Medicine and the Melting Pot
One of the little games I used to play during the course of the workday was to count how many Andersons I had on my schedule. I think my record was six. For variety, I sometimes expanded the field to include all patients with a last name ending in “–son” or “–sen.” That tally could include more than half of the individuals I saw in a given day. As a native Chicagoan, I wondered where all the Raspetellos, Coluccis, and Kowalskis were hiding when I first moved here. It seemed as if, at least in my practice, Minnesota was one big Scandinavian neighborhood.
In the past 15 years, that has changed. No longer is Minnesota snow white. No longer do we all speak a patois peppered with “ya sures” and “you betchas.” And no longer can we assume that everybody’s holiday celebrations include aquavit and lefse.
Today, the patients who walk through our clinic doors are more likely to speak Somali or Spanish than Swedish. Our waiting rooms are a veritable polyglot of Hmong, Latino, Russian, or Somali. Using interpreters has become an almost daily communication challenge for many Minnesota docs. Integrating what sometimes seem to us to be exotic beliefs about health has become quite routine, and at times it can test our tact, patience, and ingenuity. Although medical providers from different parts of the world are trickling into the system to lend their cultural understanding and linguistic skills, practitioners of all backgrounds need to become more adept at dealing with the challenges that come with having a more diverse patient population.
Physicians have always tried to treat all comers fairly and equally; but again and again, studies reveal disparities between populations with regard to medical care delivered and outcomes produced. Most of the studies have a hard time explaining why those disparities exist. The suggestion that doctors treat people differently based on ethnicity, sex, or race makes us uncomfortable and doesn’t jibe with what we all like to think we do. Most studies suggest that delivery system biases are not the most important cause of the disparities but rather the potent forces of environment, income, and life circumstances. The studies confirm that it is a lot harder to live a long, healthy life growing up in north Minneapolis or even rural Minnesota than it is in Edina or Rochester.
This reality makes our job harder. To effectively treat a community of people takes more than doling out the appropriate medication to individuals for a given disease; it takes treating the social ills of that community. Improving education and erasing poverty are big-time therapy for big-time diseases.
Most doctors know that not all Andersons are the same. From their first-year lessons about anatomical variation to their clinical realization that different drugs affect patients differently, physicians have learned that medicine is a study of diversity. We need to adjust to the expanding breadth of that diversity and look past the patient’s name to examine the patient’s circumstances.
Charles R. Meyer, M.D., can be reached at firstname.lastname@example.org