Cheryl Dickson became a pediatrician because when she was 8, a doctor made her swallow a pill.
“I had never swallowed a pill in my life and I was scared, but they made me do it,” she says. “And I remember, after that, saying, ‘I want to be a doctor that takes care of kids and understands kids.’”
Years later, other experiences pushed Dickson in a new direction — the promotion of health equity, a topic she will address at the YMCA’s Annual Community Breakfast on March 7 at the Radisson Plaza Hotel. Health equity means everyone has the opportunity to reach their highest level of health, no matter their race, gender, income or geographic location.
Growing up in urban Newark, New Jersey, Dickson, an African-American, says she was not exposed to overt bias based on her race. That changed in high school when she was the only African-American student to attend a science study program in Florida.
“My school was mostly African-American, and I hadn’t really been exposed to white people or diversity. We went by bus down South and stopped at different places along the way, and when we would go into restaurants, people would be smiling and then they would stop smiling when they saw me,” she recalls. “I roomed with a group of girls, and we had this big cockroach in our room, and the girls said, ‘You kill it. You’re used to that.’ I had never even seen a cockroach before, and I was like, ‘Why do you think I can kill it?’
“It was subtle things like that that made me aware of how people can look at you differently because of some factor like the color of your skin or your religion or something. It made me understand how important equity is.”
Now Dickson teaches aspiring doctors at the Western Michigan University Homer Stryker M.D. School of Medicine about cultural competence and health equity, helping them to understand and address their unconscious biases in treating patients from all walks of life.
How did you end up a in a career promoting health equity?
I trained in hospitals and medical schools where there was a really vulnerable population of patients that were poor and from ethnic minorities, and you could see the differences in their health. I saw diabetics who had had amputations and hypertensives who had heart disease, and they were young! There are really bad morbidity outcomes from the diseases they had, but if they had proper care, a primary-care physician or different circumstances, they would not be like that. It would not be that same kind of outcome.
I looked at the disparities, asking, “Why does that happen? What can we then do as providers? And what can you do to train new providers — the young ones coming up — about the importance of understanding of how these disparities came to exist?” They exist because of things that were created in our country: the policies, the redlining, the type of housing and areas where they live, the access to primary care, insurance, jobs — all those things which we call the social determinants of health, which matter the most for our health outcomes.
How do you teach that?
We incorporate cultural competence, humility and understanding about unconscious bias. People make misconceptions about others just based on some factor like the color of your skin or your religion because they have a lens they view the world through, based on the way they’ve grown up. Their unconscious bias makes them behave in a way that they think is the right way to behave, and they treat people differently as a result. If you become aware of these biases and have some experience, then you realize that that’s not the way to be.
We give students exposure early on to vulnerable populations by having them work out in the community with the different organizations so that they have a feel for the need and what organizations are doing to help people.
What kind of fieldwork are your students doing?
One of our projects is our student-run practice, which we do at Dr. Don Bouchard’s Holy Family Healthcare clinic in Hartford that does a lot of work with the migrant population. We developed a team of students to work there: First-year medical students do intake and patients’ weights, the second-years take the patients’ medical histories, and the third-years talk to the patients about the case, and then I or Dr. Bouchard will finalize the visit. So students are learning about the multiple cultures of migrant families. The clinic also has a food pantry and clothes closet, which our students have done clothing drives for.
What other ways do you help them learn about disparities?
I’ve tried to bring in more real-life kind of scenarios in our simulations. We want our students to learn through our simulations about how social determinants impact what they are seeing with the clinical part and how to ask the right questions.
I have a grant that’s for transgender health care because the population with the greatest disparities is transgender individuals. They are the most victimized and misunderstood. Doctors won’t see them because they say, “I can’t take care of you because I don’t know how to do those hormones.” We had a panel of transgender individuals who told the students about how they’ve experienced healthcare and what would make it better for them so that this generation of doctors will have a better understanding about taking care of that population.
This is really about empathy and compassion, which I believe they all have. It is about the patient and what their needs are and putting yourself in their shoes.
—Interviewed by Marie Lee