Candid Consult: Discussing Race in Healthcare

Racial inequities have long been a problem in our healthcare system, and it takes understanding these problems for us to help address this longstanding and systemic issue. We recently had the opportunity to sit down and speak with Dr. Ayanna Woltz from Somerset OB/GYN to discuss her own experience and unique perspective as a woman of color on both the provider and the patient side of the clinical conversation. Dr. Woltz shares how she works to make caring for women of color better, and how our Axia community is working to do the same.

Q: What inspired you to become a doctor—specifically women’s health?

When I was young, maybe 5 or 6, I was in the pediatrician’s office and had an experience that made me feel minimized, isolated and ignored. Even at such a young age, I remember thinking that I could be a better doctor than this; I could show more respect to a patient than this.  Then, as I got older and was exposed to some of the severe health issues I saw in my own family, I was forced to wonder why these things happened, to understand them, and how to help. On top of that, and perhaps what most shaped my focus on women’s health and obstetrics and gynecology, when I was nine or ten years old, my mother bought me The Teenage Body Book, and it opened my eyes and my mind to the amazing impending changes and the wonders of the female body.

This new interest was later fueled by what I saw in my own community of Elizabeth, NJ. There was a girl, maybe 12 years old, who was pregnant, and I recall being astounded that someone only a few years older than me could be in this situation.  I knew that I wanted to be a part of helping women and girls better understand their health and how to advocate for it. So much so, that by the time I got into clinical rotations in medical school, where so many clinicians change their mind regarding their specialty, I scheduled my OB/GYN rotation last. There was zero chance that I was going to change my mind–I was sure that this was what I was meant to do.

Q: Did you face adversity/discrimination in your education or early on in your career?

There are definite differences in the way you are treated as black student—without question. I recall, even back in high school and being a well-behaved kid, that I was wrongly and unexplainably singled out as being a troublemaker because of the way I looked, or repeatedly told I couldn’t possibly excel academically or take the AP coursework because I was roundly judged superficially and along racial biases. As I grew into my graduate and postgraduate work, I learned these hard lessons and became a better self-advocate. I let my demonstrated talent and accomplishments speak for me and made sure I addressed and corrected those who would have judged me otherwise.

Q: Has your own personal health journey been negatively affected by the color of your skin?

I am the kind of patient that wants a lot of information. I want to talk about and understand my options, and I think that’s not unusual for black women. There is a need for trust—we don’t want the care giver to make the decision on our behalf, we want to be partners in our care planning.

As a woman of color, I’ve found that in order to get this sort of information and engagement, I’ve had to demonstrate that I can understand it in order to earn focus and attention.  This is probably true for many, regardless of their racial background, but clinicians need to be careful to always explain things to patients to a comprehensive degree, and also in language and terms that the patient and their advocates can understand. I am very careful to do so when with my own patients, because that’s exactly what I want for myself and my family.  Using clear language does NOT mean skimping on substance, which unfortunately is often what clinicians will do when they doubt the comprehension skills of the patient.

Q: What is your opinion of the state of healthcare for women of color in this country? Does that shape your approach to practicing medicine?

A simple answer, perhaps, but my opinion is that there’s a long way to go.

Historically, women of color who have sought care have found a patriarchal, “we know what’s best,” “here’s what we say you must do, and if you don’t follow it exactly, you’re the problem” approach to care. This has created a barrier and a sense of distrust that the provider is really seeing you, truly listening to you. As a provider, if you aren’t truly considering a patient as a unique individual with similarly unique circumstances, then you can’t possibly understand why they may or may not be willing, comfortable or able to follow a prescribed treatment. You are not going to be successful at treating the problem.

It is critical to me as a provider, and for my colleagues at Axia Women’s Health, that we listen. It is so important that we consider and discuss the very unique set of circumstances that shape the woman standing in our office that day and discuss both the variety of options we have together to help, as well as the consequences of inaction. This includes ensuring the patient walks away with a plan, confidence in their care, and with all the options clearly laid out for them and their family to consider. While our team at Axia uses this approach with all patients, it’s especially important for our communities of color.

Q: What do you think organizations like Axia can do to improve in this area?

Ongoing conversation and dialog are a big part of it. If you don’t acknowledge that the problems exist then you’ll likely never address them. It’s important that we continue to take the time with each patient and do whatever is necessary to truly connect with and understand them including repeating the same information in different ways. Whether that means overcoming uncomfortable initial conversations, obstacles stemming from a history of underservice, or language barriers – whatever it takes is what we need to do. That takes patience. That takes the desire to be the doctor that these patients need you to be. There’s no question that it is a difficult job, but it’s an important one – and one that my colleagues and I are here for.

__________________________________________________________________________________

Axia Women’s Health is proud to partner with the National Birth Equity Collaborative to help bring equity and justice to women’s health care. We are currently working with the NBEC to explore new ways to identify and address systemic issues that impede access to quality care for women of color, and look forward to leading the way in improving health outcomes for women of color.