I saw a young man from Portugal, a new immigrant to the United States who didn’t speak English, a couple weeks ago in the hospital. He really needed a long-term physician. Like many such patients, he didn’t have access to health insurance here, and he hadn’t seen a doctor for more than three years. He had lots of issues that weren’t going to be resolved during the hospital stay.
So I set about looking for a physician for him. And from the 15 or so available choices in the clinic, I picked a doctor who was a young Latino man, the most similar to him.
I had my reasons for doing this. First of all, I thought I’d lower the language barrier a tiny bit—my patient spoke some rudimentary Spanish, and the physician spoke Spanish well. This didn’t remove the need for an interpreter for the discussion of complicated medical problems—it just meant that the doctor could say things like “sit down” or “breathe” and be understood. Second of all, I’d noticed in the hospital that the patient seemed nervous and uncomfortable. I was worried he might never come back and thought it might help if I picked someone who was more like him.
So here’s a question: Is this discrimination? Do patients like doctors who look more like them? And—a worse thought—do doctors take better care of patients who look more like them? Should I just have picked the next name from the list? Does it matter at all?
There’s a huge amount of fascinating research on this topic. Some studies have found that doctors do offer treatments differently based on the race or gender of the patient. Others have refuted those findings. Some have found that concordance, or matching, of race and gender is important to communication; others have not.
My personal experience is that communication (or lack thereof) has a lot more to do with the individuals involved than with race, gender, or other characteristics. I’ve had thirtysomething female patients (just like me) with whom I couldn’t forge a connection. I’ve also had excellent rapport with eightysomething black, male patients (not like me at all).
On the other side, I’ve always found it interesting how many patients do comment on the race, ethnicity, or religion of their doctors. Some do this with pride or out of personal curiosity. Others do it with a tinge of something else (“You’ll never believe it, but the ER doctor I saw was a black woman!”). So why did I set up this particular patient with a doctor who shared some characteristics with him? Maybe I was discriminating this time, but I just had that sense that for this patient, the whole medical system was foreign territory. He needed a connection, a place to start—even if that connection was only skin-deep.
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Comments (1)
I agree with your judgment whole-heartedly. People naturally gravitate to others, especially when in situations that they are uncomfortable.
For a man who is sick, in a foreign environment, and who cannot communicate effectively, he would probably be put much more at ease with an initial likeness to the person treating him.
While prejudices do still abound, (unfortunately!), I wouldn’t call this one of those situations. I’d call this compassion for another human.