Does representation matter in health care? Yes, it matters very much.
Yesterday, I disagreed with my boss, publisher Ned Seaton, about whether diversity in medicine is an issue in Manhattan, and I told him so (respectfully) in a lengthy email. That’s not uncommon in our office; we debate issues every day. This time, though, he invited me to share my opinions in print.
Ned’s letter from the publisher in Wednesday’s paper critiqued the recent meeting of the city’s relatively new diversity task force, which last week discussed health care. I think it’s fair to wonder about the task force, whose mission is not yet well defined, and also to wonder how much change it will be able to effect. But the task force is still gathering information to determine its focus — its members have said as much — so it’s not fair to be too critical yet. And while some people may believe it’s naively optimistic that a city commission-backed task force could do any good, it’s also noble of the commissioners to say, in essence, “We can’t delve into this in depth, but we think it’s an important issue. Let’s get a group of people who can give it the attention it deserves.”
But on to the health care issue.
It’s not that an individual doctor can’t properly treat a person of any race (or gender, sexual orientation, etc.). But doctors are human, and humans have their own biases and blind spots. As a whole research shows that there are real, quantifiable differences in the way patients are treated depending on their race. Those differences are smaller when the demographics of health care workers — doctors, nurse practitioners, nurses, office staff — match those of the community.
At the moment, we don’t have local information on the diversity of local doctors or any possible disparity in patient outcomes. What we do have, though, is information on a national level from several scholarly studies, including one 2018 study from Stanford, which was cited in the initial news story last week. That study didn’t point the finger at doctors, saying they’re giving worse care to patients of color. Rather, it said most of the disparity in patient outcomes had to do with patient trust of the doctors. When there was greater diversity among physicians at a hospital, patients talked more to their doctors, had more visits and agreed to more aggressive procedures. Among the 1,300 Black male cardiac patients they studied, the less diverse hospitals had a 19 percent higher mortality rate.
Other studies have shown differences in the drugs patients are prescribed, the tests ordered and the overall quality of care they receive based on race.
The idea of needing to be able to trust and communicate with doctors also applies for LGBT patients, who may have legitimate concerns about finding a doctor who is accepting and being open with that person to get the best possible care. I don’t think anyone was suggesting that Manhattan has to have a doctor who would specialize in gender confirmation surgery. That probably would be a plastic surgeon, and probably someone with additional training. But if a patient sought hormone therapy, it would make sense to find someone with experience in that area.
I can’t speak from the perspective of non-white and non-straight people, but any woman who’s had a male OB-GYN can tell you it’s more than a little important to feel you can speak openly with your doctor. It goes the other way, too; recently I was encouraging my dad to ask his doctor, a woman, questions he had about his prostate. It was scary to him! Gender’s not the only factor at play there. Race is not the only factor. But they are factors.
Disparities in health care are not something we should shrug off. For many people, they are literally a matter of life and death. If a local task force can improve those disparities even a little, we should support that.