How Can Racial and Ethnic Differences Be Reflected Accurately in Clinical Practice?
More Programs and Publications Featuring Dr. Dana Powell Baker
In this program:
How can clinical practice be an accurate reflection of racial and ethnic differences? Laboratory medicine scientists Dr. Brandy Gunsolus and Dr. Dana Powell Baker discuss historical data in laboratory medicine and how ideas can be challenged and adjusted to move clinical practice.
Transcript
Interviewer:
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 Powell 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.
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