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Sunday, January 17, 2021

Racial injustice in healthcare is real, but it need not be permanent

By combining the voices of two doctors, a black woman and a white man, we offer insights to help everyone understand persisting health injustices.

Jessica’s 4-year-old son Seth had a complex medical history, so her mother’s intuition about his sudden illness was even more important than usual. Yet, this black woman’s cries for help as her son’s oxygenation and heart rate plummeted to zero were ignored by the staff until she witnessed her child’s cardiac arrest. Her Facebook Live video went viral because her rage hammered home the painful racial health disparities that are evident in the United States.

We watched this video with anger in our hearts and tears in my eyes. As a physician, it’s appalling that some receive inferior or inadequate medical care simply because of the color of their skin. As a black woman, I, Jennifer Caudle, am sadly familiar with what I saw in the video. I understand the racial injustices that exist in healthcare because I am confronted with them every day. There is a belief that the culture of medicine prevents implicit bias from penetrating our sacred vows. But this is not always true. The ugly truth overwhelms the beautiful lie that healthcare is a fair, discrimination-free space. The stories of black women’s cries for help for themselves and their families have gone unheard in emergency rooms, intensive care units, and doctors’ offices. This breaks the oath physicians and healthcare providers have taken to “do no harm.”

COVID-19 highlighted the discrepancy in health outcomes, with blacks dying over twice as frequently per capita than whites. For the first time ever, major medical associations, such as the American Academy of Pediatrics and Academy of Emergency Medicine, are acknowledging these racial health disparities. We also know that black women are 243% more likely to die from childbirth-related causes. These discrepancies exist even when socioeconomic issues are removed. Black mothers die more often during pregnancy, as do their infants.

There are many reasons why this is the case, and most are grounded in systemic and institutionalized racism. Social inequalities, such as lack of access to healthy fresh foods, clean water, good schools, and public transportation, contribute. Lack of access to quality medical care and healthcare coverage is also part of the problem. Underlying medical conditions play a role, as well as negative stereotypes and implicit bias from healthcare providers, to name a few.

Many will argue that racism is “gone,” but this couldn’t be further from the truth. As a black child growing up in Iowa, I, Jennifer Caudle, was raised by parents who grew up in the South during the height of the Civil Rights movement. My parents keenly understood the grips of racism and taught my brother and me from an early age what “being black means.” We were made aware that while race relations have improved over the years, our country still has work to do. This conversation is not unique to my family; it happens in the home of practically every black family in the country.

Despite America’s struggle with racism, stories like Jessica’s don’t have to continue. Studies have shown that black infant mortality rates, for example, are often improved when the caring physician is also black. According to a recent study published in the journal Proceedings of the National Academy of Sciences, black infants are roughly two times more likely to die under the care of a white physician than under the care of black physicians, which corresponds to a 58% reduction in mortality correlated with the race of the doctor.

For those who might argue that this difference is driven by socioeconomic conditions, other evidence suggests that bias is also an issue in basic preventive healthcare. An Oakland field study noted that black participants assigned to black doctors were more likely to have their blood pressure and body mass index measured than those who saw non-black doctors. And for invasive tests, only men who saw a black doctor agreed to take up more services than they had initially selected. A participant who saw a black doctor was 47% more likely to agree to a diabetes screening and 72% more likely to accept a cholesterol screening than those who saw a non-black doctor. The researchers suggested these encounters provided an improved level of communication and a higher sense of trust.

To be sure, our society needs a multi-faceted approach to resolve the systemic racism that pervades our lives. As they say, “it takes a village,” and we will, indeed, need a village to solve this. But, as our society copes with implicit bias, we need leaders in healthcare to blur the lines in our functional caste system that reinforces perceived differences. Advocating for more black physicians will undoubtedly help. While 13% of the population is black, only 5% of doctors are black, and less than half of them are women. We need more black doctors. Let’s change this reality by supporting the #MoreBlackDoctors Campaign to inspire participation from underrepresented communities. Here is a game plan.

First, we need role models for the kids who are instinctively drawn to healthcare but don’t see anyone who looks like them in the role of a doctor. Analogous to the Peace Corps, I, Mehmet Oz, started Healthcorps.org almost two decades ago to teach underserved teens about health and wellness using recent college grads as coordinators, many of whom are black or Hispanic. When teenagers see people like them headed to medical school or working inside hospitals in other capacities, their vista of opportunities broadens. We eliminate health inequity in at-risk communities by educating and empowering students to be change-makers. We have raised over $100 million and celebrate diverse alumni all over the country that have gone on to become doctors, nurses, and healthcare technicians while serving their communities. We need more affordable initiatives like Healthcorps to open the eyes of young future doctors of color.

Second, we need more mentoring programs for aspiring black scientists. The Dr. Oz Show is launching Zoom monthly seminars, and this could be done by healthcare facilities or individual healthcare providers across the country.

Third, we need to support black people interested in medical careers. The racial wealth gap limits the options of aspiring doctors, which is why some medical schools, such as Columbia P&S (where I, Mehmet Oz, am a professor) are now tuition-free. And this week, the Dalio Foundation donated $50 million to my hospital (New York Presbyterian) to address racial injustice at all levels of the healthcare system.

Finally, we need all patients to feel empowered to voice concerns and communicate when they do not feel heard. These are often debilitating symptoms of implicit bias in healthcare, which is all too prevalent. Some black patients do not speak up in the doctor’s office for fear of being judged, dismissed, or discriminated against, among others. We are often afraid of not being heard. But this can have disastrous consequences. Take second opinions, for example. Only 18% of patients request second opinions, but according to the Joint Commission (a non-profit accreditation group for healthcare organizations), second opinions change the diagnosis or treatment in one-third of cases. The ability of patients to speak and be heard by their physicians is critical.

Martin Luther King Jr. believed the greatest inequality was healthcare: “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” He is right, but things can change. We are all in this together, so let’s fix this problem.

Dr. Mehmet Oz (@DrOz) is an attending physician at New York-Presbyterian/Columbia University Irving Medical Center and the host of The Dr. Oz Show. Dr. Jennifer Caudle (@DrJenCaudle) is a board-certified Family Medicine physician and associate professor in the department of Family Medicine at Rowan University-School of Osteopathic Medicine.



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