Does Diversity Matter for Health?

Apparently yes-- much more significantly than previously believed.

A new (peer reviewed & published) study shows black male patients are much more likely to agree to healthcare screening and interventions when their physician is also a black male.

http://www.nber.org/papers/w24787

Black males are one of the most underserved and vulnerable patient populations. (13% of the US population is black while less than 4% of the physicians are.) Rates of heart disease and diabetes among black men are much higher than in the general population, as well as rates of mortality from these diseases.

^That is why URMs have such a big advantage over ORMs in medical school acceptance.

With respect to black people in particular, that may not be too much of a surprise, based on existing lower levels of trust in the US medical care system: http://www.phillytrib.com/news/mistrust-of-health-care-system-runs-deep-among-blacks/article_fe34e876-da2a-57f1-a5a7-cb3aa7316e65.html

However, more generally, familiarity with ethnic-related habits that are health-related (e.g. diet and activities) may help a physician make recommendations that the patient will understand better. This does not require being of the same ethnicity as the patient, but it is more likely that a physician of the same ethnicity as the patient will have such familiarity. Gender may also be relevant – a same gender physician may be more likely to have personal experience with gender-related/specific medical issues as the patient.

Patient aspects not related to ethnicity or gender may also be relevant. For example, a patient who plays a lot of sports may find a primary care physician with an interest in sports medicine to be desirable.

As a woman, I have found I generally connect better with a female doctor and feel my concerns are taken more seriously. So this makes sense to me!

http://www.nber.org/papers/w24787

Looks like they used pre-med college students for the recruitment of patients and reception duties at the clinic. How common is it for pre-med college students to have pre-med extracurriculars in these types of studies?

Probably somewhat common. Any research program/project that utilizes human subjects needs to recruit participants. This job typically goes to the lowest man on the totem pole (i.e. undergrads in most labs).

I know D2 did volunteer recruitment both as an undergrad and as a post-graduation/pre-med school research assistant. When she first started her a research assistant position, part of her duties used to involve riding public buses around town and sitting at bus stops where she handed out flyers to people who appeared to qualify as potential study participants (smokers).

In that study, they also ended up with a small number of non-black study patients. They did not include these patients in the overall analysis, but mentioned that they saw the reverse outcome with them (i.e. the non-black patients were less likely to choose the offered services after interacting with black physicians).

Racism (and sexism) is alive and well.

D1 reports that several time/week, she has a patient complain that they have to see a female physician instead of “real doctor”.

Re female doctors: http://gomerblog.com/2018/08/advice-for-new-female-doctors/
(Gomerblog is The Onion for medicine, but that type of article doesn’t get written out of nowhere)

Re the importance of minority doctors: https://news.virginia.edu/content/study-links-disparities-pain-management-racial-bias

Also for black people and medicine, we aren’t even 50 years out from the end of the Tuskegee syphilis experiment - arguably the worst ethics violation in American medicine and completely racially motivated. I think that skepticism and fear of doctors, especially white doctors, will persist at least until we have no overlap between the people alive when that study was happening and the people living in America.

Re: “various beliefs about biological differences between blacks and whites are true or untrue; for example: that blacks age more slowly than whites; their nerve endings are less sensitive than whites’; their blood coagulates more quickly than whites’; their skin is thicker than whites’ (all false)”

Where did these particular ideas come from?

Gomer blog post is too funny, but also too true.

D1 recently confided to me she’s glad she’s starting go gray (her dad’s side of the family gray ridiculously young) because it gives her some extra gravitas when dealing with a-hole male patients and male nurses.

Many of them are traditional stereotypes, but apparently in some case these myths are being perpetuated by textbooks…

https://www.thecut.com/2017/11/too-many-doctors-still-believe-dangerous-racial-stereotypes.html

My lad has noted this often too - patients will turn to him (a 2nd year med school student now) over a female med school student - or even a female doctor, and sometimes a male, but of a different race. He redirects and stands up for folks, but even then they’ll stick to him as if somehow he has more knowledge. Neither of us get the mentality - esp after he tells the patients he’s just a med school student. They’ll still direct questions to him calling him, “doctor.”

There is a short article in NEJM about dealing with racist patients:
https://www.nejm.org/doi/full/10.1056/NEJMp1514939

There are numerous other articles and opinions on the issue, such as:
https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/72169
https://www.statnews.com/2017/06/12/racism-bias-patients-doctors/
https://www.aafp.org/news/blogs/freshperspectives/entry/20170821fp-race.html
https://www.washingtonpost.com/opinions/racist-patients-often-leave-doctors-at-a-loss/2017/10/19/9e9a2c46-9d55-11e7-9c8d-cf053ff30921_story.html
https://www.thedailybeast.com/how-i-deal-with-racist-patients

I wonder how often male ob/gyn’s are asked by female patients if there is a female ob/gyn available instead.

Does this make it less likely for male medical students to choose to go into this field?

Re: #15

Among active physicians in 2015, gynecology has the second highest percentage female (54.5%) after pediatrics:
https://www.aamc.org/data/workforce/reports/458712/1-3-chart.html

Among residents and fellows (i.e. those who will enter the workforce shortly) in 2015, gynecology has the highest percentage female (83.1%):
https://www.aamc.org/data/workforce/reports/458766/2-2-chart.html

Women frequently request a female OB/GYN. The number of male OB/GYNs has steadily decreased since the 1980s. Today, 59% of practicing OB/GYNs are women, and in the 2017 Match, 82% of those who matched into OB/GYN were women.

But by the same token, men frequently request a male urologist. (Urologists treat male sexual and reproductive issues, as well as bladder and kidney issues in both sexes.) There are few female urologists, with only about 8% of all currently practicing urologists being female.

BTW, despite there being more women than men in OB/GYN, the most competitive and highest paying OB/GYN subspecialties (gyn onc, uro-gyn, REI, pelvic surgery) are disportionately male.