Systemic racism and inequality are at the forefront of a critical national discussion today, and when these issues intersect with health care, the stakes can be life and death. While there is still work to be done, issues of racial disparities in health care are beginning to be addressed in medical classrooms across Miami, including at University of Miami’s Miller School of Medicine.
A first-year medical student at Howard University and a University of Miami class of 2020 graduate, Jabari-Ture G. Brooks said the United States refuses to truly provide equal care and access to people regardless of their cultural or socioeconomic background. According to him, African American communities are bombarded with more chronic diseases and health issues simply due to their lack of access to quality health care. “The COVID-19 outbreak makes this plainly clear. Now more than ever, we need an increase in diversity in the health sector. We also need a true commitment to providing equitable healthcare to all people and finding ways to understand the social and cultural influences on health,” Brooks said.
A major problem in the health care system is a general lack of research on the effects of certain diseases and health risks in minority communities. Topics such as the effects of UV rays on melanated skin and how coronary heart disease impacts African Americans disproportionately in the United States, reflect studies whose findings are flawed in their range of application to the general population. Still, they continue to be taught to students in medical school courses.
A Hispanic student at UM’s Miller School of Medicine, who asked to remain anonymous, pointed to the process of kidney dysfunction as an example. Kidney function tests include measuring the level of creatinine that the body produces and comparing it to the body mass typical of that person’s race. This is because African Americans are expected to have greater body mass than any other race, regardless of individual body masses, she explained, but this stereotype can have dangerous results. Although a white bodybuilder would likely have a greater body mass than a short Black person with a sedentary lifestyle, the latter would be held to a higher range of creatinine production to be considered healthy. Stigmas like these increase the risk of misdiagnosis and improper treatment for minorities.
Implicit bias is a factor that can influence not only care in the moment, but the foundation of a doctor’s approach to medicine. Dr. Michael Touchton, a professor of political science and global health at the Miller School of Medicine, explained that he has witnessed minor incidents of implicit bias in his career, including some as fundamental as a course’s reference material. However, he said he believes these issues are beginning to be better addressed in the global health care community today.
The anonymous Miller student agreed, saying Miller’s coursework addresses racial bias. “Miller does a great job of making us aware of racial disparities in different areas,” she explained. “We work on clinical skills and we also have discussions revolving around things that are wrong in our healthcare system.” She also discussed the impact lack of insurance has on one’s access to care, “Physicians,” she said, “have relinquished their power in terms of insurance, and insurance companies are run by business-minded people who do not have a healthcare provider’s point of view.”
A second-year medical student at Miller, Ibrahim Ali, said that the students at Miller have made a motion to include various races and ethnicities in lectures in an attempt to show how the same illness may physically present differently. “In fields such as dermatology, clinicians have been classically educated to identify pathologies in medical school using pictures of white males; these illnesses, however, have different presentations with people of African ancestry that can be missed on a physical examination,” he said. Ali said that this has prompted students at Miller “to make a concerted effort to include these different presentations in our standard education in order to better serve our communities when we practice medicine.”
The anonymous Miller student also expressed enthusiasm for the various programs and services UM offers through its medical school. “One of the main reasons why I wanted to stay in Miami for medical school is because there is no end to the community outreach that UM does,” she said. “Even the location gives you such a diverse pool of people walking through your doors.” This diversity, she said, extends into the classroom as well. According to Miller’s website, the class of 2024 is 36.4% white, 29.2% Hispanic, 17.9% Asian and 16.5% Black.
Florida International University’s (FIU) Herbert Wertheim College of Medicine announced this year a new companion session to its second-year curriculum titled, “Skin of Color.” The session, aligned with the college’s dermatology curriculum, is designed to help students “gain a fundamental understanding of racial and ethnic variations in clinical presentation and treatment of common skin and hair conditions.” Also available as a self-directed e-module, “Skin of Color” aims to reduce implicit bias in the health care of minority groups and increase awareness of disparities that have impacted them for generations.
As easy as it is to get swept up in the chaos of the current political climate, one area that we can take solace in is the quality of care our future physicians will provide us with. Increased awareness, class diversity and curriculums designed to combat implicit bias are molding a generation of caretakers prepared to serve their communities needs.
“The COVID-19 outbreak makes this plainly clear. Now more than ever, we need an increase in diversity in the health sector.”Jabari-Ture G. Brooks
First year medical student at Howard University and a University of Miami class of 2020 graduate
words_cassandra couri. illustration & design_andrea martinez.
This article was published in Distraction’s winter 2020 print issue.