Diagnostics Decoded | Lab Values and Ethnicity
More Programs and Publications Featuring Dr. Brandy Gunsolus
In this program:
How is the concept of ethnicity utilized in laboratory medicine? Are there differences in drug metabolism enzymes among different racial and ethnic groups? Is race correction used in clinical medicine? Respected medical laboratory scientists Dr. Brandy Gunsolus and Dr. Dana Baker discuss the complex interplay between lab values and ethnicity.
Transcript
Interviewer:
Welcome to the Diagnostic Decoded Program. I'm Deandre White, a clinical research professional and Health Equity Emissary Team member at Diverse Health Hub. Joining me today are respected medical laboratory scientists, Dr. Brandy Gunsolus, doctor of Clinical Laboratory Science at Wellstar MCG Health, and Dr. Dana Baker, President of the Society of Black Pathologists, to learn about the complex interplay between lab values and ethnicity,
In this Diagnostic Decoded Program today, we are tackling lab values and ethnicity. So some things that we'll be discussing are, how is the concept of ethnicity utilized in laboratory medicine, are there differences in drug metabolism as enzymes among different racial and ethnic groups, and is there really race correction still to be used in clinical medicine. So, thank you both so much for joining us,
Dr. Brandy Gunsolus:
Thank you for having us.
Interviewer:
So thank you so much both for joining us today. And I would like to start with Dr. Gunsolus. My first question is, How is the concept of race utilized in current laboratory medicine practices?
Dr. Brandy Gunsolus:
So right now, laboratory is in the middle of a transition, and it's a long, overdue transition. We have roughly the last 20, 25 years, been doing race corrections when it pertains to kidney function tests, especially when it comes to what's called an eGFR, and it's based off of a creatinine level, and gender and weight and height, and it's all those into this equation, and this value, that result of this equation tells you what kind of stage of kidney disease that you're in. In the last 20 or so years, they have also factored in ethnicity, specifically, the African American population, and that should be noted that we're the only country in the world that does it, that was doing this, nobody else was doing this. And a lot of that came out of research that occurred that was very racially motivated research originally, and is unfortunate that that happened, and the industry is now working to correct that, and we have now been removing that race correction. It wasn't a correction, it was really detrimental to the African American population, as they would not be diagnosed with kidney disease until they were way far advanced and wouldn't be put on the transplant list until they were much sicker than other ethnicity. So the laboratory industry has been working hard to fix that.
I know in my laboratory, it's been now almost two years since we removed that race-based correction. Many of the larger laboratories have removed it. We're still trying to get some of the smaller laboratories to make that change, it's hard for physicians to acknowledge that they've essentially been practicing medicine incorrectly, especially when it pertains to a specific ethnic population of their patients, but they have to basically say, "I'm sorry, but we've been treating you unfairly, and now we're going to try to correct this."
Interviewer:
How do you think we can move towards improving that, if anything, faster? Because I've worked at facilities even recently or worked with large, large lab companies that I still see on patient lab reports have the little AA next to the eGFR measurement.
Dr. Brandy Gunsolus:
So if you're looking at historical data, it's going to be on the historical data, that's the way it was published at that time, that's what medical decisions were based off of at that time, so we really can't go backwards and correct all of that data in the patient charts, once it's in the patient charts, it's there, so you're still going to see it, especially in historical charts. Trying to prevent it from moving forward is the real challenge. Baker, do you have anything to add to that conversation?
Dr. Dana Baker:
No, I'll just build on that and add, I know it is an ongoing discussion within the laboratory medicine community, and as we are seeing more hospitals and more facilities come on board, I think we'll see other facilities follow that model, because it's really just trying to determine the process for that conversion or changing over. I think with anything, it's hard for people to break away from old habits or old practices, especially in medicine where you have this, I'll say this variety of individuals and their clinical training and understanding and experiences and how they've become essentially relying on data to appear a certain way in medical reports, especially our laboratory reports, but it will take a collective effort for us to all move forward and just being relevant in our practice, but also being current in following those best practices. And now that we have determine that, it is best practice to come away from race-based or ethnicity-based calculators, when we look at the GFR for an example, EGFR rather, for example, I think that we will start to see that trend of more institution coming on with that change.
Interviewer:
I agree. Thank you guys for that. For my next question, How are reference ranges, as we were talking about eGFR just a minute ago, for laboratory values to be established to account for racial and ethnic differences in populations in the educational setting, and how can these differences be accurately reflected in clinical practice?
Dr. Dana Baker:
Well, I think that really touches on what we were just discussing or describing when we look at historical data versus what is now the best recommendation or best practice moving forward, making sure that the clinical practice that we are teaching within our educational setting, we do have to refer back to what has been done historically, so that they have that understanding of what needs to be practiced or normally practiced, why those changes have occurred or why we're coming away from reporting in that manner and thinking about reference ranges and correlation with race and ethnicity, but why we had to come from that, where we are now and where we're trying to go. And so, as an educator, I really made it my goal and my intention to really talk about the historical journey to how we practice medicine, especially in laboratory medicine, and reporting out of that information, how now we have determined that, of course, with race being a social construct that we shouldn't really necessarily base our reference ranges or design or create those based on race, but also speaking to what they may encounter and see in their clinical practice once they leave this education setting.
But I think it's really important to encourage that curious thinker and really teaching them not just critical thinking of what they may be interpreting or looking at or reviewing, or even just generating in the sense of data, but thinking Why or I'd say, why am I only seeing a reference range for one particular demographic where we don't see that across all demographics? Why is it only reported in black and white? Why do we not see it in other ethnicities? So therefore, if we don't see it across all ethnicities, it doesn't matter, and doesn't add value to what we're seeing. What was the purpose of the reasoning behind this being included in the first place? And I think it also goes back to how are these reference ranges developed in the first place? And is that based on credible data? Was this based on research and finding that determined that, yes, this is how this came into operation, or how this reference range was established. So by asking those questions, I think we'll find more of those answers, and encourage our emerging generation of medical laboratory scientists and laboratory professionals as a whole to really consider that are we being accurate in this approach? And maybe it is time to kind of hit the paradigm, if you will, in how we approach laboratory medicine and reference ranges when it comes to our population.
Interviewer:
Yeah, and I think it's important to really emphasize that just because these values are black and white, they're not actually black and white, and I think for providers to not make these kinds of assumptions and to think about where these values are coming from, thinking about what this research is coming from, and not just putting their patients into this sort of box, it can make them not only better providers, but see their patients in a different way and in a different light and more holistically even. And when they discuss these things with their patients, it can also help the patients to see themselves differently and not just like, "Oh well, I guess I'm supposed to be in this category", when no, no one is supposed to be in a certain category, we're all different. But do you have anything to add to that, Dr. Gunsolus?
Dr. Brandy Gunsolus:
Yes, one thing that laboratories can do to improve this is to make sure that when we're developing these reference ranges and these reference intervals, that we're using a diverse population. That has been a challenge when you're going to pull these reference intervals and reference ranges from literature is that you go and you look in this literature, and that's all from Caucasians, and that is not doing justice to the community that we serve, because a community that we serve is not all Caucasian. When we make these reference intervals, we're using at least 100 and oftentimes 200 individuals, “Well, we have such a diverse population, we should ensure that that diversity is recognized as part of making that reference range, so that we know that it would apply across our entire population.” Those values not...don't mistake what I'm saying as far as that I'm saying that there's a genetic difference, I'm not. What I'm saying is that when you're looking at diversity, you need to look at not just racial and ethnic, but also socioeconomic diversity, look at different dietary, look at different things and make sure that you've got a diverse population that is truly representative of the patients and the population that we serve in all manners of diversity.
Interviewer:
Yeah, so thank you for specifying that there aren't really genetic differences, because that's really important to specify here.
But to continue asking you, Dr. Gunsolus, are there differences in drug metabolism enzymes among different racial and ethnic groups in the term of race correction if they're still used in clinical medicine?
Dr. Brandy Gunsolus:
So we just were discussing the race correction that laboratories are really trying to move away from. As far as drug metabolism, enzymes different among racial ethnic groups, there were some studies that were put out 10, 15, even 20 years ago, that made the suggestion, and what we have found now is that that is outdated information, that's old information, it doesn't really follow racial and ethnic groups. We're such a melting pot, especially here in the U.S. and other industrialized nations that you do not see this, you can't look at an individual and say, "Oh, I know what their genotypes and their phenotypes are going to be when it comes to drug metabolism," you have to test that, you can't assume it just because somebody looks a specific way.
Interviewer:
Right. And just to kind of bounce off what you were saying, yes, we are a big melting pot, but when you look at American produced data, you'll see African American or Asian American, Hispanic American, and that those within themselves are very broad categories, honestly, especially even from a genetic standpoint, that's what we're talking about, this had continued to go off of enzymes here of cytochrome P450. I had read an article, probably one of the ones you were referring to from like 10 or so years ago, and it was interesting because what they had mentioned was they were looking at different ethnic groups, and there was a group of people in China and they were talking about different groups within China, different ethnic groups within China, and even their genetic variation of this enzyme was different. So again, just to say that that already within one country that has the majority of their population is one, they're all mostly Chinese, right? You can't go off of that data and then have American data say, "Oh, Asian American, African American," that can be a very misleading, so...
Dr. Brandy Gunsolus:
Very much.
Interviewer:
Dr. Baker, do you have anything to add to that?
Dr. Dana Baker:
I was just going to say that just to your point, that being misled in that, that that's where we also end up ending with misdiagnosis or additional treatments that were probably unnecessary treatment or intervention, that probably didn't need to happen in the first place. I think that's really crucial to the conversation that we're having and really debunking what we're seeing with the race-based information in medicine.
Dr. Brandy Gunsolus:
Or even treatments that should have never happened, and treatments that would have happened, and didn't.
Dr. Dana Baker:
A long time ago. [chuckle] Right.
Interviewer:
So, Dr. Baker, what efforts are being made from an educational standpoint to standardize and harmonize laboratory testing methodology to ensure consistency and accuracy across diverse populations for the future?
Dr. Dana Baker:
I feel like a lot of things are happening from an educational standpoint. If we just look at higher education and look at all the amazing advancements that we have there with healthcare simulation, interprofessional education, and so we're really increasing the awareness of these other professions, gaining clarity of the different roles that we have, even within the laboratory team, and so the lab isn't just comprised of medical laboratory scientist, but how do we all come together as pathologists, as DCLS, as phlebotomists, as Histotechs, and so on and so forth. Because there's a lot that happens if you look across all three phases of testing, whether it's pre-analytical, analytical, post-analytical. And so, when we look at standardization and harmonization, it's really crucial just to have that fundamental understanding of our roles, having clarity in that, having understanding of the testing methodologies that are not being used in our facility, but what are the testing methodology being employed by our regional facilities and even beyond that, and that's where even education beyond the classroom, in our national meetings and national conferences, where we're able to network and hear presentations that also connect with others from other regions or within our region, about the testing methodologies that they're using.
Of course, when I hear harmonization and standardization, I can't help but think about proficiency testing, and that's another critical or crucial area or component of the work that we do within pathology and laboratory medicine. And so, I think that speaks to or helps to contribute to that consistency and accuracy that we see across the diverse populations that we serve. But also, by having that ongoing conversation and discussion of what we're doing, what we've employed in our practice, what has been determined to be evidence-based practice, and also best practices moving forward. And so, it's really exciting just to see all the advocacy work that's happening as well as we're looking quite heavily into workforce and what our workforce is doing and sharing and producing those reports, so that everyone has an opportunity to also review that information and kind of collect from that or gather from that what they can employ in their current practice in their institution, whether it is in that academic setting or within the training and development of a laboratory team in a clinical facility. I'm not sure if Dr. Gunsolus has anything she'd like to add.
Dr. Brandy Gunsolus:
Oh, [chuckle] honestly, you touched every point that I was thinking of.
Interviewer:
Well, it's good to hear that there's a lot going on behind the scenes to keep everyone integrated and improving the knowledge and finding what works best and sharing that within the community.
Dr. Dana Baker:
And that even broadens globally. I was just going to add, that there's a lot of global harmonization that happens within our field as well. So it's not just either contiguous to United States, but also to other countries and seeing and looking through what they're doing and their professional associations and societies and sharing that information.
Interviewer:
Right. Very important.
Dr. Dana Baker:
Yeah.
Interviewer:
Dr. Gunsolus, what challenges arise in the clinical interpretation of laboratory tests for drug metabolism enzymes in racially and ethnically diverse patient populations? And how can healthcare providers navigate such challenges to optimize medication therapy?
Dr. Brandy Gunsolus:
So probably the biggest challenge is outdated information. A lot of providers, they learned what was being published when these types of tests first came on the market. And they were first told that there were racial differences and there were ethnic differences. And since then, we've determined that, well, that's not really true. But unfortunately, a lot of things that you learn when you first are introduced to a topic, that's what kind of sticks with you. So re-educating our clinicians is probably the most challenging aspect of it. The next challenge is just the testing itself. The testing has changed through the years. It used to be just looking for a couple of mutations here and there. And now, we actually sequence the entire gene. And so we're finding even more alterations within those genes that are more than just a, "You're a high metabolizer, you're a low metabolizer." Well, now there are many subtle levels within that. And so we've learned a lot more as the technology has improved. And unfortunately, a lot of physicians just have not been able to keep up with that technology, especially our primary care physicians. And I don't blame them. Everything in medicine is advancing at light speed.
And it's very difficult, especially for a primary care provider, to keep up with all the advancements in pharmacy and all the advancements in laboratory and in all diagnostics plus treatment options, all the different treatments. It's very difficult because the information is just coming at them at light speed now. So I don't blame them at all. What they can do, though, is that every laboratory that offers this testing, whether it's an academic medical center or a big commercial reference laboratory, they offer physicians, genetic counselors, geneticists that will help guide them through interpreting these test results and how that specific test result applies to their specific patient. And I strongly encourage clinicians, especially if they do not order these tests on a very routine basis, to please connect with those geneticists and pathologists, PhD chemists, that are at these institutions performing those tests to aid in interpreting those test results with that specific patient.
Interviewer:
That's very important. Dr. Baker, anything to add?
Dr. Dana Baker:
Well, just as I was listening, really, I know I said no, but I guess yes, as I'm adding to it. [chuckle] But as I was listening in, I just couldn't help but to think about just the opportunity to really leverage in a professional collaborative practice. I think that also kind of speaks to our, I would say, kind of like our old school of training, where we learned and tend to work in a silo, whereas now we're trying to work toward breaking down silos and really have effective communication across professions. And so, where we may recognize a gap in our understanding or in our even recent knowledge regarding a specific topic, whether it is drug metabolism enzymes or anything else in that nature, to bring in those other practitioners, to bring in those other specialists. I know any time I may have a question, especially if it might be drug metabolism-related, I always refer to my PharmDs. I'm always quick to give them a call just to get their perspective from their professional lens, or from their scope of practice, so that way I can use that information to help inform my thinking and my understanding.
So I think about that, but I also think about just our workforce and our healthcare providers and ensuring that we have diversity in that pipeline. And so what are we doing in terms of recruitment, retention, training, making sure that our healthcare providers or the workforce collectively represent the diverse patient populations that we're serving, because that increased diversity will also contribute to our understanding and the challenges as we are navigating this together regarding laboratory tests for drug metabolism enzyme, as well as a host of other laboratory tests when we still, just thinking about this conversation on race correction in laboratory medicine. So I'm always thinking of both ends, that recruitment end, but also where are those opportunities to collaborate with other professionals.
Interviewer:
I think not just speaking on enzymes, but just general labs that say PCP may not understand in general. I feel like a lot of the time they'll send a patient to a specialist, but I don't know, there's always a disconnect after that, it seems to be. And the pieces don't always come together, even after going to a specialist for interpreting that said lab values.
Dr. Dana Baker:
Right. And we also have to consider, is every patient going to do that follow-up of going to their specialist? Because if it didn't seem alarming or concerning with their PCP and how life may happen, they may not have the time or the opportunity to follow through with that follow-up with a specialist.
Interviewer:
Right, so it's the provider’s responsibility, really?
Dr. Dana Baker:
Right.
Interviewer:
So, how do unconscious biases and stereotypes among healthcare providers influence the interpretation of lab values, and what strategies can be implemented to mitigate these biases in the lab and educational settings?
Dr. Brandy Gunsolus:
So I have seen more bias and stereotypes in healthcare providers in what tests that they order than the actual interpretation. I have seen everything from in OB/GYN sectors at different facilities where they are only drug testing the moms that they think would be positive and those unfortunately are always minority and younger and those of lower socioeconomic status. And I have had to show data time and time again that said that the highest drug offenders are white females between the ages of 30 and 40. [laughter] It's these stereotypes that...
Interviewer:
Shows you the epidemic is very real.
Dr. Brandy Gunsolus:
Right, but they go back to over and over again. And that has in my experience, I have run into more of that, of the ordering practices than the interpretation. I have come across some physicians that have discounted some values based off of race. But more than often it is that they are ordering tests that they should be ordered across the board, or they're not ordering tests because of biases. I have also seen family practitioners where the guy comes in and he's here for a wellness exam and he's in his mid 50s and he really should get an HIV test and an HCV antibody. I mean, HCV antibody is one of those that's part of the now considered standard of care for wellness exams. And I asked the physician, "Do you want these tests?" "No, I know him. He's a good guy. He's a good family man. He doesn't have any of that". Lo and behold, patient actually had HCV. It's one of those things that those stereotypes and those biases, they come in and a lot of times physicians don't even realize that they're doing them because it's part of the way they were brought up.
Interviewer:
Yes, I was going to say it's learned for them as well.
Dr. Brandy Gunsolus:
Yes. And a lot of physicians don't even realize it until somebody points it out to them and then they have to unlearn what unfortunately their parents taught them when they were younger.
Dr. Dana Baker:
And I'll just quickly add that I think there's also assumptions that come into that. So with the example you just shared of the patient that tested positive for HCV. And so, one would assume how they contracted HCV, but depending on what has happened in their life circumstance wise, they may have received a blood transfusion at one point in their lifetime when we weren't testing for HCV. And so that can be one method of which they contracted it. It doesn't mean that they had a risky lifestyle per se, but sometimes when you do have that positive test, depending on the test, there's that assumption of lifestyle. And that can also change or impact how you're treated as a patient. And so that's something else that we have to address when we talk about biases and stereotyping and so forth. Is the taboo assumption of certain positive tests and just really being comprehensive and there's more than one way to potentially contract a certain disease or condition. So we have to be mindful and just in providing education on that.
Interviewer:
Yeah, and I think there are a lot of assumptions. This is something that particularly affects the LGBT community with assumptions and kind of over testing and you'd... I mean you want to say that over testing isn't a bad thing but it actually can be. And you could be looking for I won't say the wrong thing but you could have a gap in care and not be looking for the right thing because you're too busy fixated on something else.
Dr. Dana Baker:
And that actually touches on something that actually happened with me a number of years ago where I went to a physician complaining of feeling lightheaded, tired, sluggish, not sure exactly what was going on. And their immediate diagnosis before any blood work, I think we only talked maybe two minutes was, "You must have diabetes." I was like, "What made you jump to that? We haven't done a glucose. We haven't done...you haven't even done a physical assessment on me yet." They're like, "No, what you have... "
Interviewer:
Did they even know your medical history at the time?
Dr. Dana Baker:
No.
Interviewer:
Okay.
Dr. Dana Baker:
No, this is a new visit, new patient visit.
Interviewer:
[chuckle] Okay.
Dr. Dana Baker:
And they're like, "Well, based on your ethnicity and your weight, it must be diabetes." And so, she was even very direct in what she felt was going on with me. And so I was like, "Well, go ahead and take my glucose right now. I'm going to tell you it's normal, and I do not have diabetes." I'm like, "And if you want to take it a step further, let's do it." And so, of course, everything came back normal range, that would otherwise be increased or elevated and patients diagnosed with diabetes. I did not, still don't have diabetes. But see, but because of that fixation and the way she jumped, she didn't assess me for anything else. And so, I actually had to follow up with a separate physician.
Interviewer:
You make it harder to solve the problem.
Dr. Dana Baker:
Yeah, I didn't, I didn't leave there with a resolution or a treatment plan, because she refused to talk about anything else and just said she knew that stuff would come back and spoke to only that diagnosis.
Dr. Brandy Gunsolus:
I've actually had a very similar experience to that. A number of years ago, I had started getting these excruciating migraine headaches, and I was having numbness and tingling in my hands and feet. And so, I was referred to a neurologist and the neurologist never looked at me in my eyes, just sat there and was typing on his laptop. And he told me that the reason that I was having all of these issues was because of my weight and that gastric bypass would fix all of those issues for me. And I'm like, "I've been overweight my entire life. This just started." And it turned out, didn't go to him again, obviously, [laughter] went to another neurologist, and I had an autoimmune condition that was causing all of the problems. But I mean, he took one look at me and it was, "Oh, gastric bypass will fix your issues."
Dr. Dana Baker:
That's another example of unconscious bias.
Interviewer:
Not only that it'll fix your issues, but you're heading towards a very expensive and complex procedure that you don't even need.
Dr. Brandy Gunsolus:
Right.
Interviewer:
That can cause more issues.
Dr. Dana Baker:
As you asked us earlier, strategies that can be implemented. I think, of course, continuing education is very important. I'm glad that for most of us that do hold a board certification or some form of medical license, we are required to have continuing education. But I think that's immensely important to have that not just from a kind of national meeting or conference dance, but also within each respective institution. We should be responsible for that continued training and competency for our for those individuals who are in practice within that institution. And I think that's something in terms of professional development that should be modeled and championed and supported because that's going to impact your patient ultimately. And so, if you want to preserve and maintain that quality of care that is comprehensive and holistic, we need to be invested in professional development, ongoing professional development rather, for our practitioners.
Interviewer:
Yes, and not every patient is Dr. Dana Baker or Dr. Brandy Gunsolus that can actually stand up for themselves and be their own advocate for their health and say, "No, I do not have diabetes. No, I do not need a gastric bypass," but not every patient is in that position and will immediately follow whatever instructions are given to them. So, it's just very important for providers to take that holistic route and look at the whole patient and look at the whole chart as they're supposed to actually do appropriate testing prior to making these assumptions. So what research priorities should be established to further investigate the intersection of lab values and ethnicity, including studies of genetic determinants, environmental exposures, health care access and health disparities?
Dr. Brandy Gunsolus:
We could probably talk an hour just on this [laughter] topic itself. But to kind of shorten it down. One is to make sure that when we're doing research that we do have a diverse patient population that we're looking at, that we're looking at all potential variables. I remember that I was editing a chapter for a textbook and in this chapter of previous version of it, and it stated that African American children are always anemic compared to Caucasian counterparts.
Interviewer:
What does that even mean? [laughter]
Dr. Brandy Gunsolus:
And I was like, but this is just a blanket statement. It's not even taking into account socioeconomic status. It's not taking into account dietary status, access to healthcare. And we know that minorities overall have a much more difficult time getting access to healthcare and having access to nutrition and tend to have a lower overall socioeconomic status compared to the rest of the Caucasian population. And just to make a blanket statement, in a textbook, no less that this was due to ethnic variation. I was horrified. I'm like, no, no, no, no, no. Completely rewrote the whole thing, because you can't make statements like that if you haven't looked at all of the variables. And what we've seen in research is that the ethnicity is not the issue. It's everything else that factors into it. If those children had access to all of the food and the lunches, because they're...what the rest of the population does, if they had access to all the healthcare that the rest of the population does, that they have access to everything else, [laughter] would they be anemic? My assumption is, no, they wouldn't.
But I mean, or if they had chronic lead exposure, that can cause anemia because they're living in conditions where it still has lead paint. There's so many different...then that's environment exposure, there's so many different things that has been published previously that is just, it's wrong. And we're having to debunk all of these things, do more research to prove all of that's wrong, and then try to find the real issues that are going on at the same time.
Interviewer:
Right. Speaking of textbooks, my ninth grade biology textbook, I remember it said "Sickle cell disease in African Americans is prevalent in, I forgot the percentage, but it's like 15% of the population." That's all it said, is this percentage of African Americans have sickle cell disease. And that was, I mean, unless it was a ninth grade textbook, but that's just starting from a younger age, just teaching you the wrong thing. And if you don't go to secondary school, if you don't go to college or if you don't get a further education of these things, you may always think that. So yes, textbooks need to be corrected. [chuckle] Do you have anything to add, Dr. Baker?
Dr. Dana Baker:
I'll just add that as we discussed, of course, inclusion of more underrepresented populations in research, that we also need to probably take a step back and even look at rebuilding trust with our underrepresented communities, because there is a lot of mistrust there when it comes to medicine and when, especially when it comes to laboratory testing and research. And we would be remiss that if we don't mention studies such as the Tuskegee experiment and other instances over history, that is not that long ago actually, if you do the math, it's pretty recent and relevant and a lot of memories and lived experiences or a lot of individuals who are connected or a part of these communities. So, I think it's really important to really share the why, why it matters that underrepresented populations are more included in research. What are the safety measures and parameters in place to ensure their wellbeing as a participant in those studies? And to really just acknowledge the history that is there. And in that acknowledgement, respecting that there may be some hesitation or there may be some negative feelings there regarding that.
But I think by really being able to demonstrate the value of their participation, how it will not only increase the wellbeing of themselves as individuals, but also the wellbeing of their communities. I think that with big volume, how is this advancing health equity? How is this helping to eliminate or diminish health disparities? How is this increasing access to resources that are essential to marginalized communities? And so, we need to talk about all those benefits and make sure that we are taking the time to address their concerns so that that way, and I say they, but that also includes me. I'm part of that underrepresented population. And so, making sure that there is that shared understanding and that shared mutual respect and trust so that we can increase that engagement, but also increase that education as well of what we're doing while we're doing it. What that overarching goal or end goal that we're really striving toward with this research. So those discussions are really important. And identifying those allies and community partners to help support that increased engagement in research will also be crucial to this work.
Dr. Brandy Gunsolus:
Absolutely.
Interviewer:
Oh yeah.
Dr. Brandy Gunsolus:
Couldn't agree more.
Interviewer:
And I work with clinical trial patients, so I will definitely say that education and trust is literally everything from the screening onward.
What is the most important takeaway around equitable care delivery and the complex interplay between lab values and ethnicity in the lab setting today and also in the classroom?
Dr. Brandy Gunsolus:
I would say, clinically, the most important takeaway is that you're going to see historically where we haven't done things right. And as an industry, we are working very hard to correct those injustices that have really taken place. You're going to see in the historical records where there's ethnicity that is marked and that lab values are different based off ethnicity. And we have determined as an industry that that is not appropriate. It never should have happened. And we're making those strides to correct that issue. Also, making strives to educate clinicians on this issue, right? We've got a long way to go with basically re-earning the trust of the community that we serve. And I hope that with this videos that we've done today that it's a step towards re-earning that trust.
Interviewer:
Thank you so much. And, Dr. Baker?
Dr. Dana Baker:
Yeah, just thinking from a academic or training lens, the two words that come to mind when I think of today's learner is both hope and inspiration, just because I feel like today's learner is more inquisitive or curious as into this discussion just around health equity and health disparities and asking more questions, asking why are only certain ethnicities represented and others are not. Why are we having discussions about ethnicity in relation to laboratory data or laboratory testing? And so, just having those kinds of questions that, I don't want to say challenge, but I appreciate that challenge or pushback as into really substantiate this why, I think it has really fostered these really important, crucial conversations that need to happen. It really shows where their thinking is and that they are intentional in thinking about what is the overall impact on the patients that we're providing care for.
So that's why I say I'm hopeful, because by them really challenging this discussion and really wanting to learn more or really demanding that understanding of why were we even in this place historically and we want better for our patients moving forward. I think that just gives that insight and that light into where we want to go as a profession, that we want to be more comprehensive but more represented as far as pathology and laboratory medicine in that patient care model that even though you may not always see us directly, we are there and we are a vital part of the healthcare team. And what we have to offer strongly contributes to the quality and the outcome of that patient's care. And so, just to have that level of advocacy going on, not just from the patient perspective, but also from the practitioner perspective, especially for those of us that are within laboratory medicine, is just really affirming. And although, we have a long ways to go, we have the people in place that want to take us there.
Interviewer:
And just check off of what both of you are saying. I think it's important also for not just for providers, but for patients to acknowledge that medicine is very integrated and that there are people behind the scenes and it's okay to ask questions. And it isn't just your provider that's giving you all of the answers, there's so much more that can go into it. There's so much for you to be educated on, so much for them to be educated on. And yeah, I think medicine just needs to be practiced more holistically and taking more of a collaborative approach to medicine with the incorporation of pathologists, with the incorporation of medical lab specialists, is just to work towards a better practice of medicine in general. But a special thanks to both of you, Dr. Baker and Dr. Gunsolus. I'm Deandra White, thanks for joining the Diagnostics Decoded program.
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