There are therapeutic implications of working collaboratively in the doctor-patient relationship, where understanding the separation in priorities and seeking the shared middle ground can generate better health outcomes.
This blog, at first, may seem contradictory to the Edge Effect, because it discusses the importance of people with shared identities achieving more success in health. However, this discussion is more focussed on particular areas of social need, where a pragmatic and refined approach adds an important counterpoint to the Edge Effect.
In New Zealand, there is a significant gap in health status between Maori and non-Maori, particularly so for men. Statistics show the average life-expectancy for Maori men is 73, seven years less than non-Maori men. Maori men have a 50% higher rate of cardiovascular deaths (strokes and heart attacks) than their non-Maori male countrymen. Health services are poorly accessed and utilized by Maori, and therefore, preventable disease interventions such as blood pressure, cholesterol and diabetes screening have poor uptake.
A recent study by Owen Garrick and his colleagues in the US confirmed that black doctors were more effective at engaging black men in preventative health services than non-black doctors. Their research reported a potential reduction in the black-white male gap in cardiovascular mortality by almost 20%. They found there was a 72% difference in the ability of a black doctor to convince their black patient to have cholesterol screening, compared to a non-black doctor.
So what was the difference? It was not in perceptions of prejudice, as the study identified that patients rated all doctors as equally good. Rather, it was in the connections made between doctor and patient, particularly the non-medical issues, whether family events, sports, arts, politics, religion, or life in general.
The implications of this are challenging and potentially uncomfortable, because they raise questions about how we structure society, health care, and our biases. The most relevant message is that engaging with patients in a genuine and meaningful way is a critical part of the doctor-patient interaction, particularly where there is a degree of diversity between the two people. I have reported on an aspect of this from a project conducted in my own practice. More than this, though, is the importance of providing choice to patients in their health provider, especially for those vulnerable patients for whom the health system is daunting and less accessible.
2016 was the first year that the number of Maori graduates from NZ medical schools matched the proportion of Maori in the NZ population, 15.7%. Of course, that is not the answer, but certainly it is part of the solution. Some would argue, on the strength of the evidence, that demographic matching of patients to doctors should be promoted. Others call this segregation. However, a pragmatic review of the poor health statistics should motivate a careful review of how we deliver health care, where it could be done better, and how this can be achieved.
And the starting point for us doctors is to take time and emotional intelligence to make meaningful connections with our patients. Have a look at dr.corin.nz for more on this.