Last Updated on February 18, 2024 by BVN
Breanna Reeves
In April 2016, Kira Dixon Johnson went to Cedars-Sinai in Los Angeles for a scheduled cesarean section. Johnson died hours later after giving birth to her son, Langston, as a result of complications associated with his birth.
In 2022, her husband, Charles Johnson, filed a lawsuit in Los Angeles Superior Court which accused the hospital of not providing the best care to his wife because she was a Black woman, according to The Los Angeles Times. One of two lawsuits filed by Johnson, stated his wife’s catheter was filling with blood, so he alerted her doctor, who ordered a CT scan. The scan was never performed.
The preventable death of Kira Dixon Johnson is what initially sparked Cheyenne Page’s interest in medicine. Page, 27, is currently a first-year medical student enrolled in University of California, Riverside’s Program in Medical Education (PRIME), a program designed to train future doctors to specifically serve African, Black, and Caribbean (ABC) communities of the Inland Empire.
“It was really one of those moments where I saw myself in Kira, and saw my sister and other Black women that I know and love,” Page said. “And that really is something that drew me to the PRIME Program. I really love how it emphasizes the African, Black and Caribbean community.”
Several studies have found that Black patients have a long history of “medical mistrust” dating back to the 1840s when the “father of gynecology” Dr. J. Marion Sims conducted medical experiments on enslaved women without anesthesia. Today, Black patients often feel ignored, undertreated and discarded when they interact with the healthcare system and physicians, fueling medical mistrust.
Efforts to address the root cause of medical mistrust among patients of color such as institute implicit bias training and the development of health equity initiatives have been ongoing across healthcare systems in the U.S. in order to combat persisting health disparities.
At age 16, Damola Adeyemo, moved to the U.S. from Nigeria and was surprised to see communities of color suffering, despite the health resources available in the U.S. Now 23, Adeyemo is a first-year medical student enrolled in PRIME. She is interested in public health and learning about the barriers to health care.
“The ABC community is a community that is very affected by the health disparities,” Adeyemo explained. “I just hope that as a future physician, I’m going to do more than just learn about disparities, but actually find solutions that can help dismantle those disparities as well.”
Several surveys, including a 2022 California Health Care Foundation (CHCF) survey on Black Californians and a 2023 KFF health survey, found that Black patients and patients of color reported more positive and respectful interactions with providers who shared their racial and ethnic background. The CHCF survey noted that respondents shared how important representation and patient advocacy is in health care.
Beyond diversity, tapping into everyone’s potential
There have been several calls for diversifying the healthcare workforce, which can improve a patient’s access to care. PRIME Director Dr. Adwoa Osei explained that having diversity in the field of medicine is a “no-brainer.”
“Diversity also brings in excellence. You never know what you’re missing because different perspectives bring different things, and it just enriches the experience and enriches the whole journey of the whole process,” Dr. Osei said.
“I don’t even know that we need to keep making a case for diversity — it’s such a basic thing. I would like to say, though, that I think we need to spend more time talking about creating spaces for everyone to belong, so that they can achieve their full potential.”
Medical students enrolled in PRIME come from different ethnic and racial backgrounds, but students all share the program’s mission of addressing the health care needs of underserved communities, specifically African, Black and Caribbean communities that experience some of the worst health outcomes. Fatal outcomes like Johnson’s have become more frequent over the last decade as Black birthing people in California are three-to-four times more likely to die of pregnancy-related causes than other racial and ethnic groups.
“I think it’s everyone’s job in healthcare to invest in learning about how to be culturally competent, how to be empathetic, how to talk across different cultures and be sensitive to that,” explained Dr. Laurie Zephyrin, senior vice president for Advancing Health Equity at the Commonwealth Fund.
There is sufficient data that exists demonstrating that diversity in health care should be an obvious principle embedded into the foundation of health care policies and practices, however, more action is needed to make this a reality.
Dr. Zephyrin explained that there are multiple prongs to diversifying the health care workforce and developing practices that ensure that diversity is a “no-brainer,” such as developing early start programs that engage middle school-aged students with the goal of recruiting students from diverse backgrounds.
She explained that she’s been really impressed by UC PRIME programs like Program in Medical Education – Transforming Indigenous Doctor Education (PRIME-TIDE) which prepares medical students to provide healthcare to Native communities. According to the Association of American Medical Colleges, in 2023, just 0.3% of physicians identified as American Indian/Alaska Native.
“Programs that intentionally recruit from diverse populations from underserved populations are critical, and I think we need policies and resources and regulations to support that,” Dr. Zephyrin explained.
Part of UCR PRIME’s curriculum includes attending seminars that feature different presenters. The discussions in these seminars have made an impression on Adeyemo as she learns about health disparities through different lenses such as through a historical lens.
“If you don’t talk about it, you don’t really understand where to start finding solutions,” Adeyemo said. She explained that having these discussions with her peers, who are from different backgrounds and offer unique perspectives, opens her mind up to thinking about how to find solutions to problems.
Page shared that PRIME’s curriculum and assigned readings have really made an impression on her as she learns more about structural racism and the depth of health disparities. Such topics aren’t as heavily discussed in general medicine discourse, outside of PRIME, according to Page.
Diversity of physicians can result in better care
A paper published by Lancet noted that 5.4% of physicians identify as Black, and of this percentage, 2.8% are Black women.
“We need more physicians of color, [from] different backgrounds, that will be able to identify with the patients and improve their health care. It can be done by more than just someone of color, they would have to actually be trained,” said Dr. Betty Daniels, who was recently elected Medical Staff President at Dignity Health – Community Hospital of San Bernardino. Dr. Daniels explained that doctors need to understand the health care needs and differences among patients who have different racial/ethnic backgrounds.
As medical school programs like PRIME aim to educate future doctors about engaging with communities of color, discussing barriers to care and practicing cultural competency, in order to provide equitable care to historically underserved communities.
“I think it’s really vital for us to be learning what we are about cultural competencies and how to best advocate for our patients — even from the position as a first-year medical student to becoming an attending. We’re always going to be advocating for our people in our community,” Page said.
Similar to the goals of PRIME, Dr. Daniels hopes to encourage her staff to continue to engage with the community in her leadership role. Her goal is to lead by example and work with medical staff to understand how they can show their support and commitment to the community.
As a parent who has a son studying urology, a speciality that focuses on the urinary-tract system, Dr. Daniels offered a word of advice to him, and other physicians of color: “Be available. Be good listeners. Be proud of who you are.”
Dr. Daniels believes that being a good listener is 50% of being a good physician.
This article is published as part of the Commonwealth Health Equity Reporting Fellowship.