"First do no harm": Clinical practice guidelines, mesolevel structural racism, and medicine's epistemological reckoning

Abstract

This paper presents a critique of clinical practice guidelines (CPGs) that standardize the use of race as a proxy for biological difference in medical settings. Drawing on the illustrative example of a pediatric UTI testing guideline, we contend that when CPGs necessitate that Black patients meet a higher threshold of illness severity or duration than their non-Black counterparts to receive comparable medical testing or other medical care, they function as mesolevel sites of race-racism reification processes (see Sewell, 2016) that contribute to the reproduction of racial health disparities. We describe broader implications and make recommendations for the conceptualization and implementation of future research in the sociological study of race, health, and medicine.

Keywords: Clinical practice guidelines (CPGs); Medical sociology; Mesolevel; Race; Racism; Standardization; Structural racism.