When I was a young doctor, an older faculty colleague — like me, an African-American — made a request that I thought was unusual. He asked me to be his personal physician.
I said I would but reminded him that, since I was a researcher, it was unlikely, should he need to go to the hospital, that I’d be the doctor who would make rounds on him on the floor and manage his day-to-day care.
I asked him why he wanted me to take care of him, and his response stays with me to this day: “Because you’re the only African-American physician here, and if I need a serious, or even life-or-death decision made about my care, I want someone I can trust.”
Nearly 50 years after the end of the Tuskegee experiments that withheld syphilis treatments from African Americans, mistrust in the health care system by African-Americans and other people of color still persists — for good reason. And until we have more physicians, nurses and other health professionals who look like the people they’re treating, it will continue.
Just in case people think we’re past Tuskegee, there are many recent studies that prove otherwise. A 2016 study of residents — our young doctors in training — revealed that 50% had false beliefs about African-Americans. For instance, that they had thicker skin or were less sensitive to pain.
A 2019 study demonstrated that patients of color presenting in emergency rooms were less likely to get pain medication than white patients: African-Americans 40% less likely, Latinx 25% less likely. Even in the case of a diagnosed bone fracture — an extremely painful condition — African-Americans were 41% less likely to get pain medication than white people.
There’s plenty of evidence from the coronavirus pandemic that feeds into this distrust, too. According to testing data, African-Americans and Latinx are dying from COVID-19 at disproportionate rates. Social determinants of health, inability to social distance due to cramped living conditions, the economic need to stay at work in low-income, public-facing jobs, and lack of access to health care explain some of it. However, it’s also due to failures of their interactions with the health care system, even while presenting with COVID-19 symptoms: patients of color being turned away from an ER, not being deemed ill enough for treatment or hospital admission, or simply “knowing,” based upon experience, that they wouldn’t be treated well in the hospital.
To address this mistrust, we need more health professionals of color: The demographics demand it. California is already a majority-minority state: 39% Latinx, 36% white, 15% Asian, 6.5% African-American. Yet, the percentage of Latinx and African-American physicians in California is very low: 5% Latinx; 5% African-American. Nationally, the figures are no more impressive: 5.8% of physicians are Latinx, 5% are African-American.
It isn’t for simple “cultural comfort” that we need health practitioners of color — though, given our diversity and the history of mistrust and mistreatment, that is a reasonable request of our health care system. It produces better health outcomes.
A 2018 study demonstrated that African-American patients were more likely to follow an African-American physician’s orders, particularly on preventive measures, such as flu shots. So, when patients have a cultural rapport with a health provider, they are more inclined to pay attention and do what they are told to do.
All health practitioners need technical competence and good professional judgment to ensure their patients get the best care possible. That’s the essence of the Hippocratic Oath and other oaths that physicians and other health providers swear to uphold.
But in our diverse country, wrestling with both a pandemic and our painful history of systemic racism and gross health disparities, we have an obligation to do all we can to recruit and educate more physicians, nurses and other health professionals of color.
It will be better for everyone’s health.
Dr. David M. Carlisle is president and CEO of Charles R. Drew University of Medicine and Science in Los Angeles. He wrote this commentary for CalMatters, a public interest journalism venture committed to explaining how California’s state Capitol works and why it matters.