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Family physician Pamela Buchanan discusses her article, “Why diversity in medicine saves lives.” Pamela shares powerful stories from her career, like adjusting a biracial child’s treatment for a scalp infection and saving a Black woman with sickle cell disease from misdiagnosis, to illustrate how diversity enhances patient care. She addresses systemic biases—such as the undertreatment of Black women’s pain and misdiagnosis of women’s heart attack symptoms—and backs her insights with research showing better outcomes with diverse physicians. Pamela urges health care professionals to embrace cultural competence and collaboration, offering a clear takeaway: Diverse perspectives in medicine are essential for reducing disparities and saving lives.
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Transcript
Kevin Pho: I’d welcome you to the show. Subscribe at KevinMD.com/podcast today. We welcome back Pamela Buchanan. She’s a family physician, and today’s KevinMD article is “Why diversity in medicine saves lives.” Pamela, welcome to the show.
Pamela Buchanan: Thank you, Kevin. Thanks for having me.
Kevin Pho: All right. Tell us what this article is about.
Pamela Buchanan: Well, with this article, I’m a diverse individual. I’m an African American female physician. And there are just some times when familiarity and cultural awareness matter in medicine. And 20 years. I can give examples. Like, one in particular sticks out to me. I work in a predominantly white, rural area, and we were seeing an African American female who was having some hair loss. She was a little kid, and she also had what I recognized was a ringworm and a carrion.
And my colleague was thinking about using a therapy that I knew wouldn’t work. We have to do oral. Most of us should know that. I know that acutely because of where I trained, which was predominantly African American, and from having experienced that in my family and myself and how traumatic it is, you know, for a female to lose hair. So those types of things. Also, in OB-GYN practices, I’m a female OB-GYN, and it’s been a game-changer in the difference because I feel more open with her. It gave her all the details, and I think she’s better able to take care of my health. And so just a couple of instances like that, just where it matters now.
Kevin Pho: It goes without saying that currently in the political climate, diversity is under attack in all areas of life. So, how do you feel about that?
Pamela Buchanan: You know, when it comes to things that enrage you, that is one. I hate to hear that diversity is the scapegoat of the political climate because, in particular, there are recent posts by a news personality who said that when he sees a diverse or a Black—he says specifically a Black female surgeon—he assumes that they are underqualified and may have gotten their place by DEI practices, which, you and I both know from being doctors, is ridiculous because when you become a doctor, there’s a litany of tests you have to pass from the MCAT to the boards.
And those tests have nothing to do with race. We have to all pass them before we’re qualified and board certified, and so no one gets to do this job without being qualified.
Kevin Pho: Now, throughout your medical journey and your medical career, what are some of the things that you’ve done to focus on diversity’s impact in your practice and what you see every day in medicine?
Pamela Buchanan: Well, it’s been documented that specifically Black males who have a Black physician tend to have better health care. And that’s because there’s a distrust factor in particular in the African American community. We can trace this all the way back to the Tuskegee Airmen Experiment and other instances of racism in medicine.
And so, with that being the case, many people in my culture, African American, do not trust doctors. They believe that doctors are in it for profit or they’re experimenting on them. So I’ve been able to make inroads with the community because I’m part of the community, and thereby, hey, you know, help them with things that we have put to the wayside, not coming to the doctor.
Screening is important. And I post about that on my socials because I want to make sure that, in particular, people of color know that it’s important to prevent health issues when we can. Early detection matters because we’re getting to a climate where I feel like there’s going to be the haves and have-nots. If you can’t afford, we can’t afford to get sick. If you don’t have adequate health care, you’re not going to be able to get the most appropriate treatment. And so, our country does not focus on prevention, and we need to start focusing on prevention. So, in particular, I get the privilege and the joy of speaking to African Americans about their health because they trust me.
Kevin Pho: And you mentioned in your article that when it comes to undertreatment of pain, Black patients often feel a disproportionate undertreatment for pain. There are studies backing that up.
Pamela Buchanan: There are. You know, that happens in Black people and happens in women—the pain is not believed. And I’ve seen it firsthand in my practice in the emergency room. A year ago, we had a patient who came in, and she had sickle cell crisis. Immediately, nurses and colleagues said, “Oh, she’s seeking.” And I looked through her history, and she had sickle cell. And I said, “But what if she’s not? We have to just believe them. I know there’s a big opioid problem, but we have to believe patients first,” and try to use our discernment, but really. So I treated her appropriately, and she did have acute chest syndrome.
And, you know, she wasn’t believed, I believe, because she’s Black, and we’re in a predominantly white area, and that’s unfortunate.
Kevin Pho: Now, you also mentioned about the role of implicit biases. So can you tell us some stories about some of the implicit biases that you faced either in training or in practicing medicine?
Pamela Buchanan: Yes. You know, it goes without saying we’re all human. We all have implicit biases. There’s no way around that. But recognizing it and trying to be cognizant of it is what we all can do. I have my implicit biases because it comes from how you grew up. And so in my practice, again, in that case with the sickle cell patient, implicit biases—assuming that many of the people who come into our ER who don’t look like the other people, which are usually Blacks, get treated as if drug seekers or, you know, not a real problem.
Assuming that, oh, they’re just here for a work note, but what if they’re not? And I can tell you, I try not to make those assumptions about anybody. And even when there’s such pressure from the nurses, just hurry up and get him out of here because he’s not real. I worked up this patient, and guess what? He had a perforated ulcer.
So he was not faking. I went through the tests, and I got moans and groans: “Why are you going to all this work?” Because I feel like something’s wrong, and I need to believe him. He was unkempt, he was an African American, and he was out of place because he’s the only Black person in that ER that day.
Kevin Pho: Now, what do you do to push back against these implicit biases? Like, in that example that you just shared, there was a lot of dismissal perhaps because of that patient’s race, and you went and did a full workup and obviously found real pathology. Now, do you do anything to push back against these implicit biases and maybe use this as a teaching moment?
Pamela Buchanan: I love that question ’cause I always do, and I think my colleagues like that I do. And when I do, like that particular case is still fresh in my mind. I go, “Now, here’s a good example of why we don’t judge a book by its cover. Here’s a good example of why we take each patient each day with each complaint as if it were noon, and they were real. And here’s an instance of why we treat each of our patients like our brother, mother, sister, and we just take care of them and we believe them at face value.”
I know there are some people who work in ER, and we have them—repeat offenders. We have people who come into the ER all the time and abuse our services. But even still, like they say, a broken clock is wrong twice each day, and even people who cry wolf all the time—eventually there’s going to be a real problem.
And so I try to face each patient, each visit, as if it were real. And it’s hard to do because I can say that I can have my biases and believe that they’re full of it, all while doing the appropriate workup. And sometimes, when I feel that bias come on, I will talk to my colleagues, the nurses, and another doctor if he or she is around, and say, “This is the problem. I’m blinded by this because I have some feelings. Is this workup appropriate for what this problem is?” I just did that yesterday. Because there is one I have a particular bias from because he comes in all the time and cries, and cries more. But guess what? Yesterday he had a problem that wasn’t real.
Kevin Pho: Now, how do those conversations in general go? Are they uncomfortable in any way?
Pamela Buchanan: They’re actually not uncomfortable because of my personality type. I infuse humor into things. I say it in a relaxed… I was like, “I know this guy comes in all the time. I know, I know. And I know that he’s oftentimes full of it, but let’s just pretend for one minute that he’s not and that he were, let’s say, your brother.”
I bounced it off a nurse. He says he has abdominal pain, it’s been going on for this amount of time. The differential is this. OK. I’m ordering—and I was like, I’m ordering a CBC, a CMP, and I’m going to give him some fluids and get a CAT scan. Anything else you think I should do? And she said, “Yeah, get a lipase.”
And, yeah, pancreatitis.
Kevin Pho: Now, you mentioned that you’re one of the few Black physicians in your area, and in the medical institutions in your area. So, have you been on the receiving end of any—
Pamela Buchanan: Yes. So, in particular, there are patients who say they don’t want to see a Black doctor. And I run into that more often than not, over the last five years, it’s intensified. So we’ll have that issue.
Kevin Pho: And what do you do when that happens?
Pamela Buchanan: Well, you’re graceful when you say, “That is your choice,” and we have to respect it. In terms of how I feel, I’ve learned to not take it personally. I think that person is flawed, and I take it as a time to educate them, and sometimes they have such a severe problem that I’m their only choice. I’ve been someone’s only choice when they were having an emergency, and they didn’t care to see a Black doctor, and they had to. And at the end, they told me they thought it was a compliment, but it was a backhanded compliment, where they said that they didn’t think I would know what I was doing, but I was “right smart for a Black doctor.”
So, you know, it’s uncomfortable and it’s unfortunate, but I use it as a time to be excellent. Each time I come in contact with patients who don’t know people like me and who have their biases, I show up as my most excellent self.
Kevin Pho: So I want to get back to the current political climate where diversity is now a politically charged word, right? So how can we emphasize the importance of diversity, specifically in medicine, in the current political climate that clamps down against it? What are some things that physicians can do?
Pamela Buchanan: Oh, well, listen, we all come from various backgrounds and various cultures, and there are different things that happen in all these cultures. We’re in a melting pot. People from different backgrounds, races, religions, races will understand more than you in your narrow worldview. And when we come together and we collaborate—when I have a colleague who is, say, from a Muslim culture, who can explain things about Ramadan to me, then I can better talk to this patient about how to take his medication. It’s not an empty stomach—things that I don’t understand. And when patients have such a bias and a fear of the doctor, particularly I’m thinking about African American patients, especially if they’re older. My colleagues don’t understand, but I completely understand. I understand. I grew up in this culture where it was talked about how we don’t trust doctors unless they’re Black because the white doctors are out to get us.
Now, in this politically charged climate, you know, we talk about DEI as if the people who benefit from it—affirmative action, which is now being called diversity, equity, inclusion—are somehow substandard in medicine. It’s just not possible. You and I know that the rigor of the testing and the way that we have to get through accounts for that. There are safeguards. And also, when you have people of diverse backgrounds, then medicine flourishes. For instance, we know that female physicians, who inherently have more words, which leads to better communication, have better outcomes with elderly patients because it requires an extensive amount of patience. Just by how gender is treated in this culture, women tend to be better listeners. I know that offends some, but it’s just factual, and there are studies in JAMA to support that. And it’s unfortunate that this climate, politically, is used as a scapegoat.
But when you see a person who you think is a DEI hire, know this: They have probably worked twice as hard to get half as far, and they are probably more capable than your worldview because they have that knowledge. I know I have that knowledge that people think that I’m substandard. So I go to conferences more. I study more. I do more CME than my colleagues do. I know different techniques. I had an instance at work a few weeks ago where a colleague came after me, and a patient was dying. I did multiple procedures on her and things that he didn’t understand. I had to stay two hours explaining to him some techniques that I had done. And then he wasn’t one who liked to use the ultrasound. She needed a central line. I had to stay and do that for him as well.
And then all the while, I’m leaving thinking, and I’m viewed as the DEI hire.
Kevin Pho: We’re talking to Pamela Buchanan. Her KevinMD article is “Why diversity in medicine saves lives.” Pamela, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Pamela Buchanan: I’ll say that any time you see a diverse person in medicine, know that they are more than likely overqualified and more capable of taking care of you than any biases you have. And any of us who have implicit biases—we all do—let’s recognize that. Let’s be cognizant of it, and let’s do our very best for each person the same each time. And you can reach me at Dr. Be Strong or text STRONG to 55444.
Kevin Pho: Pamela, as always, thank you so much for sharing your story, time, and insight, and thanks again for coming back on the show.
Pamela Buchanan: Thank you again. I appreciate you.
