November 8, 2002

Panel considers prejudice of doctors

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Dr. John Leonard, Dr. PonJola Coney, and George C. Hill, Ph.D. encouraged physicians and students to examine their biases and to be aware of minority issues of health care. (photo by Dana Johnson)

Panel considers prejudice of doctors

Are doctors racist?

Perhaps. But it will take more than recognizing subconscious bias to eliminate the alarming disparities in health care experienced by minority patients, speakers said Tuesday during Ethics Grand Rounds in Light Hall.

One solution recommended in a recent Institute of Medicine report is to increase the number of minority physicians and researchers. That’s easier said than done, however.

“Minority students incur tremendous debt,” said Dr. PonJola Coney, senior vice president for health affairs and dean of the School of Medicine at Meharry Medical College. “They don’t start out with the kinds of resources that non-minority students start with.”

There is a federal loan repayment program, and other programs to encourage minority students to seek careers in medicine, medical research and public health, but “all of these programs are currently in danger of being axed from the budget,” Coney said.

Several programs are underway at Vanderbilt to recruit and train medical and graduate students from underrepresented minorities. Growing numbers of minority high school and college students participate in summer programs at Meharry and Vanderbilt, thanks in part to increased federal funding and the Meharry-Vanderbilt Alliance.

But doctors and medical schools alone can not solve the problem of disparity. “Health care is rationed in this country according to who you are, … and the job you have,” Coney said. “It is the economy and factors that have shaped society that contribute to those problems.”

Dr. John Leonard, professor of Medicine and director of the Internal Medicine Residency Program at Vanderbilt, urged every physician at least read Chapter 4 of the nearly 600-page Institute of Medicine report, which explores possible reasons for racial and ethnic disparities in health care.

The report, titled “Unequal Treatment,” is available on the institute’s Web site,

It concluded that disparities exist “even when insurance status, income, age and severity of conditions are comparable,” said Dr. Frank Boehm, professor of Obstetrics and Gynecology at Vanderbilt and chairman of the Medical Center’s ethics committee who moderated the panel discussion.

For example, Boehm said, “minorities receiving Medicare were 3.6 times more likely to undergo leg amputations for diabetes complications than similar white patients, and African Americans were 35 percent less likely than whites to undergo angioplasty and heart bypass procedures with the same disease severity.”

"Are doctors racist?" Leonard asked. "Of course we are not, and yet we are. We are all at some level, by our human nature and our social upbringing … (The) sense of belonging to one group and not another could lead to implicit bias, … and certain even unconscious or half-conscious stereotypical attitudes and behaviors."

Leonard urged the audience to embrace the ideals of the legendary 19th Century physician William Osler, who he said "mastered the art of medicine as few have done."

"Why was he a great physician?" Leonard asked. "Because his errand in life not only concerned the bodies of men and women but their spirits."

“I think it’s critically important that we continue to have these discussions on a regular basis,” concluded George C. Hill, Ph.D., Levi Watkins Jr. Professor and Associate Dean for Diversity at Vanderbilt. “Do not be afraid to raise these issues in discussions when one is considering a case or when one is considering the actions of other individuals.

“Finally, it’s very important to recognize that who we serve and how we will serve them is going to change dramatically,” Hill added. “The students in our first-year class, when they begin to practice, will be seeing a higher proportion of underrepresented minorities. It’s our responsibility as an institution to prepare them for that.”