More Than Skin Deep: Building a Workforce Patients Can Trust

Her experience reflects a broader reality in medicine. Race is a social construct, but its consequences shape who receives access to care and fair treatment. We often treat race as a “risk factor” for disease. In truth, race reflects the societal factors our patients navigate every day, including the effects of racism itself. Beyond tracheostomy placement, otolaryngology patients face racial disparities in head and neck cancer morbidity and mortality, referral and access to hearing surgery, differential exposure to infectious etiologies such as pharyngitis, sinusitis, or otitis media, and inferior treatment of sleep apnea, among many others (Curr Otorhinolaryngol Rep. doi:10.1007/ s40136-023-00459-0). But statistics on racial disparities in our system feel different when you stand at the bedside of someone who has suffered the consequences of that system.

This patient experience reinforced not only the need for diversity in our field but also the importance of specific training for our workforce that empowers us to address healthcare disparities and combat racism in medicine. In medical school, I realized how little of this history we were explicitly taught, and how much of it I had to seek on my own. My curriculum was missing the critical context of racial health inequities, including the history of how our medical system has been built on various racist research practices and other biased and misinformed principles. Together with my colleagues, we worked to change our medical school curriculum so that every student would have this necessary education (Acad Med. doi:10.1097/ ACM.0000000000004531).

Now that I am an otolaryngologist in training, I see this need within our field. Otolaryngology still has progress to make in closing the gap in the recruitment of trainees who are underrepresented in medicine so that our workforce reflects the diverse backgrounds of the patients we serve. Once we achieve a representative workforce, from the trainee to leadership level, conversations like the ones we had with my patient may naturally be easier. Equity in recruitment and promotion is only part of the solution, however. The root causes of healthcare disparities in our field are multifactorial, and as physicians, we often feel like we have little control outside of advocacy to address the larger socioeconomic factors that perpetuate these disparities. Yet we do play an individual role in the everyday care we provide to our patients.

There is an opportunity for each of us, regardless of race or skin color, to communicate more effectively and more fully address the needs of our patients from diverse backgrounds. I have learned how much it matters to understand the harm a patient has lived through, the biases we all carry, and the history that shapes even a simple conversation. That moment with my patient reminds me that while our training teaches us how to diagnose and treat disease, it rarely teaches us how those systems shape our patients’ lives. We must pay attention to the larger story in the room, know the history that brought us to this moment, and truly listen— beyond the words a patient speaks. These are interpersonal, structural, and equity-focused competencies that can, and should, be taught. The more intention we bring to this, the more we dissolve the barriers that separate the patient from the physician.