Addressing Healthcare Inequities Through Patient Relationships

— Lisa Cooper, MD, MPH, on how race impacts health outcomes


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It's no longer a surprise that race and ethnicity influence patients' health outcomes. But back in the 1990s, when Lisa Cooper, MD, MPH, first documented and published findings that supported the role of patient race on the quality of physician-patient interactions, these were groundbreaking, even radical, ideas.

Today, Cooper, a physician and social epidemiologist, is the director of the Johns Hopkins Center for Health Equity and a Bloomberg distinguished professor at the Johns Hopkins Bloomberg School of Public Heath in Baltimore. She has designed innovative approaches to improve physicians' communication skills and the ability of healthcare organizations to address health disparities. She is also a recipient of the MacArthur Fellowship and a member of the President's Council of Advisors on Science and Technology.

In this conversation, Henry Bair and Tyler Johnson, MD, talk to Cooper about her international upbringing, implicit bias in medicine, what good physician-patient relationships look like, and how we can more effectively prepare doctors to create a more equitable future.

In this episode, you will hear about:

  • 2:21 Cooper's international upbringing and how an early understanding of privilege shaped her career path
  • 7:25 How privilege can change based on community and culture, and how Cooper experienced this shift
  • 12:58 The observations Cooper made early in her career that led her to study how race and class impact health outcomes in America
  • 18:44 Facing stereotypes in a culture that is not your culture of origin
  • 26:48 How Cooper began her research on racial inequities in health and the findings from those initial studies
  • 32:56 The unrecognized assumptions that doctors are taught to make when it comes to patient care
  • 38:36 How physicians can learn to take better care of patients from all backgrounds
  • 46:40 The current state of medical education around implicit bias training and racial disparities
  • 52:53 Cooper's advice to her younger self

The following is a partial transcript (note errors are possible):

Bair: I'd like to start with your fascinating international journey. Can you take us through your childhood and formative years?

Cooper: Well, I was born in Liberia. West Africa. Small country. Uh, on the West Coast, founded by freed American slaves and people who were free people of color who had never been enslaved, who returned to Africa in the 1800s. So it's a country that is sort of a blend of people from lots of parts of the African diaspora. And, you know, it was the first independent country on the continent of Africa. And so it was an interesting place growing up.

My parents, both of them were born in Liberia, but had come to the United States for their training and education. And my father was a surgeon. My mother is -- she's still alive -- is a librarian. And so I grew up with the sense of the importance of education, of course.

But also because Liberia is a pretty poor country, a low-income country there, most of the population there, I think lives in worse conditions than a lot of people in the developed world. And so my family and I were kind of privileged people in that country. So I was really aware at a pretty early age of the advantages I had. We lived in a nice, comfortable house overlooking the ocean, and I went to an international school and the kids I went to school with were the children of diplomats and business owners. And, you know, in Liberia, we were fairly well-to-do. So I think I had this sense of like sort of how fortunate I was in many ways.

But I also saw a lot of people around me who didn't have all those advantages. So I saw lots of children who were walking on the streets without shoes on and often like carrying water on their heads because they didn't have running water in their homes, taking care of their younger siblings and not being in school. So I think I was really aware of the fact that I had a lot.

And my parents also kind of instilled this in me and my brother and sister that to those whom much is given, much is expected. So, you know, my parents also gave back a lot. They were involved in a lot of activities, civic activities. You know, my mother worked on the leprosy board, leprosy control board. You know, my father was in the Rotary Club. So I grew up with a sense of the importance of service to community. And then also, you know, I grew up in a medical family, so my father's mother was also a nurse.

Bair: So did you plan to go into medicine yourself right from the start, or did you at some point kind of realize this was, after all, the right path for you as well?

Cooper: Yeah. No, that's always an interesting question. I think as a little, as a very small child, I was always interested in being a doctor. And I don't know if it's because I saw my father doing his work, you know, going back and forth. But I think that was part of it. I think the other part of it was that I always felt like I wanted to help other people feel better. I think I've always been sort of a sensitive person to the kind of the pain or the suffering of other people. So I always wanted to be somebody in medicine, probably a doctor, because I saw my dad, but I wasn't 100% sure that I would be really cut out for it.

So, you know, I don't think I was sure, you know, as a young person, I always had that in the back of my mind and always tried to prepare for that. You know, taking science classes. I liked science and math, too. But I also liked other things, like music and art. And I played the piano. But when I did go to college, I did a liberal arts degree at Emory College in Atlanta, Georgia, and continued to take all the pre-med requirements.

And then at the end, sort of towards the end of college, I kind of made a firm decision that, yes, I was going to go to medical school because I considered lots of other things, knowing, because one of the reasons I did that was because my father worked really hard, very long hours. He wasn't always at home with us. He wasn't always on family vacations with us. So I knew that medicine required a lot of dedication and I might actually not have as much free time to do other things I wanted to do. So I tried to think of lots of other things that I might like doing, which I did, but at the end of the day, I still came back to medicine.

For the full transcript, visit The Doctor's Art.

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