[Mediterranean syndrome and the French medical world, a racist prejudice still active. A parallel with Frantz Fanon's article about the "North African syndrome"]

Racial biases in clinical practice and medical education: a scoping review

INTRODUCTION

Health inequalities represent a major challenge in contemporary medicine, with some attributed to racial biases. Recently, in the United States, a call to combat discrimination in the field of health has resonated, particularly in the context of the COVID-19 crisis, in which minorities have been disproportionately affected. These calls echo recommendations from the Institute of Medicine dating back to 2001, urging the fight against inequalities in access to health care. In France, inequalities based on presumed origin persist, yet medical education on these issues is virtually nonexistent.

MATERIALS AND METHODS

We conducted a scoping review literature review in accordance with the JBI recommendations for scoping review writing and applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to explore existing conceptual and educational data on racial biases in medicine. The inclusion criteria were interventional studies or evaluations of existing educational programs in medical training addressing the fight against racial biases in clinical settings published in French or English between 2003 and 2023. Six databases were systematically consulted.

RESULTS

Out of 748 initial studies, 28 were included in our study. The median number of participants in the studies was low, interventions were diverse, and participants were generally well received, most of whom were self-selected. No study has evaluated the clinical impact of these interventions. The highlighted concepts included levels of racism, cultural competence, cultural humility, and critical race theory.

DISCUSSION

The authors most frequently referred to institutionalized racism, demonstrating the systemic nature of these issues. At an individual level, implicit and unconscious biases were most often emphasized. It appears that the concept of "race" is a sociopolitical construct without supporting biological determinants. Humility is central to this field of study, as it encourages questioning of individual or collective medical practices. In France, the context, including the prohibition of ethnic statistics, may hinder the objectification of discrimination. Immersion and virtual patient scenarios emerged as potential solutions for evaluating the clinical impact of interventions. A more horizontal medical pedagogy seems better suited to teach these sensitive issues.

Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds

OBJECTIVE

To explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background.

DESIGN

This was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions.

SETTING

This study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands.

PARTICIPANTS

The survey was completed by 188 participants (Mage=39.89, SDage=10.2). Of whom 80 (Mage=37.92, SDage=10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis.

RESULTS

From the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one's migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination.

CONCLUSION

Dutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.