Health care was once moderately immune to the anti-diversity, anti-equity, and anti-inclusion craze. Not anymore.
California’s medical board is facing litigation for requiring physicians be trained about implicit bias. Health systems are reassessing training on systemic racism because of Florida Governor Ron DeSantis’s bill that prohibits public funding for diversity, equity, and inclusion initiatives. And Republicans in the U.S. House of Representatives have introduced a bill to amend the Higher Education Act of 1965; the bill aims to prohibit medical schools from receiving federal aid if they adopt certain policies related to diversity, equity, and inclusion.
All this, amid last year’s Supreme Court ruling that banned race-conscious admissions at colleges and universities, portends poorly for anyone who cares about the health of patients and the well-being of their doctors.
Laura (not her real name) is one of those patients — and I will soon be one of those doctors.
I met Laura, a middle-aged, Spanish-speaking Hispanic woman, in the pre-operative area of the hospital where I was training during my second year of medical school. She was anxious, and had been labeled by some of the clinical staff as a “difficult” patient. My senior resident felt I might be able to connect with Laura because of my Hispanic heritage and native Spanish skills.
She was right. After introducing myself and answering Laura’s questions about her upcoming myomectomy (the removal of uterine fibroids), she reminisced with me about her daughter and her upbringing in the Dominican Republic, including her escapades as a young girl on the coast of Santo Domingo, the country’s capital city. Laura asked me about my parents, and we bonded over the fact that both she and my mother had been housekeepers.
Then, as if disrupting herself from a trance, Laura remembered where she was and her eyes welled with tears. Resisting the urge to cry, she asked me, “Do patients cry in the hospital?” I responded, “Usually, it’s the ones with diarrhea that cry the most.” Laura laughed, almost hysterically, and said, “Thank you. I needed that.”
This was one of those rare moments as a medical student where I felt like I made a difference, particularly because I spoke the same language and shared a similar ethnic background as Laura. These commonalities gave me insight into her personality, preferences, and values.
This is what diversity, equity, and inclusion efforts wanted to accomplish: to bring clinicians who look, speak, and think like their patients into medical offices and to their bedsides.
As I laughed with Laura, the anesthesiologist scheduled for her myomectomy entered the room. I introduced myself — “Hi. I’m David, the medical student on the surgery team.” — and he proceeded to ask Laura about her medical history. She responded in broken English, so I helped fill the gaps. He then turned to me and said, “OK, why don’t you go sit in the waiting room and we will let you know when the surgery is over?”
Dressed in my blue hospital scrubs — identical to his — with my badge placed neatly on my shirt pocket, I re-introduced myself. The anesthesiologist blushed, then explained that the close relationship I appeared to have with Laura led him to believe we were related. I didn’t push back. Together, we wheeled Laura to the operating room. This time, my eyes welled up. Laura glanced up at me from the stretcher with a half-smile, as if she knew how I might have felt.
I scrubbed into the operating room and tried to focus on the video monitor televising the careful maneuvering of instruments used to remove Laura’s fibroids. But my mind wandered. I could not escape a voice that whispered, “You do not belong here.” I looked away from the video monitor and toward the surgeons, anesthesiologists, surgical techs, and nurses. I was the only person of color in the room, magnifying my feelings of exclusion and isolation. Worse, my ruminations distracted me from Laura’s care. It was not the presence of diversity, equity, and inclusion that could make care worse, as conservatives contend, it was the lack of them that had the potential to do so.
Within the space of an hour, I saw the promise of diversity, equity, and inclusion, a powerful connection that transcends barriers erected by the meeting of two strangers, and then I saw the critical gaps it has yet to fill: a diverse workforce with the ability to understand unconscious biases and navigate differences between individuals. I saw just how much diversity, equity, and inclusion efforts are necessary for patients like Laura and clinicians like myself.
Since I met Laura in 2019, various diversity, equity, and inclusion efforts have sprouted across the country. Yet efforts in medicine have at best been a fledgling phenomenon, and at worst an endeavor that’s in critical condition.
In 1978, the percentage of Black people graduating from an M.D. program was 7.1%. The most recent data from the American Association of Medical Colleges showed that in 2021, only 5.7% of physicians identified as Black or African-American while 6.9% of physicians identified as Hispanic. This is in contrast to their representation in the American population, which is 13.6% Black and 19.1% Hispanic. The research literature is laden with reports demonstrating that microaggressions and structural racism negatively affect minority medical students and doctors.
When it comes to patients, research shows a lack of progress over the past 25 years. Disparities in diabetes, hypertension, and asthma between Black and white Americans widened from 1999 to 2018, while disparities in diabetes and hypertension between Hispanics and whites failed to improve. Maternal mortality for Black women is 2.6 times the rate of white women, and infant mortality for Black infants is more than twice as high as it is among white infants. When people like Laura who don’t speak English enter a U.S. hospital, they are more likely to receive worse health care and experience poorer outcomes. But when doctors look like their patients or speak their same language, health care outcomes improve.
It is in this context that conservatives aim to dismantle diversity, equity, and inclusion within medicine. And it is because of this attack that health care leaders, including medical school deans, hospital department chairs, health system executives, and public servants must recommit to the principles of diversity, equity, and inclusion.
This means ensuring medical students understand the history of discrimination and racism within medicine, including how their own biases affect interactions with both patients and colleagues. It means diversifying the physician workforce through greater financial aid for students who need it and by creating partnerships with local institutions to strengthen minority pipeline programs. It means evaluating policies that might disproportionately affect certain patients, like the kidney disease guidelines that unintentionally discriminate against Black patients. And it means standing up to ideological rhetoric and legislation that seek to further marginalize patients and their doctors who, for far too long, have been the victims of hate and oppression.
As I transition from medical student to doctor this summer, I cannot help but imagine what a world that values diverse perspectives, equitable treatment, and inclusive environments might look like. I see myself donning a long, white coat and wheeling a patient like Laura through the hospital. She looks up at me from her stretcher, but this time, unlike Laura, she doesn’t have a half smile that reminds me of how far we have to go in accomplishing the goals of diversity, equity, and inclusion. She gives me a wide, warm smile that says, “We have arrived.”
David Velasquez is a fourth-year student at Harvard Medical School.