J Natl Med Assoc
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Hidradenitis suppurativa is a chronic, debilitating skin disease that disproportionately affects African Americans, and care-related factors may contribute to this disparity. In this study, we investigated delay in diagnosis and dermatologic care for HS at an urban Midwestern Academic Center. A retrospective chart review of 1,190 patients with 3 or more encounters for HS between 1/1/2002 and 3/19/2019 was conducted. ⋯ Of the patients who did see dermatology, 44.9% of Black patients, 31.6% of white patients, 23.1% of Hispanic patients, and 30.8% of other races saw surgery before dermatology (p<.001). Our results indicate that non-white patients have a longer delay in diagnosis than their white counterparts and that Black patients do not see dermatology as early in their disease course as other racial groups. Black patients also see surgery more often than white patients before seeing dermatology, which could suggest greater disease severity at presentation and diagnosis or difficult access to dermatology.
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After the murder of George Floyd, many professions, organizations, and institutions have begun to confront the long and persistent legacy of racism in the United States. Within that context, it is critically important for the medical education community to address the question of whether medical education is systemically racist, and if so, what should be done to address this problem. ⋯ Analysis leads the author to the conclusion that medical education clearly meets the definition of systemic racism and that recent attempts to increase the racial and ethnic diversity of medical students have largely failed. The author then outlines a three-pronged approach to address this problem with interventions at the admissions, medical school, and graduate medical education levels.
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We present a case report of a patient who is a non-cirrhotic with portal cavernous transformation secondary to previous trauma. The patient presents with portal biliopathy requiring ERCP/EUS with biliary stenting. ⋯ The patient underwent a novel technique of transplenic access with portal vein recanalization via a gunsight technique, ultimately receiving a direct intrahepatic portocaval shunt (DIPS). Subsequently, his symptoms resolved, and the biliary stent was successfully removed.
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Informal estimates place the number of practicing Black forensic pathologists (BFPs) in the United States (US) at somewhere between 35 and 45 which is less than 10% the estimated total of 600. The legacy of medical and institutional racism means that BFPs in the US encounter particular challenges to training and career development that their White peers do not have to contend with. ⋯ While personal determination is an essential ingredient to career success as a BFP, there are certain structural barriers that must be eliminated to increase the total number of BFPs. The pipeline that produces BFPs must be nurtured, reimagined, and reinvigorated.