Journey to #BlackMenInMedicine

  • hiermedia
  • November 27, 2017

There were fewer Black men enrolling in medical school in 2014 than in 1978.

In a world where the first Black president of the United States was elected nearly a decade ago with many declaring it to be a new day of progress for Blacks in America, statistics such as this one come as a surprise. Fifteen years ago only 677,000 Blacks held an advanced degree. Today that number is 1.6 million. For unclear reasons, these successes have not translated into increased representation of Black men in medicine.

The 2015 AAMC report Altering the Course: Black Males in Medicine provided interviews of premedical students, physicians, and researchers that highlighted reasons for the decline in Black men enrolled in medical school, emphasized research and data to help explain trends, and sought ways to encourage more black men to consider medicine as a career. They identified recurring themes such as unequal educational opportunities from kindergarten-12th grade, absent role models or mentors in medicine, negative societal bias and perceptions of black men, and the increasing financial burden from the cost of a medical education.

We are familiar with the AAMC report, and many of us have been working to address the issues presented.While at Duke University, Dale Okorodudu, MD created the video series “Black Men in White Coats” with the goal of inspiring and encouraging black men to pursue careers in medicine. He wrote blogs, such as Where The Brothers At?-Mentoring and Black Men Doctors, which called for strong mentorship to young men who could and would pursue medicine if they were exposed to “men of seniority…similar to our black men…who could capture their attention and gain their respect.” In September 2015 Damon Tweedy, MD released his book, Black Man In A White Coat, to document the challenges he faced and to inspire other black men to follow in his footsteps. In his New York Times Op-Ed article “The Case For Black Doctors,” he recognized that further under-representation of this group in medical school could lead to “even worse health outcomes for a population that is already the least healthy.”

So, when medical student, Vince Morgan, tweeted the statistic from the AAMC report November 16, 2017 many of the black male physicians on Twitter felt a sense of camaraderie and solidarity with Vince’s tweet. While our experiences in medical school spanned decades, we were united by our common experience of representing less than 2% of our individual graduating medical school classes. Unfortunately, for the majority of medical schools, these numbers remain unchanged today.

A robust conversation ensued on Twitter among those of us who recognized the problem and wished to do something to rectify the disparity and to find ways to lead by example and support those coming behind us. Perhaps inspired by the strength and resiliency we have seen demonstrated by women physicians and hashtag movements such as #ILookLikeASurgeon and #ThisIsWhatADoctorLooksLike and an immediate recommendation by Quinn Capers, IV, MD, we decided a social media movement and community of our own was in order. In fact, the surgeons among us had previously brainstormed with Heather Logghe, MD, founder of #ILookLikeASurgeon as to how to leverage social media and create a similar, simple to read, but influential hashtag. The goal of the hashtag would be to promote and encourage more young black men to pursue careers in medicine, especially to those who may not recognize medicine as a viable career option perhaps because they have never actually seen or met a black male physician.

Similar to #WomenInMedicine, Darrell Gray, II, MD, MPH suggested #BlackMenInMedicine. Dr. Dale Okorodudu mentioned the Facebook group with a membership of nearly 500 strong with the same name started by Dr. Henry Lewis, III. While we shared the same goal of advising, mentoring, and motivating black men to enter the medical profession with that Facebook group, our goal of re-purposing #BlackMenInMedicine is to encourage universal use of the hashtag across Twitterverse and other social media. Our hope is that the hashtag will be used not only by Black physicians and the allies similarly passionate about increasing diversity in medicine, but by anyone wanting to recognize the many accomplishments of Black men in medicine.

With use of #BlackMenInMedicine, we aim to:

  • Provide visible role models of black men in medicine, both as they practice medicine, and perhaps more importantly, how they spend their time outside of the clinic or hospital
  • Highlight achievements of black male physicians, as well as black men in medical school, and those aspiring to the premed track
  • Inspire black men to pursue careers in medicine and become motivated to care for communities of color
  • Highlight outstanding achievements of black doctors in both community and academic medicine and practice
  • Provide support, mentoring and sponsorship of black women in medicine who face additional challenges at the intersection of gender and race
  • We pledge to speak up when we witness gender-biased microaggressions, blatant sexual harassment, or harmful bias and discrimination toward other minority groups
  • Together, we aim to ensure a safe and inclusive educational, training, and working environment for all of us

Blog post written by Cedrek McFadden, MD and Heather Logghe, MD

Supported and developed by:

Cedric Bright, MD (@CedricMBrightMD)

Quinn Capers, IV, MD (@DrQuinnCapers4)

Dale Okorodudu, MD (@DoctorDaleMD)

Darrell Gray, II, MD, MPH (@DMGrayMD)

Joshua J. Joseph, MD (@joshuajosephmd)

Alden Landry MD MPH (@AMLandryMD)

Heather Logghe, MD (@LoggheMD)

Cedrek McFadden, MD (@cedrekmd)

James Moore, III, M.A.Ed, Ph.D (@DrJLMooreIII)

Brian H. Williams, MD (@BHWilliamsMD)

 

Also Supported By: Tour for Diversity in Medicine (@tour4diversity)

On Being ‘Dr. Dad’

  • hiermedia
  • June 5, 2017

I take my 10-year-old son to school as many school days as possible. We recap events from the prior day, and I give him early morning pep talks. It is a rarity, however, that I pick him up from school. During one of those rare occasions, he got into the car, smiling as he handed me a project he completed in class. It was an assignment in which he was asked to introduce his hero to his classmates. To my delight and surprise, he chose me as his hero. He explained that he looked up to me, in part, because I am a doctor.

This moment affirmed my belief that being a doctor compliments my role as a father. Being a doctor makes me a better father. Equally, being a father makes me a better doctor. While I’ve had a decade to establish a healthy relationship with my son, in clinic, I must establish a doctor-patient relationship in a relatively short amount of time. Many patients come into the clinical encounter with problems they would not share with their closest confidante. During these candid conversations, they trust I will listen and not only have solutions for their complaints but remain objective and unbiased in the process. I incorporate these same skills while instructing and nurturing my children.

One such opportunity arose after a recent track meet when my son came in 7th place during the 100-m dash run. I could see his disappointment in his performance. I could also see the embarrassment he felt. After listening to him share his feelings of being intimidated by his competition, we problem-solved and discussed ways to improve his performance for the next race. Our solutions included spending additional time after practice working on his technique. His effort paid off; he had a faster time and came in 2nd place during the following track meet. Years of listening, searching for, and offering methodical solutions to my patients subsequently have improved my problem solving as a father.

Just like my patients, my son does not follow all of my instructions. He has challenges getting homework done in a timely fashion and most definitely has challenges keeping his room clean. Guiding him through life’s challenges has taught me how to remain cool and level headed even when I am feeling anything but. Techniques that work in parenting translate to my professional responsibilities. For example, I rely on the ability to speak clearly in language the patient can understand to facilitate conversations about the medical and surgical management of various disease processes. Keeping cool and level headed in a wide range of clinical situations ranging from treating a noncompliant patient to proficiently and dexterously completing a tough surgical procedure is a necessity in my profession. Being a father of an energetic and active son has definitely equipped me for comparably challenging situations that require the same quiet resolve in my surgical practice.

Despite all the ways being a father and a doctor complement each other, it is a challenge to do them both well and give them both the time they require. I am intent to take full advantage of the time I have with each, whether in the car going to school or in the office and operating room. Time is fleeting and I recognize my son is growing older much too fast. My patients have many medical and surgical needs that continue even after the office has closed for the day. Clearly, I am not able to be present at all times for both. Nonetheless, when I am with family or with a patient, my goal is to be fully present. I know my son has a better father and my patients have a better doctor because of the experiences I have with each of them. Ultimately, I know the conversations with my son during our time in the car provides motivation, inspiration, and encouragement that will help mold him into a better version of himself that will benefit his future children and maybe, just maybe, his very own patients.

Your Top 10 Questions about Hemorrhoids Answered

  • hiermedia
  • May 2, 2017

Are you bleeding? Having pain? Any puffiness or swelling on the bottom? These could all be symptoms of hemorrhoids. But what are hemorrhoids and more importantly, how can they be prevented and treated? Here I answer your questions about this most common but dreaded malady.

  1. What is a hemorrhoid?

A hemorrhoid is an anal cushion of tissue containing blood vessels, muscle, and connective tissue. When this tissue is engorged or swollen, there is the possibility of discomfort or bleeding. Contrary to popular belief, a hemorrhoid is not a vein. Once the swelling from the hemorrhoid resolves, a skin tag may be left. There can be one or multiple tags present. Removal of the anal skin tag is not necessary unless they itch, bleed, or create difficulty maintaining proper perianal hygiene.

Anal Skin Tags

  1. What causes a hemorrhoid?

The exact cause of a hemorrhoid is unknown. Any action that increases pressure around the anus (such as straining to have a bowel movement, constipation, diarrhea, persistent heavy coughing, pregnancy, or lifting heavy objects) may lead to swelling or bleeding from the hemorrhoid.

  1. How common are hemorrhoids?

A report from the National Center for Health Statistics found that 10 million people in the US complained of troubles from hemorrhoids. Over 1 million prescriptions are written per year for medications for hemorrhoids. The peak age is 45-65 years of age, even though any age could potentially be affected.

  1. What are the symptoms of hemorrhoids?

Symptoms are dependent on the type of hemorrhoid.

The symptoms from internal hemorrhoids classically involve painless bright red bleeding that occurs during a bowel movement. Internal hemorrhoids may also prolapse or protrude outside of the anus when having bowel movements. They may reduce or go back in on their own; however, sometimes they require manual reduction (pushing them back into the anus). Pain is generally not a symptom of internal hemorrhoids, but if pain is present, it may be because of a prolapse or thrombosis of the internal hemorrhoid. A thrombosis occurs when the blood within the hemorrhoid clots and the hemorrhoid becomes very tender.

 

There are 4 grades of internal hemorrhoids:

Grade 1-hemorrhoids present but do not protrude

Grade 2-hemorrhoids protrude but reduce spontaneously

Grade 3-hemorrhoids protrude but require manual reduction (pushing them into the anus)

Grade 4-hemorrhoids protrude but cannot be reduced

Prolapsed internal hemorrhoids

 

The symptoms from external hemorrhoids involve swelling, discomfort, bleeding, and pain. They may become thrombosed. External hemorrhoids cannot be manually reduced. Struggling to “push them in” can cause more swelling and pain.

Thrombosed external hemorrhoid

  1. What can I do to prevent problems with hemorrhoids?

Drink adequate volumes of fluids each day and add bulk to the diet to eliminate straining. I recommend adding fruits, vegetables, and unprocessed wheat or oat bran to the diet. An alternative is to add psyllium seed or other fiber supplements, getting 20-35 g of fiber each day. Minimize extended periods of time on the toilet as doing so can increase strain and pressure around the anus. So that means put away the cellphone, magazines, and newspapers which may increase the amount of time spent on the toilet! Hemorrhoids may also be prevented by avoiding passing hard stools and avoiding straining with bowel movements or heavy lifting. The hemorrhoid itself may not go away. However, surgery may not be needed if there is no pain, bleeding, or swelling.

  1. So, I have a hemorrhoid. Now what?

Hydrocortisone creams may be helpful in improving symptoms of hemorrhoids.  If the over-the-counter versions do not provide relief, a stronger prescription from your doctor may be used. However, overuse of these products can make some symptoms like itching worse, which is why close follow up with the doctor is important. It is important to see an experienced physician. After a thorough examination, your doctor may conclude that symptoms reported from hemorrhoids could actually be from other anorectal diseases and conditions (i.e. anal fissures, anal abscesses, colorectal polyps, rectal prolapse).

  1. Do I need surgery for my hemorrhoids?

Not necessarily. The actual presence of the hemorrhoids or tags does not imply the need for surgery as long as symptoms are nonexistent, minimal, or tolerable. Your symptoms decide when and if surgery is needed.

  1. What are the most common procedures or surgeries for my hemorrhoids?

Internal hemorrhoids are most commonly treated with rubber band ligation, which is an in-office procedure to eliminate the symptomatic internal hemorrhoids. A ligation can also be performed in the operating room with suture. External hemorrhoids are excised in the office if a thrombosis is present (blood within the hemorrhoid clots and the hemorrhoid becomes very tender). If the external hemorrhoids are large, painful, bleeding, and not responding to medication, you may be a candidate for a surgical procedure called a hemorrhoidectomy. With this surgery, both large internal and external hemorrhoids are removed in the operating room with anesthesia.

  1. Do hemorrhoids lead to cancer?

No, they are not cancer and do not lead to cancer. However, symptoms from cancer may mimic those from hemorrhoids.

  1. So, what’s the bottom-line?

Just remember, there are a number of other potential causes of anorectal pain and bleeding. If you think you have hemorrhoids or have any of these symptoms, see a doctor. If bleeding and pain continue to be present despite treatment, definitely follow-up with your doctor to ensure you are getting the right treatment for the right problem.