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Biracial Stanford physician: We must look beyond race in medicine

Megan Mahoney, Stanford Health Care's chief of staff, discusses racism and bias in the nation's health care system and how it can be overcome.

In an August column in STAT News, Megan Mahoney, MD, Stanford Health Care's chief of staff, wrote, "In medical school, I was diligently trained to report to my attending physicians the age, race, and gender of my patients -- in that order."

She wondered how a doctor would describe her, a biracial woman, and what the medical consequences might be for her.

For a 1:2:1 podcast, I spoke with Mahoney, a family medicine clinician, about her background; about race and how it plays out in clinical settings; and about what needs to change to overcome systemic racial inequities in the nation's health care system.

This Q&A is edited and condensed from that conversation.

You wrote in your column: "It's time to stop using skin color and race in medicine and see patients for who they really are." It came out of your experience as a biracial woman. Tell me about your parents.

Megan Mahoney, waving, with her parents, Charles and Carolyn Mahoney, and her sisters, Bernadette (in their father's arms) and Cindy.

My father was born to Irish-American parents. After graduating from prep school and the U.S. Naval Academy, he married, but he lost his wife to meningitis. He decided to go into the priesthood. As a priest, he began working in Memphis and became very active in the civil rights movement.

My mother was born in Memphis -- the Jim Crow South -- as one of 13 children. Sometimes all the family had to eat were peaches from the trees in their backyard.

Megan Mahoney's father, Charles, when he was in the priesthood.

She received a full scholarship to a small Catholic college in Kansas. She returned to Memphis after college to teach at a high school. She also was treasurer at the Catholic parish church where my father served, which is how they met.

My mother received a PhD in mathematics, and later was one of the first African-American women in the United States to become a university president. She served as president of Lincoln University of Missouri for seven years.

My father was by her side throughout her career. It was quite a love story.

When were you first aware of being biracial?

I grew up in Columbus, Ohio. I was in kindergarten, the very first day of school, on the playground with a group of kids. They looked at me quizzically, trying to size me up, and asked, "So, what are you?" I had no idea what they were referring to.

Megan Mahoney as a young girl.

Later, at the dinner table, I asked my parents, "There's this question I'm not really sure how to answer." They told me to go back the next day. If I was asked again, I should respond, "I'm mixed." I felt very prepared. I went back and was asked again, "What are you?" I responded, "I'm mixed up."

As you moved through life, college and medical school, how did being a biracial woman impact you?

For most of my adult life, I was categorized as "other." On applications for various schools, I've had to be limited in how I describe my racial background. They'd ask, White, African American, Asian, Pacific Islander, Hispanic, but there often was not a box that gave me an opportunity to write in, "White and Black."

When I was in high school, my counselors were pushing me towards Ivy League colleges, but I selected a school -- UC Berkeley -- because of its racial diversity.

For the first time, I could experience being surrounded by people of all different backgrounds. I can just share with you that that sense of belonging was truly cherished. For once, I didn't have to be asked, "Where are you really from?" It didn't matter.

In your opinion piece for STAT news, you write that it's time for medicine to look beyond race as a determinant factor and see people as individuals.

The practice of medicine has not truly accounted for mixed-race individuals and lacks the precision to recognize our whole, inclusive identities. A lot of it is based in our history in medicine.

Fortunately, there is now a greater appreciation that race is a social concept, rather than a genetically bounded category, thanks to the genomic revolution. We know now that we, as a species, share 99.9% of our DNA with each other, and that our traits that are typically associated with race are not linked genetically to health-related genes.

There is a greater appreciation for the role of environmental, social and behavioral factors, their influence on health outcomes, and how they probably determine over 70% of what determines health, according to the Centers for Disease Control and Prevention. That exceeds the contribution made by genetics and even medical treatment.

Black Americans have higher rates of morbidity and mortality for COVID-19. Systemic inequities also bear out for Latinos and Indigenous Americans. Are racial inequities baked into the health care system?

Sadly, racism and bias are baked into most, if not all, of our institutions. We need to identify where they exist and then address and change them. I'm committed to that.

A recent Kaiser Family Foundation survey found that one in five Black Americans say they've experienced discrimination while seeking health care in a clinic.

That's a stark statistic, and it likely does reflect the experiences of Black Americans. I think that we as physicians are morally obligated to practice cultural humility -- the fact that we all carry unconscious biases. We all do. We have to become aware of that and approach it with a certain level of humble inquiry, questioning ourselves in how we're practicing medicine.

How do the murders of George Floyd, Breonna Taylor and many others, and the data you're talking about, meet this particular moment? Are we at an inflection point?

I think so. There is a greater interest in raising our collective awareness around these issues. I've also noticed that there is a concerted effort behind wanting to make curricular changes in medical school, so we are understanding how race and racism impacts health and health outcomes.

I'm seeing changes I've never witnessed before, happening throughout our institutions. It's really an important time.

Top image of Megan Mahoney, MD, with a patient by Steve Fisch. Family photos courtesy of Mahoney.

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