Cultural Humility, Pioneering Leadership Are Key to Address Health Disparities

Valerie Montgomery Rice, MD | Image Credit: msm.edu

Valerie C. Montgomery Rice, MD, FACOG, is a distinguished infertility specialist and researcher, renowned for her exceptional contributions to the field of medicine. She earned her bachelor's degree in chemistry from the Georgia Institute of Technology and furthered her education with a medical degree from Harvard Medical School.

In addition to her clinical and research achievements, Rice is a dedicated educator and mentor. Her talk at the American Society for Reproductive Medicine (ASRM) 2023 Scientific Congress & Expo in New Orleans, Louisiana, reflects her vast experience and wisdom in the medical field. Rice's impact as a practitioner, educator, and leader underscores her significant influence on health care.

Completing her residency at Emory University and a fellowship at Wayne State University, Rice honed her expertise in infertility treatments. Her work not only expanded medical knowledge but also brought hope to numerous families struggling with infertility.

In her presentation, "Somewhere Over the Rainbow: Lessons in Leadership," Rice used a SOAP (subjective, objective, assessment, and plan) note for the basis of her message: strong leadership to improve health care and mitigate disparities.

Seeing Everyone (Being Seen)

Rice illustrated the improvement of health alongside the improvement of socioeconomic status, using the example of giving antibiotics to a patient—it improves their health, but not their socioeconomic status.

“When I first think about mentorship in this way,” Rice said, “I think about the first step of mentorship as being seen—somebody actually sees me and cares enough about me to invest in me.”

She elaborated on the mentors who guided and inspired her throughout her career, emphasizing the difference it made for her as a Black woman who spent her summers as a young girl with a single parent in Wrens and growing up in Macon, Georgia. Since she’s been in a position of leadership, she explained that she’s never gone without an executive coach.

“I really thought that it was important to learn more about people, and empowering people, and supporting people because that's where leadership really matters.”

Rice shared a slide presenting the different roles she’s had throughout her life on a public health graph, and in looking at her own life she acknowledged that those were the aspects that increased her socioeconomic status along the way. “This was the equalizer,” she explained.

Operating in the Moment with Humility

"Cultural humility means admitting that one does not know what one does not know and is willing to learn from patients about their experiences while being aware of one's own embeddedness in culture,” Rice said. “While competence suggests mastery, humility refers to an intrapersonal and interpersonal approach that cultivates person-centered care.”

She explained that she tells her medical students and residents to ask a simple question: “Based on who’s sitting in front of me, what’s possible?”

“It automatically forces you to put yourself second and the patient first,” Rice said. “And then you begin to automatically ask those questions that used to be the review of systems.”

In OBGYN, reproductive endocrinology, and infertility, it’s the reassurance of care that makes the difference, according to Rice. However, it’s also the cultural competence that makes the difference.

“It also matters how people are trained, and the environment in which they're trained in,” she said.

Rice reviewed a statistic: 34% of patients who saw a doctor of the same race had then documented care.

“I think you have to have both cultural humility and cultural competence, particularly if we're talking about being lifelong learners, we're talking about self-reflective,” she explained.

Acknowledging the Past and Appreciating our Differences

Rice underscored the urgent need for acknowledgment and introspection within the medical community, shedding light on the unsettling chapters of history that often go overlooked. She emphasized the importance of confronting this history—a history that includes disturbing instances like the Henrietta Lacks story and the Guatemala syphilis experiments.

“We do have a dark history in this country, and we need to acknowledge that and decide what we learned from,” she said.

Inequity in terms of pain management based on skin tone is still occurring in health care today. The history of gynecology is not without blame, but it needs to be acknowledged in order to avoid repeating the chapters that shouldn’t be repeated, Rice said.

She explained that there are numerous studies looking at race and gender to improve business outcomes, but mentions one in particular that showed the team with the most diverse backgrounds, experiences, and ways of thinking was able to approach a problem from multiple angles and complete the task more quickly than the others.

“I think it adds to the richness of the solution, and ensures that the solution that comes about is going to be more applicable to more people,” Rice said. “So, diversity does matter in thought, distance traveled matters in how people think about solutions.”

Putting What's Learned Into Practice

Rice issued a call to action for the entire health care community. Addressing disparities requires a collective effort, from policymakers shaping health care policies to individual providers at the bedside. It demands self-reflection, continuous education, and advocacy for equitable access to health care for all.

"We are envisioning a healthier future," Rice said. "It is very important. So, I go back to my SOAP note: Seeing everyone, operating in the moment with humility, acknowledging our past, appreciating our differences, applying what we know and learn, pausing to appreciate what we know and learn, and putting what we learned into practice."