Does My MD Look Like Me?

The other day, as I listened to the news, a story came on about telemedicine’s increased use during the current COVID-19 pandemic.

I wasn’t surprised by the significant increase in virtual visits, nor was I surprised by some of the well-known barriers to adoption. Structural barriers include low insurance reimbursement for telehealth visits and the lack of access to the internet or a computer by some patients.

What I was surprised by, but immediately understood, was that for a large contingent of patients, especially blacks and Latinx, the barrier to participating in telehealth visits is that the physicians conducting them “don’t look like me.”

I understood this sentiment because I, too, want a provider whom I hope will be able to relate to me on a deeper level — i.e., as a woman, preferably around my age. I want someone who “looks like me.”

We have created data visualizations on this very topic for brick-and-mortar facilities delivering in-person care, so why would it be any different in the virtual setting? It wouldn’t be, and I shouldn’t have been so surprised. Of late, I’ve become exceedingly proud of my daily dose of humility.

The following is an example of the type of visualization we have created to help groups think about this issue.

(click to enlarge)

  • In the top left of the display, the percentage of physicians by race and ethnicity currently on staff is listed, immediately followed by the same rates for the community they serve.
  • A deviation graph follows, which conveys the difference between the number of physicians versus the community members in each category as both a percentage and a count.
  • The deviation graph displays the relative differences in each category (percentage), and the count makes it easy for viewers to understand the absolute differences.
  • The deviation graph is followed by a bar chart displaying how much each group is over or under-represented. The vertical reference line represents 100% fully balanced — i.e., the staff’s race and ethnicity are 100% proportional to that of the community.
  • The same techniques are used in the bottom half of the display to help groups consider their leadership teams’ diversity and how well it reflects the community.
  • Two colors are used on the charts to indicate where the physician or leadership team may be over-represented (teal) or under-represented (gold).
  • The arrangement of the entire display with the labels at the far left and all figures and charts in alignment with them leverages the fact that people read from left to right, providing a great way to get lots of contextual information on one page logically.

Hard Truths Are Hard to Face

Using these techniques is often the easiest part of developing this type of data visualization. The hard part often occurs as I listen to a team’s fears and timidity about presenting data that may reveal hard truths they fear will result in backlash (e.g., management will lay-off hundreds of white physicians and replace them).

I get it (I do). But we have to remember and be resolute in knowing that the ONLY way that we will ever improve our health and healthcare systems is to correctly capture, analyze, display and act on the opportunities that are revealed by the data. The truth is bravery is another excellent skill to have when working with data.

This circumstance brings me to my final tip. The work of creating useful data displays isn’t only about the graphs. It’s also about great, descriptive titles that can help to frame the data.

Especially in examples like the one above, titles can potentially help viewers examine any fears they may have about the display’s real intent and consider the stories and opportunities the data may reveal. For this display, we crafted the title “Working to Reflect the Diverse Community We Serve.” By leading with the word “working,” we hoped to convey that any efforts to develop a team of physicians and managers who are more representative of the community’s racial and ethnic makeup will occur over time with the objective of “reflecting the community we serve.”

And last but not least, this entire topic causes me to reflect on a book my daughter gave me a few years ago entitled: The Truth Will Set You Free — But First It Will Piss You Off. Yes, it will. Thank you, daughter Annie, and thank you, author Gloria Steinem!

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