Meet Dr. McClure
Thank you to Scarlet McClure for agreeing to talk to me and give me insight on the disparities in the medical field. She has been a great help by sharing her wisdom with me and I would like to acknowledge Dr. McClure for her work in the community. I was able to sit down and have a zoom interview with her recently.
An Interview with Dr. McClure
What do you do as a physician and how did you get into your profession?
When it came time to figuring out what she wanted to practice in medicine, she chose Geriatrics since her mother had cancer when she was in elementary school and lived with her grandmother
Dr. McClure went to medical school at University of Southern California, LA and did residency at Santa Clara Valley medical center in San Jose.She was a primary care physician for about 10 years and then switched into geriatrics
What do you know about the health disparities regarding race in the medical field?
The summer between first and second year she took a summer internship at a hospital in LA that rose to prominence right after the Watts riots.
This hospital was recommissioned after the riots, trying to figure out why the community erupted in violence, and what you could do about it to address their concerns. There was inadequate access to medical care in that community and huge disparities.
During this internship there were lecture series about health care disparities about things learned should have been teaching to every medical student.
They touched on how health care systems came to be, the history of health insurance, who gets medical and medicare.
Not only about who gets access to medical care but how systems of oppression are furthering the inequalities in clinics
Most professors tended to be white males so there were no representations or attendings for doctors like Dr. McClure, a filipina woman.
When looking for mentors who look like her, they were Flipino doctors trained in the Philippines which is a different experience of being a Filipino doctor trained in America.
It was hard to get a mentor and information about going through the systems when she was applying.
Now it’s harder for people to turn a blind eye to the disparities but it's easier if it doesn’t seem to affect you.
Can you share some insight about this topic? As a woman of color, have you experienced this racial bias first hand?
Dr. McClure doesn’t think any Asian in health care hasn’t experienced those micro-aggressions on a regular weekly basis, can’t find anyone who can't recount one or two incidences.
Worked in a nursing home she had already started wearing a mask (already doing the covid precautions), a gentleman who has a little bit of dementia: made remarks such as how [asians] look alike with their mask on, “McClure, that's not your real name, what's your real name?,” asking where Dr. McClure was really from when not getting the answer he was expecting.
Every healthcare worker who is not from a European background is bound to get that question or those remarks.
She was born here but people cannot let that go, they have the need to define you because you’re so obviously “other.”
They feel like they need to be able to place a world view or stereotype.
Her parents are Filipino but she looks chinese because one of her grandparents were Chinese and the man makes an offhand joke “you haven't just come from China right, bringing this Chinese virus”
This isn’t something you can really ignore and this was on the mild side of microaggressions because she’s a doctor in a white coat.
Nurses and nursing assistants get the ugly version. The name calling, suspicions, and sometimes agitation and violence because they don’t look like the dominant demographic or have an accent.
When you say is the stopping point, this cannot go on?
When you have to call it out and not joke about it can be tricky for a doctor like herself because she does Geriatrics. A lot of older patients are cognitively impaired, many of them have dementia.
There's a fine line between when she’ll allow people to say things.
People with dementia don’t have that filter and just say things that come to their mind. the first thing that comes to their mind through the prism of their life experience growing up in a predominantly white neighborhood not personally knowing anyone who are people of color. She will give patients with dementia and older patients more leeway than to a younger person. Dr. McClure will call people out who are younger and give older people the benefit of the doubt. You can’t inject them with an ethnic studies class and suddenly get them up to speed with what is acceptable. If they are being threatening to her staff and if their prejudice is getting in the way of their care their behavior will be called out.
Have you seen patients of color receive/get implicit biases placed on them by their own doctor.
With everything that has happened over the last couple of years we are reflecting on it after the fact, in the moment it's hard to turn off implicit bias but it's common practice to have these interdisciplinary sessions talking about difficult cases.
Deconstruct why this was such a hard interaction.
Noncompliance is often used when a nurse says one thing and the patient disregards
Noncompliance is listed as a problem. This poor descriptor could mean that somebody was non compliant because they couldn't afford their medication, they have cognitive impairment, or they perceived the treatment unfit.
When somebody is labeled as non compliant to the rest of the medical establishment it says “this person is not willing to work with you” when really, it has a lot to do with socioeconomic status or medical problems. Some don’t have the same luxury of taking a day off work to make it to the follow up appointment.
People in the emergency rooms who are people of color gets less response times to their call lights and less opiate medication for their pain regardless of their diagnosis (less strength)
Proven time and time again, this is accepted now as evidence of racism in medical care
Poor outcomes such as the fact that african american women are 3-4x more likely to have miscarriages, early birth, or poor outcomes of labor. That's even if you control for your socioeconomic background, even if they are a doctor they still have this risk.
These disparities are not an inherent problem at a genetic level. It’s a social cause that is what causes higher rates of medical problems in certain communities. There could be a lot of factors such as stress, lack of access to fresh grocery stores. If you are forced to live in a neighborhood with less green parks, less bike paths, things that are socially determined if you are to get something like diabetes. Genetics aren’t the main factor.
What solutions to addressing racial biases in the medical field do you suggest?
We had decades of implicit bias training and multicultural training, it has helped but it hasn’t fixed the problem. The treatment has to be different than that. What gets closer to addressing bias in medical training is empathy training. You put yourself in somebody else's shoes and see life through the way they’re walking through life no matter who comes before you. If you have the curiosity to ask those types of questions and get to know on a deeper level how somebody sees the world, it goes a lot deeper and is a lot more generalizable than multicultural training.
Multicultural diversity training ten years ago would be a Filipino doctor talking about the Filipino cultural experience or a Latinx doctor talking about the Latinx experience.
Not only is it so anecdotal, not based on research, but everybody is different and it pigeon holes people.
You can’t have one person talking about the experience of a whole community, you can’t target it that way.
It has to be brought down to person to person level: are you able to have a conversation with somebody and break barriers in a short amount of time? Are you able to find some common ground? Are you able to get a glimpse of where they're coming form? Are you able to ask right questions to understand what the barriers are that they've put in between
Her kids learned at a very young age the vocabulary of what empathy is, from kindergarten they start talking about what it means to be a good listener or an ally if someone is getting bullied. In order to be an ally you need to be able to put yourself in the shoes of the person getting bullied.
Multicultural training can run into problems because she’s met doctors who were like “Oh I know how to treat ___ patients” because they took a class or they read a novel. That gave them the overconfidence that they really understood what a person from a certain community was going through. It was another way to stereotype people, spending too much time reading into it
thinking you can be an expert on this culture. But, you can maybe get good enough at listening to become an expert on this person in front of you
Try not to come into it with a multicultural mindset, feeling like you are an expert on diversity. Come to every encounter with humility saying “look I don't know you but I want to get to know you I don't know where you're from but tell me a little bit of where you’re from.”
We run into problems if everyone thinks “check check check we did our multicultural training.” This can create stereotypes, for example Dr. McClure heard someone say once in medical school “if latinx patients are having abdominal pain a lot of times it’s just depression.”
It's a very blanket broad statement it would be more accurate to say in certain cultures or because of a language barrier it would be hard for a latinx patient to come in and verbalize it in that way.
They can come in and express more things like headaches or sleeping problems skirting around the fact that what's causing all of this could be depression.
Is mental health ever accounted for in regular visits with the doctor that are not specifically for mental health?
20 years ago no, it really has really shifted these past few years. Dr. McClure acknowledges that there’s only so much you can do in that short 15 minute visit. So much of it is when they leave and when they go home. If they have support from their family or community for their medical condition. You come in and fill in a form that's your chief complaint only to have time to discuss one thing. When really everything is interconnected. Many doctors now realize you can’t practice primary care without being able to identify someone's mental health. It’s such a major factor on whether or not they’re going to take that medication or whether or not they make it to your office to the lab that you ordered. Back then doctors rarely went back to train in mental health, it would be a matter of “that's not my field refer them to a psychiatrist” but doctors nowadays realized you can't separate the two. You can't learn everything you need to in schooling and residency. It takes just that long to master the medical component and to become versed in the interaction and being able to give advice and have somebody follow it. They call it Inspirational Interviewing; you have to be able to inspire people to take more concern to their medical health and well being.
Would you say doctors are different based on where you are? Such as the bay area vs the midwest.
Definitely, people who practice in rural areas are paid less. They might be able to buy a mansion but they are paid less compared to if they were to live in a city where it's more competitive. There’s a thing where the more money you make as a physician the less liberal you become. You can also track political tendencies in specialties. Certain specialities can be more conservative, in part it has to do with how much money is made. The more specialized you are, the more money you make. Primary care fields are paid less and reimbursed less for their time. Those doctors make less than say a surgeon. Somebody who believes in taking care of people who are disadvantaged has a tendency to work in disadvantaged populations. A plastic surgeon isnt gonna necessarily want to work in those populations.