Takeaways and Additional Findings

Gender and Patient Disparities:

Patient disparities when seeking medical care affects a variety of populations. Though a breadth of scholarship exists pertaining to current medical inequities, there is still a lack of knowledge among the public regarding just how detrimental these disparities can be. 

 Dayna Bowen Matthew’s Just Medicine : A Cure for Racial Inequality in American Health Care discusses the effect of physician implicit bias and how this can result in larger racial disparities in society as a whole. Through Matthew’s preliminary research for the book, it is acknowledged that many physicians even refused to admit that healthcare disparities exist, indicating a greater need for global education and increased awareness on the topic.⁵ Though Matthew’s book is impactful and important in addressing the racial biases of physicians and in providing suggestions on how to restructure the legal system to hold these biases’ accountable, it fails to address the many other populations that are disproportionately affected by healthcare, thus pointing to areas for further research.

Considering race, ethnicity, gender, and geographic location as roots of bias, these identifying sectors provide areas where there is more research to be done and change to be made to lessen the gap between those who benefit and those who are disadvantaged by the medical system.

A research journal titled “Patient-Reported Experiences of Discrimination in the US Health Care System” discusses that, through evidence from an United States national survey, (about 67%) of female survey participants reported being victim to discrimination within a medical setting, while only ⅓ (about 33%) of male participants reported experiencing discrimination. This large disparity indicates the presence of gender biases as a possible origin of discriminatory behavior—and a reason why so many female patients are disadvantaged when seeking care.

In conversation with Dr. Stacey Rosen [featured in Episode #1], gender disparities were further clarified. Dr. Rosen explains that when she began practicing cardiology, medicine and medical research was centered on men—specifically in the form of the “male model” used for studies and clinical trials. Because doctors were hyperfocused on the experience of male patients, medical complaints in females were often overlooked. Dr. Rosen explained that “I was taught that it wasn’t a disease of women [heart disease], and then all of a sudden all I started seeing were women [female patients seeking care] and they presented differently [than men].”⁶ Due to a lack of medical research that utilized female participants, medical complaints from female patients had been long overlooked and their conditions left untreated for far too long.

Though there has been great improvement in female medical research, there remains a multitude of areas where there is more work to be done. For example, fibromyalgia. Ninety percent of fibromyalgia cases are diagnosed in female patients, and is just one example of a disease that predominantly impacts female patients.⁷ However, as one cannot physically see the symptoms of fibromyalgia, many attribute the disease and its symptoms to “psychosis.”⁸ The idea of psychosis or emotions as the cause for physical symptoms and medical complaints is something that can be hard to escape, as that is an implicit bias made by a physician when attending to a female patient. Dr. Rosen discusses this concept and some of the ways that she’s seen it manifest in medical settings.

Further information covering the experience of female patients and female physicians can be found in podcast Episode #1, titled “How Gender Impacts Patients’ Experience: pain, medical research, and the ‘male-model.’”

Physician Discrimination:

Medical disparities affect patients, though they can also greatly impact their care providers. Physicians, particularly physicians belonging to minority groups, can be subject to discrimination in the workplace due to their race, ethnicity, gender, age, and a variety of other factors. Though many physicians may be victim to acts of discrimination, in my conversation with Dr. Robert Roswell [featured in Episode #2 and #3], he explained that many physicians are taught that the patient always comes first—so in the case of dealing with a medical emergency, one must continue to treat a patient despite discriminatory comments that may be directed towards them.⁹ This also creates a healthcare environment and structure, in which physicians—especially those who are victim to attacks of hatred, biases, and stereotypes—feel powerless.

Dr. Roswell expressed that there is a trend towards more positive outcomes when patients are treated by a physician with a similar background. Supporting this philosophy is a study out of Stanford University, where researchers explored how race impacts a physician-patient experience and relationship. The research results showed that the occurrence of severe illnesses, such as cardiovascular disease, could be reduced significantly if more doctors of color treated patients of color. Results from the study indicate that “black doctors could help reduce cardiovascular mortality by 16 deaths per 100,000 per year leading to a 19% reduction in the black-white male gap in cardiovascular mortality.” Additionally, the Stanford study discusses physician-patient relationships, specifically communication between the two parties. The results provide evidence that when doctors and patients belong to the same minority group or identify in a similar way, there is improvement in their communication and experience, thus indicating that a patient-physician concordance could be beneficial.¹⁰ Other sources echo similar findings, though note that this theory of physician-patient concordance would need to be researched on a larger scale to understand why this structure is beneficial.¹¹ 

Further areas of research could look into how physician discrimination and patient discrimination intersect—and perhaps serve as a route for connection in physician-patient concordance.

To hear more about some of the ways that health systems are supporting their physicians, the intersection between physician discrimination and patient experience, and some of the experiences of minority physicians, please refer to podcast Episode #2, titled “Episode 2: Physician Discrimination: Experiences of Doctors Based on Race.”

Medical School Admissions:

Medical school is the typical route into the professional field of medicine, so how are the demographics of practicing physicians determined by medical school matriculants? Well, quite directly. 

Through conversations with Dr. Robert Roswell [featured in Episode #2 and #3], the processes of medical school admissions were further described—in particular, the interview process and applicant review process, as indicators for the changing field of medicine and medical school.¹² 

By studying admission and attendance rates of minority populations based on gender, racial/ethnic minorities, and those considered economically disadvantaged (those who have a family income that is around the “federal poverty line”), the article written by Aaron Baugh (of the University of California, San Francisco) and Reginald Baugh (of the University of Toledo), adds to the discussion of diversity in medical school. The researchers determined that racial distribution has decreased in medical school in the past 35 years in relation to population growth and those who are considered economically disadvantaged are severely underrepresented; however, over the past 40 or so years, women’s representation in higher education, including medical school, has increased dramatically. While ultimately including some positive results pertaining to female representation in medical school admissions, the article and its data still lends itself to the notion that there is much more work to be done and many more advancements to be made in order to create a more equitable field.¹³ Data displayed in the article may lead one to wonder how this lack of medical school diversity impacts patient and physician diversity, specifically in the representation of minority groups—and is what ultimately formed this sector of research.

The research and data discussed in the aforementioned article, carries themes echoed in Episode #3 of the podcast. Dr. Roswell indicates similar barriers to medical school applications, which now acts as the catalyst for restructuring the process of medical school admissions.

To hear more about the topic of medical school admissions and the relationship between medical school and the medical system, consider listening to podcast Episode #3.