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In this second of a three-part video series, Managed Healthcare Executive® Managing Editor Peter Wehrwein recently interviewed Kulleni Gebreyes, M.D., director of Deloitte's new Health Equity Institute about her career, healthcare disparities and equity issues and the work of the institute.
The transcript below has been edited for length and clarity.
I read a piece in which you had written about your personal experience, as a physician, and the moment where somebody comes in, you're there, you're wearing the white coat, you probably have the stethoscope around your neck, and people ask, “When does the real doctor get here?” That reflects the sort of thinking that a woman of color couldn't be a doctor. Did you experience other incidents of racism as you were getting trained?I'm wondering, I guess, how systemic your own experience has been with race.
You reference the op-ed, I wrote, and I was very intentional about saying that I don't know what actually was in that person's heart and mind. What I will tell you is that those disparities … are quite systemic.
Probably when they have hit me the most weren't when things happen to me directly, because I actually had control over how I could respond. The times that were really heartbreaking werehow patients were being treated by my colleagues, or within medical education system when we were interviewing and assessing the candidacy of different students for residency positions or post-residency positions. You would hear clusters of words that seem to correlate with race and or gender. You'd hear the word “angry” often and I would know that they were referring to a person of color.
And you would hear (about patients) that they were exaggerating their pain or (exhibiting) pain-seeking behavior, dismissing the experience they were having. It is quite systemic.
I think a lot of it is actually unconscious. And some of it is very intentional, as well. But I would say that, you know, for somebody who lives in America, as a person of color, probably not a day goes by where you see something and makes you wonder. It doesn't always mean that it's based on racism.
And I want to highlight that there are also many other forms of bias that I think impact health equity, whether it's sexual orientation, age, language, ethnicity.
So biases are with us. And I think our only chance of addressing them is if we can become self-aware and aware of what's happening in our surroundings.
I would suspect that the people who were saying these things that were probably pretty idealistic people. They went into medicine. They want to heal people. They're smart as all heck. So how do you square that (with the bias)?
When I was in medical school we were still learning about how to use race as a risk factor in terms of assessing whether somebody was more likely to have diabetes or more likely to die from congestive heart failure.
Now that I've advanced in my professional career, I think we have a better understanding that it's racism — and all those things associated with it — whether it's poverty, housing, insecurity, education, gaps — that cause these outcomes.
And in some ways, historically, we as an industry have propagated these disparities by embedding them into our algorithms. There was an article in The New England Journal of Medicine that listed the most frequently used race-based algorithms that we continue to use today. Race is not a genotype. It's a phenotype. There are ways ways that we've embedded these disparities by making them normal.
So for those folks that you described as being idealistic, and have the best intentions in mind and have the intelligence to navigate, I would say yes, yes, yes. But we've been trained and to create these constructs and ways of thinking that we have to step out of to actually look at how we're thinking
You have written about healthcare equity in fairly lofty ways about it being a fair and just opportunity for every individual to achieve their full potential on all aspects of health and well being. It resonated with me because I think it sounded a little bit like the Universal Declaration of Human Rights. This kind of thinking and argument is familiar if you have entered into the discourse about health as a human right. But I guess for me, something always grabs. It’s so aspirational. Just wondering, do you worry that having such a high goal that it might mean that it never gets reached? And that this all ends up being just talk?
I would probably separate that in two different questions, at least the way I receive it. So is it aspirational? Absolutely, yes. And I'm going to get this quote that by Nelson Mandela exactly wrong. But he says something like, it's only impossible until you get it done.
And so when you think about other aspirations that we have had as a country. We wanted to go to the moon. And we did we wanted to establish democracy in America. And we did, we wanted to learn how to cure some kinds of cancer. And we did.
And so I'm a strong believer that if you put the right resources, investment and time, we can actually accomplish a lot more together than any one of us can do as an individual. As for the latter part of your question, can we ever get there, you know, I hope so. I don't know that we can. But regardless of what the answer to that question is, I think that not having certainty of whether we can accomplish it or not, doesn't absolve us of the responsibility from waking up every single day and taking action to advance it.
And so my goal as a professional and in my network and in the communities that I live in and influence is to advance it as far as I can, and then hand it to the next generation and, and hope that they take it even further.