Non-white patients have poorer health and get less effective care than white Americans. The problem is complicated, but part of the answer is simple: more minority doctors.
Recently, Dr. Edith Mitchell got a call from a resident needing help with a belligerent patient in the emergency room of the hospital where she is an oncologist.
The patient, an African American man, had passed out from blood loss from what turned out to be colorectal cancer. The resident had told the man he would first need a blood transfusion to stabilize his condition and would later need chemotherapy.
Mitchell was no longer on duty, but she agreed to help the resident figure out what was going on. She went down to the emergency department, introduced herself to the patient, and asked him what was wrong.
The man said he did not want a blood transfusion. A few more questions revealed he was a Jehovah’s Witness — a religion that forbids that kind of medical procedure.
Mitchell, who is the president-elect of the National Medical Association, a black professional group, knew of an alternate therapy developed for Jehovah’s Witnesses.
Lost blood can be replaced with saline solution if blood oxygen is carefully monitored. She proposed the treatment, called volume replacement, to the patient.
He agreed. His condition stabilized and he went on to have successful treatment of his cancer.
None of the events beginning with the resident’s call should be taken for granted, according to data on the gap in health outcomes between white and non-white patients in the United States.
The evidence that non-white patients, especially those who are poor and lack health insurance, have worse health outcomes is overwhelming.
According to the Centers for Disease Control and Prevention (CDC), minorities fare worse in four out of five national health benchmarks. In more than 10 percent of the benchmarks, the gap has widened in the past decade.
The problem touches nearly every stage of healthcare, from diagnosis to treatment, but it’s especially sobering when it comes to the deadliest illnesses.
“For cancer disparities, it’s well recognized that minority patients from various groups have either a higher incidence of cancer or a higher mortality or death rate or, in some instances, both,” Mitchell told Healthline.
Black men, for example, are more likely to have a heart attack and are more likely to die sooner when they do, according to a study released earlier this month.
Black men also have higher rates of death from prostate cancer than any other group.
These disparities, and a laundry list of others, add up to cheat the average black man in the United States of five years of life, compared to his white counterpart.
The problem doesn’t end with the major illnesses.
For instance, black patients wait longer in the emergency room with large-bone fractures before they are attended to or offered any kind of pain relief, according to Dr. Alden Landry, MPH.
Landry, an emergency medicine specialist at Beth Israel Deaconess Hospital in Massachusetts, cofounded the Tour for Diversity in Medicine, a group of doctors who travel to college campuses to encourage minority students to become healthcare providers.
The government has funded a heavy volume of research and a wide array of pilot programs to try to whittle down these health disparities. But there’s something quite simple that could make a big difference in providing better care to non-white patients: more non-white doctors.
In the late 1970s, the people in white coats started, as a group, becoming less white. But the efforts behind that shift have stalled.
In 2014, the number of medical students who didn’t identify as white or Asian was less than half the number of white students. The number of Asian students was nearly equal to the number of all other non-white students.
For black men, the picture is worse now than it was in 1978. Fewer black men enrolled in medical school in 2014 than 36 years before. Of more than 85,000 medical students, just 515 — or about 0.6 percent — were black men.
It’s not that non-white or female doctors are necessarily better than their white male counterparts.
But patients in every racial and gender group report that they prefer to see a physician from their own demographic. They also report higher satisfaction with those doctors, suggesting they at least believe they’re getting better care.
“It appears that given the choice people certainly perceive that there’s a better connection or better quality of care,” said Thomas LaViest, Ph.D., a professor at the Bloomberg School of Public Health at Johns Hopkins University and director of the Hopkins Center for Health Disparities Solutions.
Mitchell attributes patients’ preference to better communication between them and doctors with whom they share a cultural background.
Studies have shown that a patient who feels comfortable with a doctor shares more information. That patient is also more likely to follow the doctor’s advice.
That means the patient has a better chance of a positive outcome, even if the doctor has no greater skill.
All of the black doctors Healthline spoke to said there’s nothing magical that happens when they provide care for patients who are also black. The variable is not race but communication, they said.
However, they also described instances where they found themselves better equipped to handle diseases and conditions that occur either differently or more often in black patients.
Dr. Dina Strachan’s Manhattan dermatology practice draws a lot of African American patients. Her website’s biggest source of Internet traffic comes from Google searches for “black dermatologist” and Strachan gets emails from all over the world from black patients looking for help.
That interest exists even though Strachan’s website doesn’t mention her race. Only a professional headshot reveals that she is black.
“I definitely never set out to be a skin of color specialist,” Strachan said.
She opted to specialize in dermatology as a resident at the University of California, San Francisco, when many in that city’s substantial gay population were suffering from skin lesions as a result of HIV infection.
The need for that kind of care dwindled and Strachan eventually ended up in private practice on the other side of the country. African American women began to come to her with hair loss and scalp problems.
“They came to me because I knew how to take care of it. I didn’t know that a lot of people didn’t know how to take care of it,” Strachan told Healthline.
Her patients also often come to her with pigment problems, whether from scarring or vitiligo, that white doctors have shied away from treating, Strachan said.
Dr. Lynne Holden, associate professor of emergency medicine at Montefiore Health System and the Albert Einstein College of Medicine and the president of Mentoring in Medicine, said there hasn’t been research to show that a cultural match between doctor and patient produces better results because no one wants to disparage doctors who treat patients with backgrounds different from their own.
“But anecdotally, this happens. I’ve seen it. I’m sure everyone’s seen some instance, some case where this occurs,” Holden said.
Part of Holden’s job is overseeing residents. One confessed he couldn’t figure out why a patient was dizzy. But for Holden, a quick look at the African American woman told her everything she needed to know.
“Right away I saw that her lips were pale, her eyebrows were pale, her tongue was pale. Blood flow to her extremities was very slow because it was being shunted to her internal organs,” Holden said. “I could spot it right away because I know what a pale person of color looks like.”
She’s also seen residents miss an obvious skin infection because irritation doesn’t necessarily show up as redness in darker-skinned people.
She doesn’t think that only minority doctors can develop the familiarity and communication that make for a faster, more respectfully delivered diagnosis. But it’s hard to deny that it helps.
For example, Holden mentioned ackee, a plant common in Jamaican cuisine. When not prepared properly, it can be toxic, causing vomiting, seizures and even coma and death.
If there’s no one in the emergency room familiar with its effects when a patient enters, doctors might not consider it among the likeliest causes of the patient’s symptoms.
Business analysts say that diverse workforces make better products for everyone.
The same seems to be true in medicine, doctors said.
White doctors learn about black skin reactions and ackee. But they also learn about volume replacement, which often works just as well as a blood transfusion.
“Because of what I do, my willingness to talk about race and bias, my colleagues do feel more comfortable coming to me with questions,” Landry said. “People often dismiss opinion, but when you start talking facts, when I can start talking to colleagues and say, ‘Hey, there’s data out there that says this,’ that changes their perspective.”
As the National Institutes of Health (NIH) has made stricter demands on how racial and ethnic diversity and gender are handled in medical research, medical evidence has become richer.
Where it once identified the symptoms of a heart attack based almost entirely on how white men behaved, it has more recently traced out a broader set of circumstances based on how heart attacks affect women and black men.
“It changes the entire dynamic of the system,” said Dr. Nathan Stinson, Ph.D., MPH, director of scientific programs at the National Institute on Minority Health and Health Disparities (NIMHD), part of the NIH. “The culture of the system becomes more diverse, then it treats whoever may come to their door in a different manner than it had previously.”
Keeping rigorously to evidence-based medicine, instead of invoking the doctor’s gut, where assumptions and biases may lurk, is the quickest path to better care for everyone, LaViest and Stinson both said.
“If physicians practice evidence-based medicine as opposed to experienced-based medicine, they have less disparities,” LaViest said.
Putting more black and brown people in white coats won’t close the gaps in health outcomes that stem from long histories of discrimination and poverty.
But nor will they go away entirely without a workforce of doctors that includes more people from the groups it hopes to serve better.