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February 07, 2011

African-American Surgeon Calls for Equality in US Medical System

Report finds discrimination against blacks, women, Hispanics and obese patients

When Augustus White was growing up in the American south in the 1940s, racial segregation was an accepted part of life. African Americans got second best - in education, employment, and health care.

But White overcame those barriers, becoming an orthopedic surgeon, professor of medicine at Harvard  and a leading figure in the struggle to reduce discrimination against minority medical patients.

Overcoming barriers

White was the first African American to reach a series of academic and professional milestones that were unheard of in the 1950s and ‘60s. The first African-American president of his traditionally white fraternity at Brown University, White was the first African American to graduate from Stanford Medical School, the first black resident, the first black surgery professor - at Yale University - and the first black department chief at Harvard’s teaching hospitals.

But what White may be best known for is his groundbreaking exploration of the deeply-rooted bias against minority patients that he believes is prevalent in the American health care system.

Struggle for medical equality

White first became aware of discrimination against minorities at the start of his medical career in the early 1960s and, later, while serving as a combat surgeon during the Vietnam War. His personal observations were further confirmed when he read a 2002 report that revealed some disturbing statistics about discrimination, not only against blacks, but also women, Hispanics, gays, the elderly and even the obese.

"This Institute of Medicine report, "Unequal Treatment," just spells it out in just blatant, statistical, overwhelmingly convincing ideas and realities about this inhumanity that exists," he says.

It’s conscious and unconscious, says White, but it’s a prevailing situation. "When are you most vulnerable? It’s when you’re sick. And to realize that under those circumstances you’re at risk to receive disparate care is really quite an issue."

Unequal treatment

The report also cited that African Americans receive less pain medication for the same injuries than white Americans; women dying from kidney disease are less likely to receive transplants; Hispanic Americans receive less angioplasty and bypass surgery for heart disease than whites; and the elderly are treated as less valuable than younger patients.

White finds this shocking, and inexcusable. "It’s a moral issue. It’s a legal issue. It’s a public health issue. This is a question of human rights," he says. "People should be getting the best care that the profession can offer them. And now they’re not getting the best care the profession can offer them."

What was even more surprising to White was seeing just how unconscious this bias seemed to be.

"There are examples of female doctors actually giving disparate care to female patients. There are examples of African-American doctors actually giving disparate care to African-American patients. And my theory is that the culture of medicine is so powerful that when you come through it as a student and as a resident and as a young doctor, and you get inculcated into the profession, sadly, part of that momentum includes these biases."

Medical inertia

To counteract these discrepancies, White calls for changes in education for doctors, nurses, medical school faculty, even insurance companies. He says they need training in self-awareness, so they can recognize their internalized prejudices, and be able to work from that.

White believes doctors need to understand the culture their patients come from - something he calls cultural literacy.

"Medical students should be taught something about the characteristics of the cultures that they may be treating in large part. So if 30 percent of your patients are Muslim patients, you should have some insight, some idea about what some of the prevailing practices of the Muslim culture may be."

With a new book about his experiences, called "Seeing Patients - Unconscious Bias in Health Care," White hopes to make the medical community aware of the problem, and trusts it will motivate them to doing something about it.

But he admits that it’s going to be a challenge.

"There is a kind of denial, there is a kind of inertia, but I think this is a mission that deserves a lot of energy and enthusiasm to get medical schools to be more committed with resources, with determination, with sustained efforts to really change the culture of medicine."  

White remains hopeful that change will come - and that everyone will have equal access to the best medical care the nation can provide.