Med students need to be culturally aware, dean says

By Jaime Winston

When Ronald Harris was attending medical school at the University of California, San Francisco more than 20 years ago, a black man was refused surgery for prostate cancer without a reasonable explanation.

“There really was no discussion on why he wasn’t a good candidate for surgery,” said Harris, a dermatologist and the assistant dean of the U School of Medicine.

But black people are not the only victims of the health care gap, he said.

“Native Americans have gotten the shaft big time for a long time,” Harris said. “Health care on the reservations is truly appalling, and associated with that are higher rates of cancer and higher rates of hypertension.”

He said students heading into the medical field should be made aware of the inequalities of health care and treatment when it comes to different cultures. Harris spoke about this problem last week to the Association of Future Female Physicians, a group dedicated to the education and empowerment of females in the medical field.

Harris, who is also the associate vice president for diversity for health sciences at the U, said that throughout his 19 years of experience in the medical field one thing has become clear to him.

“There are definitely systematic and inherent problems that impact the delivery of care to minority and other culturally different populations,” Harris said.

According to the U.S. Census Bureau, the number of uninsured Caucasians from 2005 to 2006 did not significantly change, staying at around 11 percent. But the number of uninsured black people rose from 19 percent to 20.5 percent during that same year.

However, Harris said even if the numbers were the same, there would still be a gap between the treatment minorities receive.

“Even if you do have (insurance), there are disparities based on race, gender and ethnicity,” Harris said.

One example is treatment with tissue plasminogen activators, which dissolve blood clots in stroke patients. To receive the treatment, a patient needs to reach the doctor within three hours. If the patient is a black person he or she is 80 percent less likely to get tPA because, in many cases, it is never offered, Harris said, because physicians rarely tell black patients the treatment is available.

But disparities such as this aren’t new.

Harris cited the Tuskegee experiments on 399 black men infected with syphilis between 1932 and 1972. The men were not told they had the disease and were observed to see how it affected them. Harris said the black men were not made aware of the disease or offered treatment because the U.S. Public Health Service wanted to see how the syphilis affected the black population differently from the Caucasian population in Alabama.

“There are still Tuskegee people alive,” Harris said.

Harris noted another study in Chicago that showed Hispanics were seven times less likely to receive pain medication for bone fractures.

“That’s just stupid! It’s idiotic!” he said.

Hispanics are also 17 times less likely to be prescribed a nebulizer to combat asthma, Harris said.

“My kid has asthma, and that’s the first thing we got is a nebulizer to use at home so she doesn’t have to go to the E.R.,” Harris said.

But there is hope.

To combat cultural disparities, Harris facilitates a cultural competency class for second-year medical students. The class tells students how to recognize inequality and take responsibility to give all patients the best care possible. As part of the course, Harris explains how intent matters more than body language when it comes to treating patients who are diverse.

Other programs that promote cultural competency are the U’s Health Sciences LEAP classes and East High School’s Health Professions Academy. The goal of these programs is to educate students early about disparities in the medical field.

“You need to not just have the facts, but the skills to recognize the issues,” Harris said.

The content of Harris’ lecture is important to the entire medical field, said Maya McSpadden, the group’s national president and founder.

“As health care providers, these things need to be addressed and people need to learn the proper skills to ensure racial disparities or any type of disparities in the health care system are reduced,” McSpadden said.

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