Ensuring equitable, quality treatment in Black and marginalized people [PODCAST]

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“For Black patients—or any member of any marginalized group—to ensure you receive equitable and equal treatment, it is important to advocate for yourself. Speak up, ask questions, and seek different opinions if you don’t feel like you are being heard. Keep asking for what you deserve, and do not allow your pain to be dismissed.”

Bayo Curry-Winchell is a family physician and can be reached on TikTok, Instagram, LinkedIn, and Twitter @DR_BCW.

She shares her story and discusses her KevinMD article, “Ensuring equitable, quality treatment of pain in Black and marginalized people.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show, we have Bayo Curry-Winchell. She’s a family and urgent care physician, and her KevinMD article is titled “Ensuring equitable, quality treatment of pain in Black and marginalized people.” Bayo, welcome to the show.

Bayo Curry-Winchell: Thank you, Kevin, for having me. I’m so excited to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are today.

Bayo Curry-Winchell: So when we talk about my story, it’s complex, but it’s so filled with so many different aspects that have led me to the journey and the opportunity of delivering health care in a nontraditional way. So I’m a family medicine and urgent care physician, as well as a medical director, but also a health advocate for marginalized communities, the underserved, and people of color. I love bringing forward health care in a nontraditional way.

And so that journey has led me to the opportunity to create my series, Beyond Clinical Walls, which happens to stand for my initials, Dr. Curry-Winchell, and it has brought me so much joy to be able to shake it up a little bit and bring health care forward in new and digestible ways for patients to really be informed and also have the opportunity to ask questions. And I think that is a part of my journey, and it’s who I am every day as a physician.

Kevin Pho: So when you say that you practice medicine in nontraditional ways to help people of color, Black and marginalized patients, how do you go about doing that?

Bayo Curry-Winchell: So the first thing that I do is I lean into the question of asking a question. And why I say that is, often we talk about meeting people where they are, or we talk about, you know, fear, anxiety, and mistrust within health care. And I think if you can ask people, “What are your concerns? What are your thoughts? Why do you have mistrust?” it opens up the opportunity to discuss and hear people and find out why they have mistrust, and that is a gift in itself.

And so that’s the way I deliver health care, by leaning into asking questions. And then the information that I receive, I put it forward in helping people based on what they have shared. And so I get to deliver health care, whether it’s in the clinic or through different mediums such as television and writing, and also by pushing forward the issue of race-based medical algorithms and their impact on lives every day. So that’s a way that I’ve been able to really deliver health care in a nontraditional way, and it’s brought me joy.

Kevin Pho: So you mentioned race-based clinical algorithms. Tell us what you mean by that and how that impacts patients.

Bayo Curry-Winchell: So, you know, as most of us learned in health care, certain diseases were associated with certain races. And I thought to myself, “Well, why is that the case?” Because when we look at race, we know it’s a social construct. So I never understood, as I went through medical school and residency, why we were associating someone’s race with disease. And so I found myself looking at algorithms such as the GFR and thinking to myself, “Why do we have a differentiator of Black versus non-Black?”

And then when I looked a little bit further, I saw that if you were considered Black, your kidneys were considered healthier than someone who was non-Black. And we learned, you know, anatomy, and I’m looking at it, and I know Black kidneys and white kidneys are the same.

And so when you look at how the GFR is impacting Black lives every day, just based on the color of our skin, and how it leads to patients not being able to get care sooner or be on the kidney transplant list, it really brings to light, when we talk about inequities and disparities, how Black patients are disproportionately impacted at a higher rate. When you look at an algorithm that is putting you at a disadvantage from the start, it really shines a light on why we have these inequities and disparities. And of course, it’s complex. There are social determinants of health and other factors, but that algorithm is definitely a huge part of it. So those are some of the race-based algorithms that I am trying to highlight and also trying to remove from our health care systems.

Kevin Pho: So your KevinMD article is titled “Ensuring equitable, quality treatment of pain in Black and marginalized people.” So tell us, how did this article come together?

Bayo Curry-Winchell: So the article stemmed from my TED Talk. I received the opportunity to share an idea, and I thought, “I really want to talk about race-based health care, and I want to talk about representation. And I want to share a personal story,” including my father, who, when we talk about my journey, is definitely instrumental. He was a 99-year-old World War II, Korean, and Vietnam War veteran, a Black man who served in a segregated war. And he would share with me his mistrust, or I would see the dismissal of his concerns that would happen in health care. And this happened even before I went into medicine.

And so I decided to put all of those stories, personal experiences, together, but use data to support what I was saying, and put it forward in my TED Talk, and then write an article about it. And I did that in hopes of amplifying these important topics, in hopes that, number one, it helps someone advocate for themselves, and number two, that we really look at how we need more representation in health care. And I really decided to look at Black female physicians. And that’s not to discount other genders and races and so forth in health care, but for me, I wanted to highlight that I represent less than 3 percent of the physician population, and how that impacts health outcomes.

Kevin Pho: So in primary care, why is it so important? From your perspective, why is it so important to have more representation? Why do we need more Black female physicians practicing primary care?

Bayo Curry-Winchell: We need it because there is the need to be able to connect with patients on a deeper level. And I say that from the fact that when you have someone who has an understanding of your shared experiences, acknowledges your history and how you may have heard or experienced different things, and also sees you for whatever ailment, concern, or just overall concern that you have, that is needed. And representation helps really highlight race-based algorithms, like I mentioned before. It also helps people feel like, you know, “She looks like me. She understands me.”

And having more representation is just needed, because it does help health outcomes. It does help share experiences, and it helps patients feel like they can have someone that they can relate to. And when you do, it’s a way to build trust and talk about people’s concerns. So representation is needed across all fields, and in health care, it’s something that we need to think about and invest in more.

Kevin Pho: So can you take us into your exam room and share a story about how your shared lived experience helped a patient in front of you?

Bayo Curry-Winchell: I can. I can share that. I had a patient who, from the start, when I walked in the door, you could see her eyes light up, and she said, “Oh, you’re a Black doctor.” And I said, “Yes, I am.” And she said, “I have never seen one.” And there was this automatic trust that happened, and she said, unsolicited, “Well, I know you’re going to hear me, and I know you’re going to listen to me.”

And when I share that story, I know people are going to say, “Well, it shouldn’t have to be about color. It shouldn’t have to be those things to connect with people.” And you’re right, it shouldn’t. But sometimes having someone who looks like you, when you are in an environment where you don’t get to see people who look like you or represent you, it does make a difference.

And so that experience was amazing, and it happens quite often, even when I have little Black girls to whom I introduce myself. I say, “I’m Dr. BCW,” and they’re like, “You’re a doctor.” And so we need more imagery, more representation, to know that if I see it, I can be it. And that is so true, because when you see somebody who’s doing it, it helps either plant that seed or grow that seed into, “Yes, I can be that.”

Kevin Pho: In your KevinMD article, you talk about a couple of measures in addition to GFR regarding race-based algorithms, specifically with oximetry and with pain scales. So talk about those two specific instances.

Bayo Curry-Winchell: Yes. Studies have found that pulse oximeters and thermometers are not reading at the same level, or giving the same number, as you would find in someone who is non-melanated. And why that makes a difference is that, as health care providers, we really rely on our vital signs and all of those things to really help us assess our patients. And so if your oximeter is reading one to two degrees different than what it really is, that’s a huge change in your differential workup and how you even provide care immediately in that acute setting.

And so when we go back and we think about COVID, and we think about how people were struggling to breathe, if you have a reading that says that your respiratory status is one number versus, let’s say, 91 versus 88, there’s a huge difference in how you are going to treat that patient. Same as a fever. So those are measures that we have to look at, because it does impact Black and brown lives every day.

And another piece that I like to talk about, Kevin, is when we look at hypertension. We rely on studies that in the past have told us to provide a certain medication for Black patients. And we have seen that that actually leads to poor health outcomes, because you are limiting a medication to someone based on their race and not allowing them to try other medications that may be a better fit, just based on the color of their skin.

Kevin Pho: So you are clearly outspoken when it comes to these race-based algorithms and the differences in race when it comes to these diagnostic tests. So what are some ways that we can speak out about that, and how successful have you been when you bring these issues up?

Bayo Curry-Winchell: So the first thing that I would say people can do is take inventory, or take stock of what you’re doing right now, because I have seen several providers who share, “Well, that’s the way I’ve always done it,” or, “That’s just the way I do it.” Well, we pride ourselves on helping people. And we think about how we took an oath to do no harm. And there are studies that show that this is causing harm.

So I encourage people to think about what they’re doing, especially when it comes to race-based medicine, and look at the data that shows that it’s impacting health outcomes. And then go a little bit deeper. Think about just your definitions of race, genetics, and ethnicity, because I think when you take a look at that and you inform yourself, you are going to be able to see why health care is changing and why health care in that manner is no longer the right fit.

And, you know, it’s been an uphill challenge to share this information, but I’m going to keep going because it’s so important. And, you know, I’ve had people share, “Oh, I’m not interested,” or, “I want to keep doing what I’m doing.” And that’s OK. And so the way I’m approaching this is sharing the information, in hopes of really informing, but not talking at people, in hopes that they just take a second look and ask themselves why they’re doing certain things. And so it’s been an uphill battle, and I’m sharing it with anyone and everyone, people I don’t even know, because this is such an important topic, and it impacts lives every day. So as you know, I reached out to you, and I’m reaching out to anyone.

And so I encourage you, please share this information. Please share my TED Talk. And I say that because I wrote it in an intentional way, in hopes of informing people, but in a way that is disarming, in a way that is just sharing the information. And I hope if we can amplify this message, we can help patients. We can improve our health outcomes, which is why we became doctors. That’s what we’re in this for, to help people.

Kevin Pho: One of the things that you mentioned earlier was increasing the representation within the medical community. How can we go about doing that?

Bayo Curry-Winchell: So leaning into mentorship and sponsorship. Think about, you know, people of color, and find ways to connect and help them through the journey. There are so many challenges, whether it’s sitting for the MCAT, learning how to apply for the MCAT, finding ways to send your application, or getting those clinical hours. All of those things are a part of getting into medical school, and they can be challenging. But if you have someone who can help you through that, it is just a leg up in, number one, getting through it, and number two, not giving up.

So reach out to different organizations. I mentioned Black Girl White Coat, which is an amazing organization. I talk about it in my TED Talk. It is providing sponsorships for not just physicians, but any woman of color who is trying to get into health care, whether it be nursing or a PhD. They’re trying to help women get through this process, which is overwhelming.

Kevin Pho: We’re talking to Bayo Curry-Winchell. She is a family and urgent care physician. Her KevinMD article is titled “Ensuring equitable, quality treatment of pain in Black and marginalized people.” Bayo, as you know, we have a shortage of primary care clinicians, and you are in a primary care setting. Now, for those medical students who may be listening to us on this podcast, what are some reasons they should consider primary care as a career?

Bayo Curry-Winchell: So primary care is the anchor of health care. And I would encourage you to consider it, because when you get to practice family medicine, you are practicing all areas of medicine. It is a joy to be able to help someone, whether it’s their heart, their lungs, or, you know, a chronic disease that is affecting every organ in their system. You get to be a part of it, and you are a part of their journey, their story, through all areas of their life.

And I enjoy it, and I cherish it. And I tell my medical students and residents that as a family medicine physician, you are the be-all and end-all. You are the person who really helps your patient stay healthy, because you are helping them mind, body, and soul, and keeping them at the forefront of staying as healthy as they possibly can. So I love it. Take a look at it. Reach out to me, and I’m happy to share why I love being a family medicine doctor. You get to see anything and everything, and you’re always up to date on areas of health care, and it’s just a joy.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Bayo Curry-Winchell: I would love for providers to lean into remaining curious and think about it, whether it’s a patient that you consider noncompliant, whether it’s an underserved or marginalized group, or whether you want to help people of color. Ask questions and inform yourself. And when you do, you will develop a skill set that will help you in your practice every single day. So I encourage you to look at the practices that you’re doing currently, think about it, think about race-based health care, and think about how you can change your patient’s life just by informing yourself and asking questions.

Kevin Pho: Bayo, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Bayo Curry-Winchell: Thank you for having me.

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