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Who is accountable for stopping racism in our children’s hospitals?

Pediatric Research (2024)Cite this article

What was surprising about Karvonen et al.’s publication?1 Very little was surprising for many of us who work in children’s hospitals. What is new and refreshing is seeing data that our personal experiences of bigotry and racism are not just anecdotes but clearly can provide disincentives to stay in such a working environment as a resident, fellow, or faculty. In this well-constructed single-center study, Karvonen et al. used a mixed-method approach to identify racism in a NICU located in San Francisco. The nature of the study design, mixed method, and the observation that this study was done in a single center provides some evidence of racism. Still, the results of this study cannot be extrapolated to experiences outside the single NICU.

The study addresses a systematic approach to understanding the staff and families’ perception of the patient’s treatment. Too often, the child cannot voice their complaints or concerns. The observation that staff witnessed parent’s experiencing racism than parents reporting racism reinforces the challenges in the workplace for non-white staff, medical students, residents, fellows, and faculty. Where do you draw the line and report the covert, overt racism or unprofessional behavior? In my narrow experience, despite the rhetoric that all children and their parents should be treated the same in a children’s hospital, rarely have I seen published data or parent-pediatric satisfaction information based on race to determine the fidelity to this aspirational goal. When I asked for such data after five site visits for hematology-oncology programs over the last decade, I have yet to be provided patient-driven data demonstrating that there is any difference in parent-patient experience based on race.

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References

  1. Karvonen K. L. et al. Parent and staff perceptions of racism in a single-center neonatal intensive care unit. Pediatr. Res. 2024.

  2. Greenwood, B. N., Hardeman, R. R., Huang, L. & Sojourner, A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc. Natl Acad. Sci. USA 117, 21194–21200 (2020).

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  3. Glassberg, J., Tanabe, P., Richardson, L. & DeBaun, M. Among emergency physicians, use of the term “Sickler” is associated with negative attitudes toward people with sickle cell disease. Am. J. Hematol. 88, 532–533 (2013).

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Authors and Affiliations

  1. Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, TN, USA

    Michael DeBaun

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M.R. DeBaun confirms sole responsibility for the following: study conception and design, acquisition of data, analysis and interpretation of data, drafting and revising the article critically for important intellectual content and final approval of the version to be published.

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Correspondence to Michael DeBaun.

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Competing interests

M.R. DeBaun and his institution sponsored two externally funded research investigator-initiated projects. Global Blood Therapeutics (GBT) provided funding for the cost of the clinical studies. GBT was not a co-sponsor of either study. Dr. DeBaun did not receive any compensation for the conduct of these two investigator-initiated observational studies. Dr. DeBaun was a medical advisor in developing the CTX001 Early Economic Model. Dr. DeBaun provided medical input on the economic model as part of an expert reference group for the Vertex/CRISPR CTX001 Early Economic Model in 2020. Dr. DeBaun consulted for the Forma Pharmaceutical company about sickle cell disease in 2021 and 2022. Dr. DeBaun is on the steering committee for a Novartis-sponsored phase II trial to prevent priapism in men with sickle cell disease. All other authors declare no potential conflict of interest.

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DeBaun, M. Who is accountable for stopping racism in our children’s hospitals?. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03089-4

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