More Than Skin Deep: Building a Workforce Patients Can Trust

Topics such as racism in medicine, healthcare disparities, and structural determinants of health are critical to integrate into resident training and continuing medical education efforts for established otolaryngologists. In fact, there has been a call to action in this regard at the graduate medical education level. The strategies identified for improvement of our systems include incorporating inclusive pedagogy and structural competency into education, building a diverse and inclusive learning environment, and increasing community engagement (Acad Med. doi:10.1097/ACM.0000000000004664). Our charge is clear, yet we are currently failing to meet it. A minority of otolaryngology residency programs have quality curricula on health disparities, with the described barriers to development being insufficient time, limited perceived ability, and faculty disinterest (OTO Open. doi:10.1002/ oto2.148).

We have a duty to meet the needs of our patients, and the solutions to the healthcare disparities they face should be both varied and nuanced. The first step in addressing these issues is to recognize them, and then we can begin to rectify them with the individual patients we sit across from in our clinics, emergency departments, and hospitals. With the proper training, we can do more to rise to the call to action and move the needle forward, patient by patient.

My patient was willing to die over her mistrust of our medical system, and she was a living example of how the disparities we discuss affect the real patients we care for. I learned that knowledge and skill are only a part of the essential training I need. My experience, history, and identity are things I carry with me, too, and things I should bring into the care of my patients. Sometimes, those things are what a patient needs from their physician the most.

I am humbled that my patient placed her trust in me when she had every reason not to. That trust may have saved her life that day, but it also left me with a responsibility I am still learning how to honor. It is my reminder of the work that remains, both for me and for the future of our field.

Ajay S. Nathan, MD, MS, is an otolaryngology– head and neck surgery resident at the University of Connecticut in Storrs Mansfield, Conn. His interests include health equity, medical education, and patient-centered communication in surgical care.