Bienvenido, bienvenue, hello and welcome to the website, www.elementarymydearmd.com, and blog of the Elementary My Dear Humanities in Medicine Podcast Experience.

My name is Dr. Michelle K. Watson, my pronouns are she/her/hers/ela/ella/elle, and as your bold, unabashedly intrepid host, I am pleased to have you accompany me on this sublime audio journey where the belief is that equity in medicine can be both evolutionary and revolutionary.

Our mission in healthcare is to include and stay divine, every single time. 

I am thrilled to have you accompany me on this journey to educate, investigate, evaluate, and create an open think tank for solutions necessary for achieving healthcare equity for BIPOC populations around the world.

In the April 1, 2022

Bulletin of the American College of Surgeons

The article,

Overcoming Disparities in Surgical Care among Native Americans

by THOMAS L. SUTTON, MD, CLAYMORE KILLS-FIRST, PHARMD AND BRETT C. SHEPPARD, MD, FACS

ACS recognizes that Native Americans and Alaskan Natives are the original inhabitants of the Americas, and that European colonization, as well as legislative and military action by emerging American nations, resulted in the decimation, displacement, and marginalization of hundreds of unique tribes over the course of centuries. 

Consequently, Native Americans now are a marginalized group, not just in society, but in healthcare as well. 

As with all specialized services, healthcare or otherwise, oncologic care is an area of significant disparities for Native American patients. 

This article highlights this problem and provides details on how Oregon Health & Science University (OHSU), Portland, has sought to address these inequities.

According to the First Nations Development Institute, 68% of Native Americans live on or near reservations or tribal lands, which are largely rural. 

The Indian Health Service or (IHS), a branch of the US Department of Health and Human Services, operates healthcare facilities near these regions. These institutions often suffer from inadequate staffing and funding. 

According to the National Congress of American Indians: 

The IHS was allocated $2,849 per capita for patient expenditures in 2013 versus $7,717 per patient for healthcare spending at the national level, and 

The IHS budget covers only 59% of the calculated cost per patient. 

Because of location and underfunding, IHS-operated centers are understaffed by 25% on average.

Furthermore, because of the relatively low cancer volume at these institutions, there is a lack of providers who are able to deliver cutting-edge treatments—such as those offered at the National Cancer Institute-designated Comprehensive Cancer Centers—to these populations.

When looking at population-level data, the lack of access to oncologic care translates to several disturbing findings:

Native American patients are more likely to present with higher-stage disease at diagnosis for the four most common cancers (lung, breast, prostate, colon) and 

Are significantly less likely to receive curative-intent resections for these malignancies than White individuals after accounting for relevant clinicopathologic differences.

In addition, Native Americans with breast and colon cancer are far less likely than their White counterparts to receive adjuvant therapy. 

Moreover, the adequacy of postoperative surveillance in Native American patients with resected prostate and breast cancer is suboptimal compared with White patients.

I have constantly alluded to these issues in several episodes previously.

In the Humanities in Medicine Podcast Experience Episode 1: Pesticides in Parturition:

Racial and ethnic minorities are less likely to receive even the most routine medical procedures and intensive care than are white Americans.

This has been well documented with examples, including differences in pain management and treatment of BIPOC patients when compared to whites experiencing the same health conditions, 

Minority patients are less likely to receive the appropriate cancer diagnostic tests, treatments, and analgesics.

African Americans, AAPI, Native American, Arab American, and Latinx patients are less likely to receive appropriate cardiac medications, or to undergo coronary artery bypass surgery, or CABG.

Inadequately treated and managed diabetes mellitus in minorities can result in more expensive complications, such as end stage renal disease requiring dialysis or kidney transplantation. Even when this is the case, these patients are still less likely to receive peritoneal dialysis and kidney transplantation.

The use of African Americans’ and Native American’s bodies in unauthorized, unconsented medical experimentation, and 

Racial bias in health algorithms for the purpose of guiding health decisions and assessing health care costs.

Actions like these have led to a general mistrust of the healthcare system within the BIPOC community. 

It is clear from the available data that health systemwide efforts to improve access to care are important; however, trust is an important factor in ensuring that Native American patients will use available care at rates similar to other racial and ethnic groups. 

Unfortunately, in many tribes, historical trauma from colonization, genocide, displacement, and mistreatment by medical providers remains a shared memory.

A study showed that Native American race was predictive of higher mistrust and lower satisfaction scores for cancer care. Native American patients more often and more strongly agreed that “in the past, clinics and hospitals have done harmful things to patients without their knowledge.” 

Furthermore, more Native American patients “worry that doctors and nurses will do experimental studies…without telling or asking,” and reported delaying “medical care in the past” out of fear of being treated disrespectfully. 

Trust must be rebuilt in order to broadly address outcome disparities in cancer and surgical care, as must the infrastructure that would allow Native Americans to access high-quality cancer care.

An IHS allocation of $2,849 for Native Americans versus $7,717 per patient for healthcare spending at the national level, and 

The IHS budget covering only 59% versus what is spent per patient at the national level,

And underfunding and understaffing by 25% on average of IHS-operated centers,

Is verifiably unjust, inequitable, and unacceptable treatment of the most American of all Americans. To continue to do so is morally deficient and spiritually bankrupt.

Inclusion is An Important Part of the Solution:

A critical step in improving trust in the US medical system and reducing disparities in cancer and surgical care is the recruitment of Native American individuals in medicine. More representation in the medical specialties would improve advocacy for the structural changes necessary to improve the healthcare of Native American patients.

Unfortunately, Native Americans compose only a small portion of active physicians in the US.

Based on the most recent data, only 2,570 or (0.3%) physicians in clinical practice identify as Native American out of a total of 918,547 in the US.

A similar underrepresentation is noted among academic surgeons: 

A 2020 study identified 23 Native Americans (17 male and six female) among 14,340 academic surgery faculty (0.16%).

Furthermore, recent trends in Native American matriculation rates to medical schools show a decrease from 0.39% in 2007 to 0.2% in 2018. 

Although there has been recognition of the need to improve diversity in medicine, these numbers are troubling and underscore the lack of focused attention on recruiting and retaining Native American physicians.

The Northwest Native American Center of Excellence at OHSU is an example of a successful program designed to increase Native American matriculation rates to medical schools. The Wy’east Post-Baccalaureate Pathway for Native American applicants is for those who have unsuccessfully applied to medical school, have Medical College Admission Test scores that fall short of minimum requirements, or lack other clinical experience.

Upon successful completion of the intensive 10-month program, students are granted conditional acceptance to one of three participating medical schools.

The Wy’east program is unique and specifically focused on Native American students. Led by Native American faculty, Wy’east places a priority on cultural activities and knowledge and fosters a learning environment focused on the unique needs of Native American students. This cultural focus culminates in a blanket honoring ceremony upon successful completion of the program, which is a significant cultural milestone.

The Wy’east program serves as a model for successful strategic recruitment intended to increase the number of Native American physicians in the US. Based on the success of the Wy’east program for medical students, OHSU is considering expansion into other healthcare schools at the university. These efforts are reproducible at other institutions and are key to improving Native American trust in the US medical system as well as improving disparities in cancer and surgical care for Native American patients.

Great job-Northwest Native American Center of Excellence at OHSU!

All Humanities in Medicine Podcast Experience blog articles and podcast episodes illustrate the significance and virtues of the diversity, equity, and inclusion (DEI) concepts of cultural competence and cultural humility with an extensive healthcare literature review, and touches of world culture, humor and musicality.

All ages, gender identities, races, nationalities, creeds, religions, and ethnicities worldwide are welcome to enjoy an audio escapist edutainment moment with me, Dr. Watson, the podcast creator, producer, and host.

Join me, Dr. Watson, your Chief Diversity Guru, producer, and host, on this groundbreaking audio revolution for a new episode every month on all major podcast hosting platforms.

To learn more about diversity, equity, and inclusion done the EMD Executive way, head on over to the links listed in the description area. Be certain to visit my website and landing page and sign up for exclusive content, DEI healthcare news, and a most wicked plethora of edutainment delectables to titillate your fancy.

To learn more about my experiences in diversity, equity, and inclusion as a physician, purchase my book, The Women of Purpose Anthology, a collection of inspiring stories from empowered women from all walks of life from the EMD Executive Equity online store on this website.

Informed, culturally relevant content.

Custom-created and curated for an informed listener base.

For a more informed future.

Elementary my dear listeners.

I am Dr. Michelle K. Watson, innovator, producer, host, and creator of the Elementary My Dear Humanities in Medicine Podcast Experience. Join me on this audio revolution for a new episode every month on all major podcast hosting platforms. 

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I thank you for allowing me to be of service to you.

This is Dr. Michelle K. Watson, signing off, wishing all of you a safe and equitable life journey.

Until we meet again, for the next episode in this revolution.

Evolve safely. 

Be the change you want to see in the world.

Namaste.