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We explore the complex factors contributing to ethnic health disparities in the United States with our guest, Melody T. McCloud, an obstetrician-gynecologist who was bestowed a Distinguished Alumni Award by Emory University School of Medicine. Since 1958, only fourteen women have been so honored, and Dr. McCloud is only the third Black woman to receive this prestigious recognition. We’ll discuss the impact of psychosocial stressors, access to health care, cultural competence, and the role of diet and lifestyle in shaping health outcomes for Hispanic, Black, and Asian populations. Melody will also share insights on successful community initiatives, the effects of historical trauma, and the urgent need for policy changes to address these disparities.

Melody T. McCloud is an obstetrician-gynecologist.

She discusses the KevinMD article, “Breaking down the link between social rejection and Black women’s health outcomes.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Melody McCloud. She’s an obstetrician-gynecologist. Today’s KevinMD article is “Breaking down the link between social rejection and Black women’s health outcomes.” Melody, welcome to the show.

Melody McCloud: Thank you for having me, Kevin, Dr. Pho. I appreciate being here with you and your audience.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Melody McCloud: OK. I grew up in New York City. I actually was blessed to have a Black female pediatrician when I was a little girl, and we’re talking about back in the 60s, Dr. Doris Wethers. And I think she was the inspiration for me to go into medicine, because I used to love to go to her office and smell, at the time doctors’ offices smelled like rubbing alcohol, and for some reason I just loved to smell fresh and clean. And I would hear how she helped people feel better, and I really think that had something to do with my inner energies and spirits.

I became a candy striper at Columbia Presbyterian, and then I entered college as a premed. And one interesting thing, when I was in high school, my high school vice principal and history teacher told my mother, make sure she takes typing, because Black people don’t become doctors. But I already knew better, because I had Dr. Wethers. So I’ve just had a wonderful life journey into premed, medical, and practicing.

Kevin Pho: So you’re an obstetrician-gynecologist. How’s your practice, and what’s life like today as an obstetrician-gynecologist?

Melody McCloud: Well, actually, in the last few years, I hate to use the word retired, but I’ve stepped away from active clinical practice, and I’m doing writing, public speaking, some lecturing, some media appearances. But I do miss the active practice of medicine, even though it’s a whole different animal out there now.

You know, I’m old school, so I’m kind of a purist for our profession and a fierce protector of it. So, but my patients miss me, and I miss surgery, I miss all that. But I’m still involved. Of course I keep up with everything, and I do lectures, I try to lecture to the communities and different organizations and to medical schools too.

Kevin Pho: Yeah, so tell me about that transition into a personality where you do that speaking, do that writing. I know a lot of physicians do that outside of clinical medicine, so tell me a little about that transition.

Melody McCloud: Well, actually, even while I was practicing, Emory, which is where I trained, and then I had my own private practice, which is kind of a novelty these days, to have your private practice. But I had an independent practice, I always wanted to hang out my own shingle, and I did that. Had two patients the first day, one at 9:30 and one at 3, and I thought, I was like, oh cool, but that didn’t last long.

So anyway, as a result of my practicing and my patient care, Emory began to send me out to CNN to do TalkBack Live and talk about things like that. So that was kind of the beginning of my doing some public speaking and appearing in the media. And I’ve always loved to write, and so I kind of began to start writing, and from my lecturing, one thing just kind of led to another, and that’s how some books came about, and more public speaking as a result of the books, some public speaking activities came about.

But again, it’s great, but it’s still not the hands-on experience of surgery and patient care. And I’m still in touch with a lot of my patients.

Kevin Pho: And I think a lot of physicians, I always advocate for them to be involved with the media, because they’re going to have a much bigger platform to share their health message. So if you were to offer one tip for those physicians who want to break into the media, what would that one tip be?

Melody McCloud: Oh my, you’re the one who should say that, because you’ve kind of done that whole thing. I would say, one, just make sure that your professional career is intact, hopefully without blemish.

And something I didn’t do, which really is, maybe get a publicist or agent. I really haven’t done that, and I need probably to even do that now, even with my books. The publishers did some stuff, but I would say get someone if you want to get on out there.

And again, I’m an old school lady, so social media is the place to be, as you well know. And if that’s your thing, either do it yourself or hire someone to maybe start putting you out there on social media, because that seems to be what the issue is, even with me and my books. I’m not really on social media a lot, but they kind of want you to follow a zillion people and get followers.

So right now, in this day and time, make sure you’re a physician in good standing, have someone prepare your presentation for you, your media kit, and maybe get a good agent or a publicist, and hire someone to do some social media posting for you, to get your name out there.

Kevin Pho: All right. Let’s talk about your KevinMD article, titled “Breaking down the link between social rejection and Black women’s health outcomes.” For those who didn’t get a chance to read your article, tell us what it’s about.

Melody McCloud: Well, as a physician, of course, I’ve taken care of women of all walks of life, Black, white, Hispanic, Asian, Native American, across the board. But as we hear, there are different issues that are facing Black women that truthfully other women are not going through.

And in my speaking to women in public and going to different seminars, I would hear, yeah, be happy and this and the other, but what about the crap that’s coming to us as Black women? So some of these things are causing anger, emotional pain, affecting our mental health.

You may have heard the term recently, microaggressions, and for people who don’t know what that is, it’s kind of these little snide things that people say to us as Black women. And it’s a fact. I mean, I get followed when I go into a little gift shop. I have to tell someone, I’m not going to steal your little card with two little earrings on there for $20. So it still happens.

And so, some of these things, such as, and this is a little insight into the Black community, there’s still a thing called colorism, where people in my color, more brown, more chocolate, OK, are not as favorably looked upon as the lighter skinned Black women. OK? It’s called colorism, and it happens even with marriages. OK, that’s a problem. And also, too, historically, lighter skinned Blacks were deemed less threatening than brown skinned Blacks. So that’s one, colorism.

I feel too, pop lyrics, some of the language in there is very misogynistic, calling people out of their names. That’s a problem.

We have very low marriage statistics in the Black community, and that affects your psyche, being desirable to somebody.

Our natural beauty is rejected. It’s so funny, quite honestly, to many of us as Black people, that we don’t have to bake out in the sun to get some color, but white people do, and other people do. So why is our natural skin color rejected, but yet people are working hard, spending millions of dollars a year in tanning booths to get what we already naturally have? I say our skin was naturally kissed by the sun, my God.

Also, if we get upset about something or respond to something other people said, we’re being a B, or we’re being evil. But all these things are negativities that come at us, truthfully. And what happens is, that can cause emotional pain, affect your self-esteem, it can make you angry, because you’re trying to do the best you can.

Quite honestly, even with school, people don’t like to hear this, but as a Black person, and not so much with Asians, because Asians are like the top of the class many times, but with Blacks, you have to prove yourself. You have to be better, in many instances, to be deemed worthy to be there at all. OK? So it’s this pressure, this kind of tax.

So those things can cause anger and pain. And with that, as the American Heart Association just came out with an article about anger and heart health, that causes stress. As you know, stress and cortisol hormones go up, endorphins go down, and all of that can affect your heart, your blood pressure, and they cause obesity, overeating, stress eating. And all of those things really in turn are conditions that can lead to serious heart disease, heart attack, stroke, diabetes, and even death.

Kevin Pho: Now, when you were seeing patients, did you bring up some of these cultural microaggressions that the Black community may have experienced? And how did you address that when you were seeing patients in the exam room?

Melody McCloud: Actually, I didn’t have to do that so much at the time. When I first began practicing, I was the first Black female OB/GYN to set up a practice in DeKalb County, Georgia. And as a result of that, I naturally drew a lot of Black patients from the get-go, OK? And so maybe it didn’t come up, because we were just talking about our own lives. Now that I think about it, in retrospect, yes, we were discussing microaggressions and things that we experienced, and I just tried to be supportive of my patients in that.

And also, too, as a physician, I’ve experienced some racial attitudes. I’ll never forget a few cases, but one in particular. A patient had been flown into an Emory hospital in the wee hours of the morning, or maybe like right around midnight or so. She had what we believed was a ruptured ectopic pregnancy. The patient was kind of in and out, because she was unconscious, because her H and H, or hemoglobin, hematocrit, were terribly low.

And so they had told her husband that Dr. McCloud is on her way. I was the GYN on call for the ER that night. And so when I got there and I walk in the room, I’m ready to go, because this patient’s critical. And sure enough, he said to me, you’re the doctor? You’re the doctor? Oh no, we’re not having some Black doctor operate on my wife. And here we have a patient who’s practically unconscious, in and out. And so it happens. It happens, and I just want people to be aware of that. It still happens in many instances.

Kevin Pho: What about those clinicians who may not have the lived experience of the Black community? How can they be more culturally sensitive to some of the issues that you bring up?

Melody McCloud: Thank you for that. You may have heard recently this phrase of implicit bias. OK? You may not realize, some of the things that are said to a Black person or person of color, an Indian or whoever, Hispanic even, it may affect them in a certain way.

And also, too, there unfortunately has been a distrust in the Black community towards medical professionals. Not only because of the syphilis situation years ago with Tuskegee, but some of these stories are passed down. Dr. J. Marion Sims, he’s deemed the father of gynecology. He is the one who created the speculum that’s used, the bivalve speculum that we use. Also, back in his day, in the 1800s, he perfected repairs of a vesicovaginal fistula by operating on enslaved Black women without anesthesia.

OK? And if you look this up, it’s well known. He perfected that by operating without anesthesia on enslaved Black women, so that when he operated on white people he gave them anesthesia. So just think of that pain. And these stories are still passed down in the Black community.

So I would encourage non-Blacks to just be mindful of these things, and be mindful that there may be some distrust, some suspicion. Are you really looking at me as a patient? Are you offering me the same care and tests, procedures? It’s a fact, when many Blacks go to the ER they may not be considered for heart disease as others might be. So just please, just be equal and fair in how you treat all patients, all patients, and be aware that we may have some of these sensitivities in our mind, and just show us the same respect that you show other people.

Kevin Pho: So knowing that there may be an inherent distrust in the Black community when it comes to the medical profession, other than being mindful, are there any questions that we can ask our patients, anything that we can say to build that trust back up again?

Melody McCloud: I would say take the time, and maybe even ask them, do you have any concerns that I haven’t addressed for you? Just something maybe even as basic and simple as that, OK?

A lot of being a physician, you want to make the patient comfortable with you. And again, we’re in a time of short visits, 10 minutes at the most, some people don’t even want to examine patients anymore. I don’t like the way a lot of medicine is going these days, driving me crazy.

So I would just say, just try to keep in mind the sensitivity your patient may have, and ask them, is there something on your mind? How are you feeling about some of the issues going on in our society today? That’s an open-ended question, and hopefully they’ll tell you, I’m a little stressed out by X, Y, or Z. OK, is there something I can do for you, or anything I can address that you would like me to? Just open up a question, an open-ended question, to your patients regardless of their walk of life, but especially to women of color, and men too.

Kevin Pho: Now how about outside the exam room? Are you aware of any successful community initiatives that have helped improve the health outcomes in ethnic minority populations, anything to successfully tackle the challenges of these health disparities?

Melody McCloud: Well, I will say that last year I actually had the honor of addressing a CME at Boston University School of Medicine. It was held on Hilton Head Island, which is a great place to hold CMEs, if anyone wants to come on down. And I actually presented to mostly white, in fact I think last year our audience was totally white, maybe some Indians, but it’s mostly white audience.

I presented the story of Dr. Rebecca Lee Crumpler, and for those who don’t know, Dr. Rebecca Lee Crumpler was the first Black female physician in the United States, and she graduated from what became, bless her heart, Boston University School of Medicine. OK? At the time it was called the New England Female Medical College. And she graduated as the Civil War raged, in 1864, she graduated from what is now BU School of Medicine. And then she went to Virginia to treat recently freed slaves that the white doctors did not want to touch. She did that in 1865.

So one thing is, people like myself, I’m trying to get the word out even about her history and bringing it forward to today, because she caught hell, as I say. Even some white physicians then disrespected her, pharmacists didn’t want to honor her prescriptions, she was denied hospital privileges at times. In fact, I did a segment on NBC Nightly News about her, because she finally got a headstone a couple years ago up in Boston.

So allow for people like myself to advance some of the stories at your conferences, things like that. And also, I wrote a book, Black Women’s Wellness, that actually addresses a lot of health issues. I encourage you to get it, OK? Because in there I get into looking at the disparities, and I have comparative data of everybody, Black, white, Hispanic, Asian, Native American women. Comparatively look at the data and realize some of these factors.

Yes, we know about lack of access to care, yes, we know about lack of insurance, but the fact is, even for those with those things, there’s still a big gap in disparity. And I think that’s where the anger and the social aggressions, I call it societal stress and Black women’s health, the rejection connection. Why is it that, if you have insurance, you have access, you’re intelligent, you’re smart, you’re educated, but you still have these health issues? What is it? And I think it’s that psychosocial stress that’s affecting people. So I want people to be more aware of that, and I do that through my public speaking and through my writing and through this book Black Women’s Wellness, that was endorsed by Dr. Jen Ashton and Paul Washington, by the way, if I can say that.

Kevin Pho: Now, how about from the patient standpoint? You talk about some of these historical traumas that some in the Black community have. What can they do as patients, if they become aware of this connection, what can they do?

Melody McCloud: Well, one thing in the book, again, I start out telling patients in my writing, one, go in, you have to be your best advocate, especially in this day and time. OK? You have to just be engaged with your own health care.

And in the beginning of my book I have a family medical history checklist, so look and see where you’re starting from. Who had diabetes, heart disease, kidney, stroke, Alzheimer’s? So I have this checklist for that. Also, in the back of the book I have a personal inventory. Go ahead and kind of look at yourself, do you have lesions, do you have whatever, take that to your doctor.

I tell people to go armed with some questions written down, because you get to the doctor’s office, you’re a little nervous, and you may feel rushed by the physician or the PA or whoever’s there. But you are the patient. And I know it’s tough in this day and time, but I encourage people, go with your questions written down and just say, no, I’m sorry, please, before you leave, can you please answer this for me? OK?

Also, I encourage people to take someone with you to the doctor’s office who may have some medical training, because they may hear something that you don’t hear, or they may ask a question that you don’t even know to ask.

And I tell people also, don’t tell me you don’t have money, at least for one visit once a year. Right now in this society everybody’s celebrity driven, and they buy tickets to Taylor Swift or Beyoncé or whoever for hundreds, thousands of dollars, or they’re buying clothes or Jimmy Choo shoes, or get their hair and their nails done. You have money for one visit a year that could help save your life.

So those are some of the things that I tell people. I’m pretty straight up about personal responsibility, OK? And I put it on both. I put it on the physicians and other health care providers. I don’t use providers for physicians, keep that separate, we’re physicians. And I also encourage patients, you’ve got to be proactive, especially in this day and time.

I also tell people, get your medical records. Get your medical records. If you have a test done, get the report, because sometimes the office may not get back in touch with you. Make sure you follow up.

Kevin Pho: We’re talking to Melody McCloud. She’s an obstetrician-gynecologist. Today’s KevinMD article is “Breaking down the link between social rejection and Black women’s health outcomes.” Melody, let’s end with some of your take-home messages to the KevinMD audience.

Melody McCloud: Thank you. I would say, overall, in general, as physicians and medical professionals, to have a patient come to us is a great honor. We are in a noble profession. To have a patient entrust their body to you is an honor, and I want doctors and other health care professionals to walk worthy of that to which we are called. And I really feel it’s a calling.

I want you to take care of the patient, not the procedures of an insurance company. I want you to document, don’t just rely on check boxes in the electronic medical record. I’m for narrative notes. Tell the patient’s story. Make eye contact with the patient. Examine the patient. Look at the patient, don’t just, even with their clothes on, I mean, how do you know the woman doesn’t have bruises on her back if you don’t see the skin?

So I want us to be responsible and walk worthy of the profession to which we are called. And as it pertains to this particular topic of Black women or whatever, I encourage you to get Black Women’s Wellness, because I give information in there for everybody. Look at the data, look at the comparative data, look at the pains we suffer. And you may see things in there that open your eyes and awareness to how we feel as patients, and as your Black colleagues in the workforce.

Kevin Pho: Melody, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Melody McCloud: Thank you so much for having me, and thank you for all the work you do in getting word out to everyone. Thank you.