The Secret to Keeping Black Men Healthy? Maybe Black Doctors

I had a brother with serious health issues and also some obvious developmental limits. Half his doctors treated him without noticing HIM. The others - one black, one Pakistan born, one woman PA - did see him as the individual he was. They could tease, cajole, "threaten"(humorously) and nudge him to do what needed doing. They could read him. Given America's level upon level of racial history, misinformation and tension, it isn't a surprise that in a study like this, measuring many doctors and many patients, we see that Black men are most compliant with Black doctors. Who else would Black men be expected to trust when they cannot walk on public streets, shop in public stores, swim in public pools without being assumed to be criminals by at least some non-blacks? We all want to be seen for who we are not who someone else thinks we are.

Not a word in this article about the role of health education in keeping men healthy. It's easy to tell someone to have a test and have them agree to it. How about educating them about the role of diet and other modifiable factors in determining health? I believe such education would have more of an impact--whatever the race of the source--than a doctor telling you to have a diagnostic test.

I mean, as a gay man, it’s nice to run into a gay doctor—and because of our shared identities, I may even be more inclined to trust them and follow their advice. However, in a multicultural America, there’s no place for such tribalism. Despite the fact that gay people have been institutionally and individually persecuted in the past and today, we have to learn to trust and be treated by straight doctors. Same can be said of black patients—and for any patient.

I'm amazed that in this article and in none of the comments is the most surprising, yet obvious factor, based on America's long history of institutional racism. I'm a White man, and I've been treated by doctors of every race since I was a child. Growing up, 2 doctors in my home town covered each other's patients when either was unavailable. One was the only Black doctor, the other was White. While our doctor was the White one, the Black doctor took care of us frequently. I remember him playing chess with my brother when he was recuperating in the hospital. He was kind, competent, capable, and beloved, with many families, both Black and White, in his practice. Over the years, I've had good and bad experiences with all kinds of doctors, but not once a bad one with a Black doctor, male or female. My wife, who distrusts ALL doctors intensely, only completely trusted one doctor, a Black man, because he spotted just one tiny thing when she moved and wouldn't let her go until she admitted to what was going on, and then he treated her for it. He never once told her "it's all in your head". We were one of the few White couples in his practice, and he was as perfect a GP as we've ever had. This lead me to the conclusion that Black men and women who want to be doctors have to face far more hurdles and barriers to conquer, and therefore have to be twice as good to get half as far in our STILL racist America.

The key here is that patients will be more likely to follow their doctor’s advice if they have confidence in them. Following that advice leads to better outcomes. Given that we hardly live in a post racial, post religious or post sexual culture, patients should be afforded the option of being treated by a physician with whom they identify the most. That means accepting a wider variety of applicants to medical school and residency programs. Regardless of your political persuasion, it will save both lives and money.

The secret to keeping black men healthy? Oh, I don't know. Maybe a healthy diet? This is not a very hard question for even the moderately informed. The really--really--surprising thing about healthy diets is that they keep white men healthy, too. Who could have predicted this? The color of your doctor's skin? Not too important, especially if your doctor (regardless of skin color) is not informing you that you don't need pills and procedures, you just need a whole foods, plant based diet. (I can hear the pharmaceutical reps, stent manufacturers, hospital CEOs and insurance company potentates gnashing their teeth in the distance.)

With so few black, male doctors in our country, this study seems aspirational at best. How to get ALL doctors to connect with black men patients might be more helpful. Sometimes the NYT seems to have an 'Alice in Wonderland' kind of take on the world that is not truly helpful to people in need.

NYTimes failed to mention that : "Although our recruitment efforts were focused on African-American men, 12 clients identified as from another racial or ethnic background. Among this out-of-sample group, individuals were 14 percentage points less likely to choose services in the ex post stage when randomized to black doctors (a finding that is more extreme than 93% of bootstrapped coefficients on draws of 12 in-sample subjects)." (page 4 of the study) So the study also found that black doctors, in addition to increasing health service utilization among black patients, also cause a larger decrease in health service utilization among non-black patients. NYTimes, hiding this narratively inconvenient piece of evidence from your readers is a clear breach of journalistic ethics.

“It doesn’t seem so controversial if a woman requests a woman physician,” he said. “If a black patient asks for a black doctor, it’s understandable, especially given this study. But what if a white patient asks for a white doctor?” We are willing to acknowledge that tribalism and group affinity play a role in the political process. It is not surprising that it also plays a role in interactions between patients and their doctors. What I do have to wonder about though is whether there was a significant difference between how black male patients perceived black female physicians relative to their male counterparts. If there was a significant difference, why omit this from the article, Gina Kolata?

The same could be said for women as well.

This is an important study...but at some point the patient needs to take ownership of his health outcomes. The keys to good health have not changed and are not expensive: eat right, excercise 30 minitues a day, Drink in moderation, Avoid recreational drugs, wear a condom, don't get involved with the wrong crowd and get regular physicals. It is up to black men....and I am one...to take care of ourselves and stop blaming others.

As interesting as this research is, how would many of the commenters hear react if research indicated white patients do better with white doctors? Jewish patients do better with Jewish patients? I am guessing there would be totally different reactions to the studies outcomes.

I teach pharmacology at Harvard Extension School. There’s a great joke going around. An elderly Jewish man had been treated all his life at Beth Israel Hospital in Boston (the old Jewish hospital, now Beth Israel Deaconess, part of the Harvard hospital system). However, he now had something seriously wrong with him and was taken to Mass General for special treatment. A social worker looked in on him to see if all was going well. “How do you like Mass General?” she asked. ‘Can’t complain” answered the patient. “Is your room okay?” “Can’t complain.” “Is the food okay?” “Can’t complain.” “Is the staff okay?” “Can’t complain.” “Is there anything that you liked better at Beth Israel?” the social worker finally asked. “There I could complain” answered the patient. I guess everyone feels more comfortable with people they feel are like themselves.

My initial takeaway from this article is the very low number of comments. Is it an indication that the NYT audience is uninterested in the healthcare of black men? I appreciate the writer's intent to open up the discussion. I imagine everyone feels more comfortable and is more responsive to a doctor who is the same ethnicity as themselves and speaks the same language even...

So...can I then assume that as a white woman and a senior, I should stick to white, female physicians of around my age, and my husband should only see whit males for his medical needs? This is a racist theory and a racist conclusion. A step too far.

If this was about white men being more likely to accept recommendations from white doctors, it would simply be reported as 'white men show significant racial bias towards black doctors'. Or put simply: racism. This is no different, just with reversed roles. I'm not even judging, trusting those who look like us, while being wary towards those who are different, was hard-coded into us over millenia of evolution. But the double standard in reporting is sickening.

"Why would black doctors have such an effect? Perhaps they used more nonverbal cues to communicate empathy, said Dr. Amber E. Barnato, a professor of medicine and health care delivery at Dartmouth College." I suspect that this might be more important than the color of the doctor's skin. White and asian professionals people talk to black people (especially poorer blacks) differently than black professionals do. Every patient-doctor relationship (regardless of race) is built on trust. Up front, black men trust other black men more, but white and asian physicians can win black trust, if they make an effort to demonstrate that they care about the patient. The truth in 2018 is that black people are accustomed to being treated dismissively (or worse) by white and Asian professionals, so they are more suspicious. That said, when white or Asian professionals demonstrate genuine empathy and concern, black people are often so surprised, that they become much less suspicious. I don't think this study should necessarily persuade us to educate and train more black (male) doctors, although that might have other benefits. I do think this study should lead us to train all doctors to do their job better. To satisfy the obligatory identity check, I'm a black male practicing doctor.

Imagine going to see a new doctor for an exam and during the examination hearing your new doctor ask you when you got the gunshot scar? Not, what was the cause of your scar! That doctor was white, I am black, the scar was from a biopsy for a thought to be a cancerous lesion. White assumption as fact causes more distrust of white doctors when one feels convicted without proof! Having had experiences with both black and white doctors I've consulted over the years, the Good ones put you at ease and do their learned physician detective work. AIDS among many black men in our community are still paranoid of taking the anti-viral medications such as ”PREP”, which prevents healthy blood cells from being infected by the HIV virus. As an activist, I still hear far too many of those young men say: ”I am afraid that the government (ie; white) are wanting to poison me. Illogical, yes, experiential history of white America = white doctor distrust. No one should poo poo that distrust illogical as it is, it is real for those folks of color who hold those views... and it is probably the same if one were to reverse the race situation. That some people still think of doctors as which doctors in 2018 is astounding to me. EDUCATION, EDUCATION, EDUCATION, all around.

When the Canadian public broadcaster reports: "A woman who demanded that a "white doctor" treat her son at a walk-in clinic in Mississauga was not just an isolated case, but part of a bigger problem, according to the president-elect of the Ontario Medical Association." It is clearly racist. But if we substitute a black patient demands to see a black doctor then it is good public health policy?

I suspect the black doctors in the study had a certain comfort level and ease of engagement with their black patients that the patients responded to. This is something that could certainly be emulated by white and Asian doctors who are made aware of the need to work a bit harder to engage patients who don't look like them. Also, black doctors are more aware of the historical (an often well founded because of things like the Tuskeegee Experiment) mistrust blacks have of the medical profession. For example, Dr. Jordan knew how to deftly handle the myth that the flu shot gives you the flu. The take away should be that black doctors may have something to teach their counterparts of other races.

Why weren't black women included in this study? Especially given all the recent evidence that women make better physicians, seems bizarre that black female doctors are invisible here.

This article is really well received. As a college educated black man, who works in corporate America, even the nicest white (male or female) doctors present a situation for me where I feel like I have to be on my best behavior. My life experiences have always had the backdrop where as a representative for my race, I have to only present my best when dealing with white colleagues, for fear of judgement or alienation. As a result, it is very difficult to be open about vulnerabilities (like my body!) with white doctors. It's certainly not these physicians fault, I've had many wonderful, caring, and professional doctors, but 'the effects of race' are way more evident than just racial incidents. Going to the doctor is a strong example of this. Thank you, Gina, for your thoughtful commentary.

I suspect you would get the same finding if the experiment were instead on how men respond to the race of the salesman when buying a suit.

This a great finding. One more factor to keep in mind: the medical establishment has had a very bad history with African Americans (e.g. Tuskegee syphilis experiments, etc.) so there is an inherent distrust of the black male population to an institution that has harmed them, or even dismissed them. So when presented with a member of their community, they can trust the recommendations more easily. Add to that, the black physician's notes show they speak in non-academic terms (e.g. "“needs food, shelter, clothing, job, ‘flu shot makes you sick,’") versus the other doctors using very impersonal terms, which might indicate how they interacted with their patient (e.g. no emotional connection, etc.)

Black males have a long history of being negatively targeted and abused. It's natural for black males to identify closer with someone who looks like them. The "preventive measures" used by the medical doctors in this study DON'T prevent anything. How many of us are born with high blood pressure, high cholesterol, diabetes and the flu? Most of us are not. Destructive medications for these preventable diseases bring pharmaceutical companies BILLIONS. Until medical doctors are properly taught the benefits of a plant-based diet and regular vigorous exercise, deaths from chronic disease will continue to rise for all ethnic groups.

Before I moved I had a black male doctor. He was a friendly gentleman who listened, never rushed, and seemed genuinely interested in my health. I'm white.

Seems to me, black, blue, green or purple, most patients will be "far more likely to agree to certain health tests if they discussed them with a" doctor with knowledge, compassion and is attentive to needs.

Before we revamp the whole medical school system, let's note that this study was based on a one-time, first-time interaction between a patient and his doctor. In a more realistic setting I would think the doctor (black, white, Asian, male, female, whatever) would be a bit more of an established figure in the patient's community. Maybe the patient comes in for periodic check-ups, maybe his friends and family do, and maybe trust develops over time. Continuity of care, familiarity with a clinic, even getting to know the receptionist - all might help a regular patient feel more comfortable and open to medical advice. Or maybe trust doesn't develop. But this study was not designed to examine that.

On the other side of the printed Times page on which this article appeared is the story about how patients do better with female doctors than male. The two stories together imply 1) stay away from white male doctors no matter your ethnicity or gender and 2) medical schools are not turning out culturally competent doctors but reinforcing established, traditional societal roles by ethnicity and gender in the medical students. So power relations of the larger society play out in the doctor's office.

I almost decided to reply and expand on Dr. Dixon's comment, but decided on my own. First, this is not difficult, yes, trauma, historical and present racism, economic disparities; how many social issues ring with truth for the conclusions of this research? But, does this article ring with amnesia also? We've not forgotten Tuskegee or the enslaved women who had experimental gynecological surgeries without anesthesia. And, this does not address the many times Black people have been condescended or treated less than in medical establishments. Too often, there are multiple issues to wade through in seeking and obtaining medical services for people of color. There is nothing new or unknown in this research for any casual observer of the American enterprise.

As a psychiatrist who happens to be a black male, everything in this article rings true. Black men have suffered (and continue to experience) collective trauma. Within the trauma model, you tend to gravitate towards those men whom you feel share your history. I had the pleasure of sitting on a Healthy City panel with Gina Kolata and I’m stoked that she wrote this article and shares groundbreaking experiences from our perspective.

Nobody would accept big changes in medical care because one study reports a specific result. And, we shouldn't do that here. One big possible issue for this study is the background of the 14 doctors involved. Dr ChaReandle (see photo) is clearly exceptional as a graduate of Stanford Medical School with many biological research papers to his credit. He is far from the typical doctor patients in almost any clinic are likely to encounter.

There are two ways to react to this (not terribly surprising) information: 1) Take it at face value and advocate for what I would argue amounts to segregated health care, or 2) Dive deeper and ask why this is the case. Focus on resolving the ROOT cause of this discomfort. I believe that whenever we find data like this, we push hard on #2 and reject #1 as the lazy, regressive approach that it is. Eliminating discrimination at large will eliminate issues like this. Let's focus on that instead of restructuring our health care system to accommodate prejudice.

This article doesn't address whether the findings from the study included black male patients' responses to doctors who were black WOMEN. It only discussed responses to black male doctors. Since more primary care residency slots are taken by women, than men, and there seem to be more women in general making up the freshman classes in medical schools, this might be an important distinction to make. This past week a NYT article reviewed findings of a study that showed how patients fare better when cared for by women doctors, rather than their male counterparts.