Structural, Institutional, and Interpersonal Racism: Podcast with Deborah Ejem and Deep Ashana

In prior podcasts we talked about racism and COVID, lack of diversity in the palliative care workforce, racial and ethnic differences in end of life care, and implicit bias in geriatrics and palliative care. Today our focus is on structural, institutional, and interpersonal racism, and how these different but related constructs negatively impact the care of older adults and people with serious illness.  

We are joined by Deborah Ejem, a medical sociologist and Assistant Professor in the School of Nursing at the University of Alabama Birmingham, and Deep Ashana, a pulmonary critical care physician and Assistant Professor of Medicine at Duke University.  We discuss:

• What are the differences between structural, institutional, and interpersonal racism?
• Examples of how these forms of racism operate in the care of seriously ill patients, including from one of our guest’s personal experiences.
• The importance of attention to religion and spirituality 
• Clinician reluctance to engage in advance care planning with minoritized patients as a driver of disparities
• How abandoning support for advance care planning might foreground implicit biases inherent in the heuristics (or nudges, or short cuts in thinking) inherent to time-pressed in-the-moment decision making.
• Lack of diversity in the participants represented in AAHPM State of the Science presentations, as well as lack of focus on disparities (no link - see upcoming presentation by Deboarh Ejem at the virtual conference).
• Co-opting of disparities issues by the Alzheimer’s Association in their argument for CMS/Medicare coverage of aducanumab (see this Twitter thread by Jonathan Jackson here and article by Daniel George here).  Action Item: Please submit a comment to CMS about aducanumab coverage today.  Feel free to express your outrage at the lack of diversity in the trials.

We could have continued talking with our guests for hours.  We will continue to address the issue of racism in future podcasts.

-@AlexSmithMD