There's no such thing as the average patient
Interview with Maaike Muntinga
Greater attention to diversity makes care fairer. There's no such thing as the average patient. But this is often what doctors have in mind when they listen to symptoms.
A lack of awareness of patient diversity can mean that not all patients receive the same high-quality care. Maaike Muntinga makes medical students aware of this.
"Doctors claim to be objective", says Maaike Muntinga, researcher and lecturer in the Metamedics Department at Amsterdam UMC, location VUmc. "But much medical knowledge is based on the white, heterosexual male. This can lead to incorrect assumptions about patients who do not fit this frame of reference, such as people with a non-Western background or LGBT patients.
As a result, doctors don’t ask certain questions, or they overlook needs." This means that there is a bias, which may result in substandard care for these patients.
Referred less often
A well-known example of bias is that women having a heart attack experience different symptoms than men, so it can take longer for a doctor to correctly diagnose a female patient. Muntinga has more examples. "People with a non-Dutch background or migrants are sometimes not understood properly by doctors. There is prejudice on the part of the doctor, cultural differences or a language barrier. These patients go to the doctor more often, but their average consultation time is shorter and they are referred to a specialist less often. Or consider a transgender patient who has chosen not to have his uterus removed. If he is registered as a man, he will not be summoned for cervical cancer screening."
Equal outcomes
Muntinga believes that individual doctors should spend more time reflecting on what they don't know. At the same time, changes are needed in the healthcare system as a whole.
"It is important that we focus on equal outcomes of care, not just on equal treatment of patients. The basic question must always be: could this aspect of this person's identity influence their care needs or outcomes? If so, what can or should I do about it?"
Talk about ourselves, too
Muntinga makes doctors in training aware of this. Students need to learn how their background contributes to their assumptions about patients and about each other – and how this affects patient care.
"To understand this, we also need to talk about ourselves when we talk about diversity. What or who is the norm? Who decides? And how do we ourselves – as doctors, as a care system – serve to preserve the norm and the injustice?"
Modules for the degree program
Together with students and doctors, Muntinga – aided by a Comenius scholarship from the Ministry of Education, Culture and Science – has designed an Equal Opportunities module for the Master's program in medicine. Previously, she developed a practical for the second year of the Bachelor's program. Both course units promote discussion about diversity, for example by showing films by the artist Lina Issa. Muntinga: "It turns out that even for students who have been on the receiving end of discriminatory comments themselves, it takes a while before they voice them. They downplay the experience to themselves. It is not easy to speak up; you need to feel very safe in order to do so. We give the students options for how to respond, as well as the awareness that it’s also okay to not respond. Exclusion or discrimination is not only a problem for the student, but for all of us."
Proud
Many students find the education valuable, but there are also 'shruggers'. Muntinga: "There's a group who don't think this qualifies as medical knowledge. I think we need to convey that this is part of medicine.
What is very important is that there is a lot of support for this way of thinking from the management at Amsterdam UMC, location VUmc. I'm proud to be a part of this.”