Tip/Thought of the Day

The Golden Era

The “golden era” was a time when physicians enjoyed an incredible level of stature and esteem. For decades, they were considered “god like” and even wrote prescriptions in Latin so patients couldn’t understand what was given. If a doctor said something was needed, you didn’t question the orders.

One doctor told me my first day of residency,Informed consent just means that we are informed and the patient needs to sign the consent.”

When I started my training this era was ending. To those still clinging to the old ways, it was fast becoming clear social perceptions, inequalities in healthcare availability, corporate involvement (HMO’s), the introduction of other types of practitioners (Nurse Practitioners), and laws were changing forever the way physicians interacted with patients.

The pedestal was crashing down, and for some, the descent was too much to bear. The upcoming providers were encouraged to stop paternalistic elements that separated patients from their physicians and made medicine appear godlike. It used to be you were examined in one room then dressed and brought back to a private office to discuss results. In a white coat, sitting behind a desk, the picture of authority was complete. That’s why newbies were taught to shed this uniform and anything else that set us apart.

Another huge change around this time was the affirmative action law that forced schools to accept qualified applicants who were not just white men. It made a small dent, before it was banned in the late 1990’s. By then, close to 20% of physicians were female or those color. This generation introduced a completely different perspective from the white male dominated generations. In my medical school class half were women. Bringing in a wider range of students with differing ethnic, racial, social and gender backgrounds can only enhance an education since these are the very people we’ll be treating.

The medical field suffers from the same ingrained racial and gender inequalities as any other. When a white male orientation is the only viewpoint and provider, often even understanding the inherent bias is difficult. I have always wondered why a key lab result that defines renal concerns is defined differently for “ African Americans.” Was there a genetic or ethnic difference that substantiated this decision?

Over the last few decades we have grown to understand the importance our genetics play in setting us up for future medical issues. In my case, Jews from eastern Europe are more likely to pass on Tay Sachs to their children. It’s a devastating and deadly disease when the gene from both parents is inherited. That’s why my ex and I chose to be tested before starting a family.

But we are now investigating if that’s the primary reason for racial or gender disparities in all cases. Classifying people of color as “ African American” may not be the best way to truly evaluate renal risk. Especially when they represent 35% of those recieving dialysis in the U.S. That’s why many are demanding we assess how we look at entrenched ideas that may be affecting care.

And it’s not just labs but how we treat and interact with those who aren’t white males. Too many women had heart attacks because their symptoms were written off as “hysteria” or indigestion. Or those of color diminished or outright ignored when they seek help. Many document providers assuming an STD is the issue, even when the patient denies unsafe sexual practices, or “drug seeking” when complaining of pain.

According to Harvard Health, it is well-established that Blacks and other minority groups in the U.S. experience more illness, worse outcomes, and premature death compared with whites. These health disparities were first “officially” noted back in the 1980s, and though a concerted effort by government agencies resulted in some improvement, the most recent report shows ongoing differences by race and ethnicity for all measures. Most physicians are not explicitly racist and are committed to treating all patients equally. However, they operate in an inherently racist system. We now recognize that racism and discrimination are deeply ingrained in the social, political, and economic structures of our society.
A natural progression when only one group is represented.

Change is never easy.

Change is never automatic.

It’s too comfortable and important to those who reap its benefits. But it is always required when we want to move forward in any setting. Whether we are forced into it, see the writing on the wall and realize if we don’t adapt we will be left behind, or are too entrenched in our ways we choose to quit, change is inevitable. In my field, like others that have an impact on our health, wellness and very existence, it’s essential. Having educated, intelligent, informed patients who actively engage in their health always improves outcomes. Their interaction doesn’t diminish our expertise or knowledge, but expands it. We are all being asked to look at our training, backgrounds, beliefs and preconceptions to see what impact our own reflexive behaviors have on how we deal with others.


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