Racial disparities associated with the diagnosis of endometriosis

Derek van Amerongen, MD, MSc: Let’s change the subject and ask about the racial disparities seen in endometriosis diagnosis. Dr. Hawkins, this is his one of your main focuses.

Dr. Soini Hawkins, MPH, FACOG: Endometriosis is a very specific and painful condition that usually accompanies menstruation. That’s an argument being considered below the belt. Many women don’t even know what’s normal and what’s not. Additionally, when they go to the doctor’s office, the doctor may not believe they are in severe enough pain to warrant further investigation. This goes on for years. It takes an average of 7-10 years to diagnose endometriosis. Black and Hispanic women can take twice as long. There is definitely a disparity in the stages of getting a diagnosis.

It leads to diagnosis at a late stage of the disease. Endometriosis can be very invasive. If they were sent to me, it would mean a more complicated procedure. I’m doing it laparoscopically so I could endanger my fertility and such. When diagnosing black and Hispanic women, the incidence of endometriosis is thought to be less likely, but there is definitely a linkage between the disparities. It simply isn’t true. Asian American women are more likely than white women to be diagnosed with endometriosis. But if the population is miseducated, they too [diagnosis] with subsequent illness. So there is a lot of work to be done on the front end. We’ll see some improvements when communities that don’t have access to experts are able to introduce them and earn them. Endometriosis is a highly invasive disease. It can be very destructive for women.

Sharon Deans, MD, MPH, MBA: So we are forced to steer towards prejudice. Historical literature shows that endometriosis was a disease of white upper-class women because it was thought to delay childbirth. This is her one of the risk factors for endometriosis. Historically, the disease was associated with white, upper-class women, and poorer women did not have this problem. In addition, there are differences in the interpretation of pain when women of color suffer. The idea is that black women have a higher pain threshold and that their pain is associated with infections and not necessarily with organic disease. We return to providing education to raise awareness.

As the discussion progresses and results for maternal and child health are reached, awareness of how bias is important and how to educate individuals about unconscious bias and how to approach members based on what is taught. We know how important it is to raise what they believe. A few years ago, I was stunned when I found out it was an ACOG. [American College of Obstetricians and Gynecologists] The difference in transfusion hemoglobin levels in black and white women for obstetric bleeding is completely unfounded. I didn’t realize it at all. It was like a bible for me when I was practicing. I’ve been treating patients based on what I’ve seen, so I didn’t realize it at all. Many of these prejudices are ingrained in our literature and are now being cleared. But most importantly, individuals receive training on bias in clinical settings. It’s very important.

Derek van Amerongen, MD, MSc: Dr. Wells?

Dr. Roxy Cannon Wells: I certainly agree. You should get that training in medical school. It should happen very early on. Studies have shown that residents treated pain differently because they thought black women had a higher pain threshold as opposed to white women. Such women tended to suffer more. That education has to start very early. Not among trainees, not after becoming a doctor, but in medical schools across the country. From there we remove those prejudices and begin to help individuals understand that they need to deal with the visible, not the unseen. That’s a very important point.

Sharon Deans, MD, MPH, MBA: and it must be repeated.I was doing a series at New York University [New York University Grossman School of Medicine] On racism and sexism in medicine. I did this over the course of 2-3 years. By the time I finished speaking, I was talking about obesity and how people are treated differently for being obese. that is not acceptable. We have to put it in the corner of our heads. He annual like HIPAA, should start early and repeat. [Health Insurance Portability and Accountability Act of 1996] It’s training to monitor your biases and raise awareness so you can check yourself as you go. We do it all day, every day. We glance at the patient and put him in the box.

Dr. Roxy Cannon Wells: absolutely. One of his things that stands out is how we deal with sickle cell patients and their pain. I can talk about sickle cell patients here because some of them are women. Some are pregnant mothers. you have to think about it. Is it not only the pain threshold, but also the drug-seeking behavior? Time and time again I have heard some people make the assumption that black women seek painkillers to feel euphoric rather than to treat actual pain.

Derek van Amerongen, MD, MSc: These are very important topics.

I edited the transcript for clarity.