Diversity and Dialysis


By Gordon Lore

Several years ago, Vanderbilt University’s School of Nursing presented a program in which nurses discussed “the impact of diversity on the healthcare system.” They traced the demographics of underrepresented patients and their rise in the U.S. population.  

During the last two decades of the 20th century, the White population in the United States increased by only 10 percent while Hispanics shot up by a whopping 125 percent. For the first time, Hispanics became the largest minority group, comprising 13 percent of the overall population. When you throw into the mix the numerous other minority groups, it becomes obvious that the American population is becoming increasingly diverse. Underrepresented groups comprise 30 percent of the overall demographics. By 2030, that number is expected to increase to 40 percent.

It is also clear that the workforce has not kept up with the changing demographics. Physicians from underrepresented groups comprise only 7 percent of the current healthcare workforce with nurses and pharmacists logging in at only 3 percent. And minority groups are less likely to receive dialysis treatments or kidney transplants.

Healthcare Disparities

Dee M. Baldwin, PhD, RN, FAAN, the Executive Director of Georgia’s Office of Women’s Health, added that “disparities in health and healthcare have been around for more than two centuries [and] continue to be problematic, with little progress made to eliminate them over time.”

“It is well documented that ethnic/racial minorities are disproportionately affected by many healthcare conditions that impact their health…,” Baldwin remarked. Among the reasons for this are:

  • No health insurance;
  • Health behavior;
  • Less access to healthcare;
  • Environmental factors;
  • Discrimination;
  •  Lack of transportation; and
  • Remote geographical locations.

Patient/Doctor Communication

Many minority patients have reported that a big problem in eliminating the obstacles to adequate healthcare involved patient/doctor communication. Baldwin indicated that many patients “mistrusted the system…” They harbored the feeling that the doctor did not listen to them about their chief complaint(s).

“Framing the… discussion around the distinctiveness related to disparities in… healthcare is [necessary] for finding effective solutions to eliminate unequal burdens in health status,” Dr. Baldwin concluded.

As the Founding Editor of the Renal Support Network’s KidneyTimes e-journal, I had the pleasure of working with Margaret S. Washington, MSW, MSPH, on an article she authored on improving communication between the nephrologist and kidney patient. Washington is a vivacious, dedicated, highly energetic woman who has spent several decades of her professional life caring for kidney disease patients. For 23 years, she was the Executive Director of an ESRD Network of 160 dialysis facilities and 10 renal transplant centers. Washington is also the author of "Doctor, Can You Hear Me?  Patient, Are You Listening?" Her many years of experience have taught her that cultural differences can play a major role in doctor/patient communication.

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