HJAR Jul/Aug 2023

Editor I was told recently by a major medi- cal university representative that we need more Black doctors. I get that concept, but I couldn’t help replying that what we need is more “good doctors” regardless of their skin color. President Verret Yes and no. We need more good doctors, okay?And we have good doc- tors. The complication of representation within the clinics is not so much that one needs to have a doctor that looks like me, but it’s important to have within the clinic, or within the hospital or within the prac- tices, doctors who look like the population that they serve. Why? One, we know that there are a number of trust and quality of service issues that have occurred across different groups. For example, from the medical stan- dards exams, basic neurological baselines for determining normal versus abnormal function distinguish between baseline met- rics forAfricanAmericans and Blacks. Those are historical and not scientifically based. We have a number of things within medi- cal practice that are influenced by our racial ideology that formed the United States. We have hospitals in Maryland who are look- ing very hard at basically the metrics that they use to determine whether a patient should have a C-section or not. And they have different metrics forAfricanAmericans and Whites. Even though all the science is saying that basically race is not a biological indicator, it’s not a biological basis. Espe- cially within populations that are funda- mentally very dispersed, to say one standard applies for Blacks where some Blacks may have European andAmerindian descent and alsoAfrican descent, others may haveAsian andAfrican descent. Those differences seem not to matter, because we have one stan- dard that defines what Black is. Likewise, we define what White is, but they are of no biological merit. There are issues that are ingrained, standard medical practice, that are based upon our thinking in terms of racial ideology that need to be questioned. The issue of trust of patients in the medi- cal system, as was tested during the COVID pandemic, is also based upon representa- tion — that trust in the system. Populations that have less trust in their clinical practice also benefit less in the clinical practice. So, representation is an important factor. The fact that we have anywhere from 13 to 15% of the population, depending on how one counts, and less than 5% of the physi- cians are Black, says something about the representation issue. Even in the field of the biomedical research to attend to the major problems that we face, there’s a major disparity that has to do with the fact that the major ques- tions are very often not being defined in rooms where African American research- ers are present. So, we do need to encourage and develop and grow the capacity for bio- medical researchers of all representations within our population. There are too many examples of the priority given to certain problems in different populations, and the priorities are influenced by basically who the groups are that are being served. Diver- sity within biomedical research, as it is in the clinics, would be an important piece of addressing the major disparities in health that we are seeing within our communities. That does not say that doctors are not good. We also have a body of work that says we as Americans think likeAmericans, and there- fore we have certain biases that influence our thinking. If I would point to a major study that is now somewhat dated, looking at even the factors of treating pain in patients around the country, and looking at the smart sam- pling, one would see that there’s a bias in the treatment of pain for African American patients versus White patients. And that study even has the interesting notion that when one looked at patients seen by Afri- can American practitioners, the Black and White patients, there’s also undertreatment of pain. The unconscious biases we bring into the clinic are also due to ourAmerican- ness. We need to actually deconstruct and think clearly about how and why we prac- tice medicine. Adiversity of physicians that question those would be useful as well. Editor Our generation seems a bit con- flicted on race, would you say? President Verret Yes, with good reason because it is a confusing concept. Editor I think you and I are probably somewhat close in age, a decade apart. We’re a product of societal strides of racial integration. On one hand, we were taught to try our best to be colorblind, ignore the color of one’s skin, and to look at the per- son underneath. We’re not great as a soci- ety in doing this, but our group was really, I feel, taught to try to do that. But recently, as you discussed, these undercurrents and racial disparities, health disparities in a lot of cases, have bubbled up, and they’re not pretty. So now, we seem to be sepa- rating things more on race and not less. Where do you feel we should be as a soci- ety on this? As a healthcare community, as Americans? At some point, we say we look at race; and sometimes when we do, we’re told, “that’s racist.” President Verret Well, first of all, I would say that from beyond healthcare, our soci- ety and our generation, especially the gen- eration that is even younger than you and I, have a great desire to see individuals as individuals regardless of race. The prob- lem is that our unconscious as Americans also influences our thinking. For example, studies of housing selection by realtors have shown if the person comes in with a name that can be Africanized, let’s say maybe Malik as opposed to Michael — the same person, same income, same credit score, things like that — the different name seems to influence the outcome. If the name is identifiable as of the disfavored group, that person is handled differently whether it’s for housing, even a job search, there are biases that are felt and biases that play out. HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2023 21