I saw the promise of diversity efforts in health care. A moment later I saw its critical gaps
“Healthcare was once moderately immune to the anti-diversity, anti-equity, and anti-inclusion craze. Not anymore.
California’s medical board is facing litigation for requiring physicians be trained about implicit bias. Health systems are reassessing training on systemic racism because of Florida Governor Ron DeSantis’s bill that prohibits public funding for diversity, equity, and inclusion initiatives. And Republicans in the U.S. House of Representatives have introduced a bill to amend the Higher Education Act of 1965; the bill aims to prohibit medical schools from receiving federal aid if they adopt certain policies related to diversity, equity, and inclusion.
All this, amid last year’s Supreme Court ruling that banned race-conscious admissions at colleges and universities, portends poorly for anyone who cares about the health of patients and the well-being of their doctors.
Laura (not her real name) is one of those patients — and I will soon be one of those doctors.
I met Laura, a middle-aged, Spanish-speaking Hispanic woman, in the pre-operative area of the hospital where I was training during my second year of medical school. She was anxious, and had been labeled by some of the clinical staff as a “difficult” patient. My senior resident felt I might be able to connect with Laura because of my Hispanic heritage and native Spanish skills.
She was right. After introducing myself and answering Laura’s questions about her upcoming myomectomy (the removal of uterine fibroids), she reminisced with me about her daughter and her upbringing in the Dominican Republic, including her escapades as a young girl on the coast of Santo Domingo, the country’s capital city. Laura asked me about my parents, and we bonded over the fact that both she and my mother had been housekeepers.
Then, as if disrupting herself from a trance, Laura remembered where she was and her eyes welled with tears. Resisting the urge to cry, she asked me, “Do patients cry in the hospital?” I responded, “Usually, it’s the ones with diarrhea that cry the most.” Laura laughed, almost hysterically, and said, “Thank you. I needed that.”
This was one of those rare moments as a medical student where I felt like I made a difference, particularly because I spoke the same language and shared a similar ethnic background as Laura. These commonalities gave me insight into her personality, preferences, and values.
This is what diversity, equity, and inclusion efforts wanted to accomplish: to bring clinicians who look, speak, and think like their patients into medical offices and to their bedsides.
As I laughed with Laura, the anesthesiologist scheduled for her myomectomy entered the room. I introduced myself — “Hi. I’m David, the medical student on the surgery team.” — and he proceeded to ask Laura about her medical history. She responded in broken English, so I helped fill the gaps. He then turned to me and said, “OK, why don’t you go sit in the waiting room and we will let you know when the surgery is over?”
Dressed in my blue hospital scrubs — identical to his — with my badge placed neatly on my shirt pocket, I re-introduced myself. The anesthesiologist blushed, then explained that the close relationship I appeared to have with Laura led him to believe we were related. I didn’t push back. Together, we wheeled Laura to the operating room. This time, my eyes welled up. Laura glanced up at me from the stretcher with a half-smile, as if she knew how I might have felt.
I scrubbed into the operating room and tried to focus on the video monitor televising the careful maneuvering of instruments used to remove Laura’s fibroids. But my mind wandered. I could not escape a voice that whispered, “You do not belong here.” I looked away from the video monitor and toward the surgeons, anesthesiologists, surgical techs, and nurses. I was the only person of color in the room, magnifying my feelings of exclusion and isolation. Worse, my ruminations distracted me from Laura’s care. It was not the presence of diversity, equity, and inclusion that could make care worse, as conservatives contend, it was the lack of them that had the potential to do so.
Within the space of an hour, I saw the promise of diversity, equity, and inclusion, a powerful connection that transcends barriers erected by the meeting of two strangers, and then I saw the critical gaps it has yet to fill: a diverse workforce with the ability to understand unconscious biases and navigate differences between individuals. I saw just how much diversity, equity, and inclusion efforts are necessary for patients like Laura and clinicians like myself.”