By SUSAN ADELMAN, MD
When I was a surgery resident at Henry Ford Hospital, we greeted each patient on morning rounds in the same way. Good morning, Mr. Jones. Good morning, Mrs. Smith. How are you today? Or something like that. At least it was courteous and respectful. It did not matter if Mr. Jones was black or white, poor or rich. On our rounds, and in discussion of patients, staff doctors modeled color-blind treatment of their patients when they trained the residents. They even would call a child Mr. Jones, out of habit, then laugh, realizing it sounded silly. And Diversity, Equity, Inclusion training (DEI) had not been invented yet.
We learned at the bedside exactly what our parents had taught us. “Do unto others as you would have them do unto you.” This comes from the Bible: the Golden Rule.
We knew that some medical conditions were commoner in certain ethnic groups. That is part of medicine. Children have children’s diseases. Older people have geriatric conditions. Those with some black heritage have a higher risk of sickle cell anemia, thalassemia, or prostate cancer. The government Office of Minority Health elaborates that they also are more prone to “heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS.” I do not know. I am a pediatric surgeon. According to other authorities, Caucasians are more prone to die of cardiovascular disease and cancer. Huh? Anyhow, the point is that both groups have their own medical issues. When I was a resident, we did not know yet about the increased risk of certain cancers in Ashkenazi Jews with the BRCA gene, but we would learn soon. So we knew there were differences, but those were medical differences, not social ones.
Now, in a world in which the volume of medical knowledge is exploding, are our medical school colleagues using valuable curriculum time and resources teaching DEI? Is it true? Is it beneficial?
The American Association of Medical Colleges (AAMC) has released several strategic plans. One is designed to “increase significantly the number of diverse medical school applicants and matriculants,” one to “equip medical schools and teaching hospitals and health systems to become more inclusive, equitable organizations,” another to provide a “framework for addressing and eliminating racism at the AAMC and beyond.” Sounds good, but are we comfortable that students who are admitted with relaxed standards for the sake of diversity will graduate as self-confident physicians and that their work will inspire confidence in both colleagues and patients?
The AAMC has a publication titled “Race-Conscious Admissions in Medical Education.” In it we read that “The AAMC works to advance diversity, equity, and inclusion (DEI) principles across the continuum of medical education. As part of this effort, the AAMC… identifies several pillars to guide the actions of individuals, organizations, and communities. The tools, data, and publications listed below offer a view of the current DEI work in medical education being led by the AAMC and are organized according to this anti-racism framework.” The AAMC clearly is taking the matter seriously, but what does it all mean?
According to the AAMC, at present “100% of participating medical schools have admissions policies that support a diverse class of students,” “97% of participating medical schools have senior leaders who show commitment to DEI,” “94% of participating medical schools provide equitable access to employee benefits,” “91.1% provide flexible parental/family leave with equal accommodation regardless of gender or sexual orientation” and “85.1% have inclusive and equitable paid leave for medical or other family caregiving responsibilities.” “
[Eighty-nine percent] of participating medical schools report that DEI is prioritized in their school’s mission, vision, or values statement.” All this may be good, though DEI is not explained clearly, jumbling together gender, sexual orientation and race.
How much does all this cost? “Florida Gov. Ron DeSantis released survey results showing DEI program costs ranged from $8,400 to $8.7 million at public colleges and universities in Florida…[and] public universities in Mississippi budgeted at least $23.44 million on DEI programs from July 2019 to May 2023.” Other sources quote an average of $3.3 million to run a medical school DEI program.
Do these programs teach White students that they are oppressors and Black students that they are the oppressed, in other words victims? That surely must cause resentment and bitterness on the part of both groups and cannot contribute to a harmonious learning or practice environment. Do they teach future doctors about the specific medical conditions that affect certain ethnic groups? Excellent. But I bet they do not. You do not need to pay compliance officers six figures a year just to teach that.
To teach the Golden Rule, you simply need compassionate, sensitive doctors who will mold young students into caring and skilled physicians trained to treat all their patients to the best of their ability.