Cross-cultural communication （100）
101) Bull's-eye is taught differently!
In the June 25, 2020 issue of the New England Journal of Medicine (NEJM), there was an article in the Perspective section that included a photo of a bull's eye (target = ◎), which is a skin lesion caused by the bite of a tick that carries Lyme disease (https://www.nejm.org/doi/full/10.1056/NEJMp1915891), there were photos of lesions on both black and white patients side by side. As most of the articles in Perspective are not medical papers but rather opinion pieces, I wanted to read it to see what it said.
The author is a female doctor from Harvard University, and she clearly states that when she was a medical student, there was clear discrimination against women and against people of African descent in medical education. The author says that this is not only discrimination as a social phenomenon, but also discrimination in medical education. In most textbooks and lecture slides, the bull's eye photo shows a clear red target mark (◎) on a white person's skin. However, in reality, in black people (or even Asian people), it just looks like a normal insect bite-like skin lesion. Black doctors know this from experience, but white doctors who studied in the US may overlook this lesion when examining patients of color, leading to misdiagnosis (or at best, delayed diagnosis).
Another example is the mannequin used in CPR (cardiopulmonary resuscitation) training. In the United States, all medical schools use white male mannequins. The author argues that this is harmful gender discrimination, not only socially but also medically. Statistically, the rate of CPR performed by ordinary people on patients who appear to be having a heart attack in the street is clearly lower for female patients than for male patients. The majority of people who perform CPR are also male, but it seems that men do not want to perform CPR on a woman they do not know. Firstly, even if it is a life-saving act, there is a possibility that touching a woman's body could lead to a sexual harassment lawsuit. Even if it doesn't go that far, it is normal for men to feel uncomfortable about touching a woman's breasts if they don't know her. Considering this social trend, the author states that if CPR training mannequins at medical schools were to include female mannequins, and if training was to include how to touch a woman's breasts and how to explain to and obtain consent from female patients during CPR, then more women could be saved.
In this way, the author seems to have wanted to say that discrimination based on gender or race in medical education also has the side effect of lowering the quality of medicine and medical care. It is true that there was once racial discrimination in the United States when entering medical school, but now there is none at all, and in fact, diligent Asian students are achieving outstanding academic results and passing medical school in large numbers, to the extent that white applicants are complaining that they are being discriminated against. So the perspective of this article, which pointed out that the unconscious discrimination between men and women and between races in medical education is causing harm to minorities in the United States, was very refreshing.
The author is currently affiliated with Harvard Medical School, and the tone of the article makes me think that the medical school she studied at was also the same Harvard. Therefore, I think the tendency to give priority to white males was even stronger. When I was a resident nearly 40 years ago, the hospital in Brooklyn, New York, where I did my residency, had a predominantly black (African-American) patient population, and the supervising physician during my pediatric emergency rotation was a Filipino female pediatric dermatologist who was very knowledgeable about skin conditions in black pediatric patients and was able to explain the differences between them and white patients through specific examples. For example, if you look at the skin rash of a child with scarlet fever, you can easily tell if it's a white child with a red rash, but with a black child it's harder to tell by color, so you have to judge by the roughness of the skin when you touch it. My personal experience shows that at teaching hospitals where they see many minority patients, they have always provided practical education.
| BACK |
