We’re shining the ProjectIMPACT Spotlight on Tiffany Mayo, MD, an individual who is making a positive impact in healthcare by reducing racial bias in medicine. Dr. Mayo is interviewed by Ana Preda-Naumescu, a medical student at the University of Alabama at Birmingham School of Medicine and a VisualDx Student Advisory Board member.
Ana Preda-Naumescu: Please describe your job and your favorite aspects of your current position:
Dr. Mayo: I am an assistant professor of dermatology at The University of Alabama at Birmingham. In addition to this role, I am also director of dermatology clinical research and a course director for the school of medicine. I am passionate about learning, teaching, and inspiring positive change. One of my very favorite aspects of my current position is that I have the opportunity to do this with my patients, residents, medical students, and colleagues. Also, as a skin of color physician in dermatology, I have the opportunity to bring attention to and improve the outcomes in conditions affecting skin of color patients, who often feel their concerns are disregarded. There is a lot of fulfillment, gratification, and joy that comes from making a difference in someone’s life, and I get to do that every single day.
APN: What do you see are the biggest challenges in reducing bias in healthcare?
Dr. Mayo: One of the biggest challenges in reducing bias is the failure to acknowledge that there is a problem.
We are all biased in one way or another and, in healthcare, it is important for us to become conscious of our personal biases, but then also be willing to listen, learn, and change.
Confronting bias can be uncomfortable and the results of its existence can be overwhelming for those who realize they have taken part in it. Denial is dangerous in healthcare and it is inherently important that we recognize the problem widely so that we can begin mending and building trust in those affected most.
Beyond recognizing bias, another challenge is that of actively engaging the populations that can help educate and overcome the biases. Lack of diversity in leadership positions, committees, and teams all contribute to bias. We need more people whose personal perspectives and experiences are the very tools that can change how we approach this challenge in healthcare. The effort has to be intentional. As medical professionals, we need to recruit diverse applicants who are not only interested in the field, but who can also enhance the field by sharing different viewpoints so that we may tailor our approach to minority patients on a more individualized level.
APN: What are you currently working on that addresses healthcare equity?
Dr. Mayo: It seems a little ironic, but educating on our differences is how I am currently working on addressing healthcare equity. Before I became course director for the dermatology module at UAB, I was asked to give a lecture to medical students. I was given a template of pre-made slides. Before even editing the lecture content, I spent time going through each of those slides and adding as many skin of color images as I could.
I wanted to demonstrate how images of the same conditions could look differently in skin of color. I wanted students to understand and adjust their perspective to ensure adequate diagnosis in different skin types.
Similarly, as healthcare providers managing disease, it’s important to adjust management plans based on the individual needs of patients. As I work with residents and students in clinical practice, I intentionally spend time talking with patients about topics beyond their reason for visit. This is not just to build rapport. It is also important in identifying challenges and modifications that may be needed to adequately address the medical condition considering external factors that affect the patient, including values and cultural views.
Education about how our differences affect outcomes starting early in medical school and residency training is an important step in addressing healthcare equity. Having these conversations in a safe atmosphere where students can feel free to ask questions, learn about differences, and dispel myths may lead to long-lasting positive change. In addition to working with students and residents, I am leading our department’s efforts to incorporate unconscious bias trainings and frequent diversity lectures to faculty.
APN: What are some of the ways in which students or residents can work to improve healthcare disparities and rebuild confidence in medicine for patients of color?
Dr. Mayo: There is this saying, “Meet them where they are.” What that means is the very first step in treating patients of color is trying to understand their unique perspective and experiences, and from there, tailoring your clinical approach.
It is unreasonable to expect patients to comprehend medicine and disease in the complex way a physician’s training affords. It is up to the provider to figure out where the patient is and meet them there.
Show true interest in understanding the historical context of distrust. Listen to patients. Seek experiences and educational opportunities outside of the standard training and one’s comfort zone. Do not be afraid to have conversations with people from different backgrounds in order to understand what their viewpoints are on medicine or research.
I believe the application of this approach to patients is incredibly important and it is something medical students and residents can start practicing early on. In my experience, if patients feel like you are working with them, they begin to build trust in you. This is the stepping stone to rebuilding confidence in medicine as a whole for patients of color.
APN: Even in conditions that disproportionately affect people of color, these populations are often significantly underrepresented in clinical trials. What change would you like to see in this area?
Dr. Mayo: I would like to see efforts to increase diversity at every level of trial development, funding, and execution. Otherwise, why would we expect diversity at the participant level? I attended Tuskegee University for undergraduate and graduate education. The Tuskegee Experiment and bioethics are integrated in education regardless of degree type. This along with being in a small town where many people are grandchildren of the individuals that underwent the study, you see first-hand the salient repercussions of the break in trust that happened for skin of color individuals and medicine. The Tuskegee Experiment directly affected the grandparents and was made public to the parents of the Black patients we expect to willingly trust and enroll in clinical trials.
There is clearly a gap that must be bridged. In order to begin to repair this damage, we first need more minorities in research. In my opinion, this will lead to facilitating better communication and genuine community outreach/public education regarding clinical trials.
APN: What or who inspires you?
Dr. Mayo: My grandmother. She was the epitome of perseverance, self-determination, compassion, and goodwill. She lacked formal education, but she was certainly a leader. She instilled in me a desire to learn and made me truly believe I could be and achieve anything.
APN: How do you pledge to make an impact to improve health equity?
Dr. Mayo: I pledge to make an impact and improve health equity through teaching, researching, and continuing to work toward a better understanding of the conditions that disproportionately affect skin of color patients. My goal is to use medical education and research to address gaps in knowledge for both the medical and general community, as well as use my position as an academic dermatologist to fight for increased representation of minorities in medicine and research.