An Urgent Call for Diversity in Medicine, ‘the Profession I Love’
The consequences of disparate care are not trivial
This article originally appeared in STAT News on March 10, 2016.
By Clyde Yancy
The movement to improve diversity has landed in medical schools. Some see this as yet another social agenda run amuck. They couldn’t be more wrong.
Remaking the physician workforce so it accommodates the increasingly diverse US population is a path towards better health and lower health care costs. Diversity in medicine should matter to everyone.
Improving diversity changes the culture of medicine and helps all doctors be more patient and more sensitive to the unique needs of all patients. Ignoring diversity impoverishes medical care, leading to poorer disparate health for millions of Americans.
The consequences of disparate care are not trivial; they are both painful and pernicious. In my field of cardiology, that means lesser care for heart attacks and strokes, more heart failure, more hypertension, and fewer surgeries for African-American patients.
We can do better than this.
My perspective on this often emotive issue is filtered through the lens of my early experiences with discrimination and bias.
Born in 1958, I grew up in Scotlandville, La., a highly segregated community. As a boy, I felt the sting of discrimination: I sat in the back of the bus, drank from “colored” water fountains, and watched movies from balconies for “colored only.” I heard the “N” word far too many times. Over time you become embittered or emboldened. I chose the latter, which fueled my ambition to become a doctor and now reinforces my commitment to address bias and improve diversity in the profession I love.
As the grandson of sharecroppers, I was fortunate to attend college — Southern University, a historically black undergraduate college in Baton Rouge. I made no secret of my dream to attend medical school, but some of my African-American advisers dismissed it because they worried about abject failure for a black man aspiring to attend medical school in the 1970s. I quietly disregarded their advice, persevered on the steep path to medical school, and enrolled at Tulane University School of Medicine as a 20-year-old.
I value and respect the education I received at Tulane. Those were four extremely transformative years. But overt bias created indelible events in my sojourn through medical school. One of them stands out.
Charity Hospital in New Orleans was a historic safety-net hospital. No patient was ever turned away. It hosted old-fashioned grand rounds: a revered professor would bring a patient into a lecture hall and conduct a history and physical examination in front of the assembled students and doctors.
I vividly recall one such patient, a soft-spoken, partially disrobed older black woman who the physician addressed by her first name. The privilege of witnessing a master physician practice medicine soon gave way to a quiet internal cry. The woman, who was sad and embarrassed, could easily have been my aunt, my mother’s older cousin, or a close family friend, all of whom lived in New Orleans and sought care from Charity Hospital. The reawakening of my boyhood experiences with segregation replaced my wonderment.
Thankfully, such displays are a thing of the past. But there is so much more to be done.
The challenge now is seeking truly equitable health care. That emerges in part from care provided in a culturally sensitive environment. Those sensitivities come from a diverse group of care providers — and in that space we are failing.
Case in point: There are no more black men entering medical school today than there were in 1978, my freshman year.
At Northwestern University Feinberg School of Medicine in Chicago, we are striving to make a difference by focusing on four main strategies: recruitment, awareness, engagement, and research. We make every effort to attract minority students with exceptional credentials to create a diverse class of medical students.
During their first year, all students complete a test for subconscious bias and take part in exercises to better identify and navigate bias. We bring in scholars to explore cultural competency and disparate care with the student body and the faculty. And a core group of funded Northwestern researchers study the root causes and consequences of bias in health care.
Will any of these strategies work? Critics have opined that adding lessons on bias, diversity, and inclusion to the medical school curriculum is a misapplication of resources and the effects will be impossible to measure. Perhaps. Scientific endeavors such as medicine thrive on data and proof. Yet culture change is different and can’t be quantified with traditional analyses.
Thus, we will count as success every time a future care provider understands his or her patient’s cultural context. We will consider it a triumph when the distribution of skin hues in our medical school classes covers more of the color spectrum even as the performance of the class exceeds expectations. And we will declare a win when disparate care and other destructive consequences of the lack of diversity fade away.
Conversations about discrimination, diversity, and inclusion should be taking place at every medical school across the country. We shouldn’t bemoan this movement, but celebrate it. High-quality and sometimes extraordinary care is the standard in the US health system. Equitable care is not.
Clearly, we have work to do.
- Clyde W. Yancy, MD, is professor of medicine, chief of cardiology, and vice dean for diversity and inclusion at Northwestern University Feinberg School of Medicine.