Sickle Cell Disease and Implicit Bias
By Addison Sember, PharmD Candidate 2022, University of Findlay
Sickle cell disease (SCD) is a life-threatening inherited blood disorder that affects predominantly Black patients, and has a long-standing history of associated implicit bias because of this. In SCD, red blood cells are crescent shaped which restricts their ability to travel and limits oxygen delivery. This causes severe pain and organ damage, which is considered a sickle cell “crisis” and leads these patients to present to the ED for crisis treatment. Implicit bias is seen in treating these patients at all points of care because a majority of SCD patients are Black and require opioids for adequate pain management which is often perceived by healthcare workers as drug-seeking behavior.
While on rotation in the hospital, I witnessed an SCD patient in agonizing pain admitted to the floor after receiving one dose of IV hydromorphone in the ED. This didn’t even touch their pain based on their chronic pain regimen and what they had received during previous admissions. Providers can be reluctant to prescribe adequate doses of pain medication due to their implicit bias and fear of contributing to the opioid epidemic. This patient told me they make sure they get nicely dressed before coming to the hospital, so they have a better chance of being properly treated.
To prevent this implicit bias from continuing, we need to recognize the racial overtones in healthcare, as providers are often convinced that SCD patients who present at the hospital in pain are exhibiting drug-seeking behavior. These thoughts are influenced by the color of their skin, being considered a “frequent flyer” due to their crises, with many having a lower socioeconomic status. We should support SCD research, promote provider education of SCD, and utilize electronic health records to establish crisis treatment protocols, reduce the time to opiate administration, and improve health outcomes.
In the community setting, pharmacists should educate themselves on SCD and see these patients as real people with a real disease that puts them in constant pain. It is important to recognize this implicit bias against SCD patients and work on leaving the physical appearance of these patients behind so we can focus on creating a safe space for SCD patients and get them the treatment they need.