Rights Act and how it would make a difference: 1) prohibit unintentional discrimination, 2) provide for existing disparate impact jurisprudence to continue with the addition of negligence cause of action standard when reviewing a policy or program that does not in fact have anti-discrimination goals, and 3) restore a public-private enforcement model. The author presents a scenario of a case a plaintiff takes forward under the new Title VI provisions she proposes and why it would help. Lastly, she anticipates objections which I found to be a compelling way to convince readers. This book is an ‘appeal to health care providers to begin to act collectively, at systemic and institutional levels, to address the extent to which inequality and racial discrimination diminish the quality of health care in America.’ There is too much evidence in support of policies and programs to address unconscious racism in healthcare (and beyond). Failure is not an option.
So what can we do about it? I liked how the author walks through the policy history and case law, explaining why it hasn’t reduced disparities to date. In part, it’s because we aren’t addressing poverty and enacting real universal healthcare. Those structural changes would go a long way to closing the gap. It’s also that there’s a long standing belief that if racial bias is unconscious you can’t control it, which is far from the truth. I like how she used the evidence on how laws have been largely successful at preventing and litigating (treating) discrimination in the workplace, so why not in healthcare where again, the question is one of life and death. The book ends with a specific guide to amending Title VI of the 1964 Civil Rights Act and how it would make a difference: 1) prohibit unintentional discrimination, 2) provide for existing disparate impact jurisprudence to continue with the addition of negligence cause of action standard when reviewing a policy or program that does not in fact have anti-discrimination goals, and 3) restore a public-private enforcement model. The author presents a scenario of a case a plaintiff takes forward under the new Title VI provisions she proposes and why it would help. Lastly, she anticipates objections which I found to be a compelling way to convince readers. This book is an ‘appeal to health care providers to begin to act collectively, at systemic and institutional levels, to address the extent to which inequality and racial discrimination diminish the quality of health care in America.’ There is too much evidence in support of policies and programs to address unconscious racism in healthcare (and beyond). Failure is not an option.
jennywear's review against another edition
4.0
A must-read for anyone working in healthcare or a health-related field.
jane_henningsen's review against another edition
5.0
I picked this up because I wanted to understand racial healthcare inequities, both as a healthcare consultant and a human. I expected this to be a dive into social determinants of health, but it was actually an exploration of the impact of implicit bias throughout the healthcare system. Definitely a valuable read.
Just Medicine explores bias in both sides of the provider-patient relationship and the harm that unfolds when that bias goes unchecked. There are difficult stories in here- providers who chose not to prescribe effective treatments because they doubted patients were capable of adhering to treatment protocols or paying for medications, women with tumors whose pain was initially dismissed by their providers, etc.
On a more subtle level, Matthew explores communication styles and the importance of a collaborative physician/patient relationship in which a patient feels that he or she is a partner in care decisions. White patients with white providers are the most likely feel that they are partners in their own care, Black or Latinx patients with white providers less so. Cultural and language barriers add an additional disconnect for many immigrant patients. This matters - providers who do not fully engage with their patients may miss important information, and patients who feel disconnected from or judged by their providers are less likely to return for crucial follow-up care. It's a tangled web.
Matthew's solutions are legal and policy solutions, which are not my wheelhouse as a healthcare strategy & performance person. I was out of my depth there, but I still picked up valuable knowledge. I would recommend Just Medicine to any healthcare friends on Goodreads!
Just Medicine explores bias in both sides of the provider-patient relationship and the harm that unfolds when that bias goes unchecked. There are difficult stories in here- providers who chose not to prescribe effective treatments because they doubted patients were capable of adhering to treatment protocols or paying for medications, women with tumors whose pain was initially dismissed by their providers, etc.
On a more subtle level, Matthew explores communication styles and the importance of a collaborative physician/patient relationship in which a patient feels that he or she is a partner in care decisions. White patients with white providers are the most likely feel that they are partners in their own care, Black or Latinx patients with white providers less so. Cultural and language barriers add an additional disconnect for many immigrant patients. This matters - providers who do not fully engage with their patients may miss important information, and patients who feel disconnected from or judged by their providers are less likely to return for crucial follow-up care. It's a tangled web.
Matthew's solutions are legal and policy solutions, which are not my wheelhouse as a healthcare strategy & performance person. I was out of my depth there, but I still picked up valuable knowledge. I would recommend Just Medicine to any healthcare friends on Goodreads!
leapfeetfirst's review against another edition
4.0
While I think that the author's ideas and theories are interesting, I am not 100% convinced of her conclusions. It was an interesting read that lead to a lot of great discussion in our book reading group.
margaret_adams's review against another edition
Required reading for healthcare professionals and civil rights lawyers. Dayna Bowen Matthew lays out 1) the realities of implicit racial bias/unconscious racism in the provision of healthcare, 2) the enormous impact that has on health outcomes even after accounting for all other confounders, and 3) her proposal to reduce health disparities with new laws against implicit bias. At once kind and unyielding, Professor Matthew tracks society's progression from explicit to implicit racism and dismisses the current laws against explicit racism as no longer useful. "Laws effectively influence social norms by reflecting underlying social values that exist but about which there is incomplete information or uncertainty," Matthew writes. Making a clear differentiation between socially-maligned explicit racism and unconscious implicit racism, Matthew nonetheless is unwilling to let anyone off the hook, supporting her proposals with studies showing evidence of physicians' ability to correct unconscious racism.
I especially appreciated the way she unpacked how our medical training encourages performing "sorting patterns," the use of familiar patterns and generalizations about people and their maladies to correctly identify, understand, and address illness in relatively short periods of time--an integral part of the differential diagnostic process that also makes us especially susceptible to being swayed by implicit bias.
Very densely written, but worth your time.
I especially appreciated the way she unpacked how our medical training encourages performing "sorting patterns," the use of familiar patterns and generalizations about people and their maladies to correctly identify, understand, and address illness in relatively short periods of time--an integral part of the differential diagnostic process that also makes us especially susceptible to being swayed by implicit bias.
Very densely written, but worth your time.
kays_pallet's review against another edition
4.0
This book is about the important topic of conscious and unconscious racial discriminations in the medical field. This book has so much potential to spread a lot of information and awareness to yet another injustice in our society. However, this is so dense and repetitive, it's hard to get that information out. In my opinion, this book was difficult to get through due to writing style (page long paragraphs, repetitive phrasing, fact after fact without much backing it up (at some point she even says that she doesn't have evidence backing up a claim because the experiment was bad)). I'm really not a fan of this writing style, however, I think this topic is important and the take away is informative, which is why I rated it 4 stars instead of my wanted 3 stars.
rachael_a's review against another edition
4.0
Everyone should read this, the first 2 chapters are a little rambling but it has ideas and perspectives invaluable to health care equity.