Representation Matters

2
Dr. Katasha Butler

I've held many roles in my pharmacy career that has spanned seventeen years now. I've been in formal leadership roles for more than fifteen years out of those seventeen. 

I've worked in many places, doing many different types of work in pharmacy. I've worked in FQHC clinics serving the underserved and underinsured. I've worked for for-profit corporations where I did a lot of business travel in 5-diamond hotels and black car service. I've worked in hospitals where the mission and ministry was to serve the people as Jesus served when He walked the Earth.

I've worked for the federal government serving our nation's veterans and I find myself, right now, back in serving the underserved population — the least, the lost, the last and the left out.  It has become a personal mission of mine and gives me the ultimate in job satisfaction. It brings purpose to what I do every day as a pharmacist. 

Out of all of those roles I've held, this one and one previous role in retail pharmacy has been very significant and impactful to me. I graduated from a prestigious, private pharmacy school that was very pricey, and, frankly, there were not a lot of people who looked like me when I was matriculating, especially in the pharmacy program.

I took a job at the local retail pharmacy that was close to the school campus and it happened to be in the “hood” — a very urban and blighted area. I spent many, many years working at that pharmacy, even after I graduated.  Of course, I had other opportunities to work in the more desirable areas of the city, but this particular store at 38th and Illinois always felt like home. 

Other pharmacies like it — at 18th and Illinois, 38th and Emerson — those stores felt like home to me, too, and the reason why they felt like home is because I was around my people and I was actually doing good in the community. MY people who came into that pharmacy really needed my help and they trusted my expertise. 

Why was this? 

The pharmacist was the only health care professional and resource that they could get to in their time of need. We had a wonderfully diverse crew that worked there and we were like family. 

One of the things that I noticed when I first started working at that particular pharmacy was that a lot of customers came in to grocery shop. I couldn't understand it in the beginning because food shopping in a neighborhood pharmacy is very expensive. Knowing the neighborhood that I was in, I often questioned why they would spend their money here in that way. 

I soon figured out that they grocery shopped in the pharmacy because that was all that they could get to! I worked right in the midst of a food desert; this was the only place that they could conduct their business just to meet their daily nutritional needs. It was also the place they utilized when they needed support in their healthcare. This was where I came in as a Black healthcare professional.

I encountered so many patients there that I still remember to this day, many of them no longer with us: 

Mr. Martindale.

Ms. Gaither.

Mr. Robinson.

Mr. Neely. 

Ms. Bradley. 

Each of them with their individual conditions, medications, concerns and questions. They would come to me and the other pharmacists there with issues that I'm sure they would have talked with their physician about, had they been able to get to the doctor's office. Thankfully, with my advanced training as a PharmD, I was able to help. 

I talked them through saving money on their medications so they could afford to buy and take all that they needed. I would help them come up with over-the-counter remedies that they didn't know about. One of the key things I would always tell my patients there was this: 

“I wouldn't recommend anything to you that I wouldn't recommend to my own grandmother and you know that I love her dearly!  I care about you, too.” 

We built up a natural rapport. They became comfortable with me and easy to work with because they trusted me. I know beyond a shadow of a doubt that it was because I looked like them and could speak their language.  Even in the times that I had to be stern with them, they trusted me and took my advice. 

So, what? 

Why was my personal story of one of my favorite jobs important to this particular discussion? 

It's because that job taught me the importance of representation in healthcare and it forever colored my decision-making as a leader in the pharmacy space. 

At this point in 2020, we've all had the opportunity to educate ourselves on the healthcare disparities that COVID-19 has illuminated. It is a fact that underrepresented minorities oftentimes get the short end of the stick when it comes to their care. 

Massive, historical injustices in our populations, the impact of residential segregation, and the entrenched disinvestment in our communities have long led to the disenfranchisement of our people. The same social determinants of health place Black people at higher risk for many chronic illnesses like heart disease, hypertension, diabetes, asthma, COPD, and now, COVID. 

Where we live, where we work, and where we play drive most of our health outcomes. Underrepresented minorities are more likely to live in areas with high population density, sub-standard housing, and a lack of access to resources like healthy foods and doctor's offices.  Many physicians remain unaware of their unconscious racial biases, according to a study published in the American Journal of Public Health in March 2012. This was even with doctors who served in the inner city and has a vested interest in serving underprivileged communities!  

Just think about that for a minute.  

Racial biases in healthcare influence the way providers communicate with their patients of color. A number of studies have shown that physicians are reluctant to give Black patients strong doses of pain medicine or any pain medication at all. Physicians are less likely to monitor the pain of our children with sickle cell anemia or to give Black men in the ED with chest pain complaints diagnostic testing such as cardiac monitoring and chest X-rays.  A 2010 University of Michigan study even found that Black patients referred to pain clinics received roughly half the amount of drugs that White patients received.

In the past twenty years, thousands of studies have proven that Black people receive lower quality medical care than Whites, independent of disease status, setting, insurance and other clinically relevant factors.  This is why representation matters!

Click on the image below for a larger view of the many obstacles, as shown in this Fishbone diagram:

Credit: Julie Savage-Fournier, P. Eng, M. Eng., Multipurpose Atypical Engineer Supporting Healthcare Executives

I'm a minority and, oftentimes, I am the only in a particular space. I have been in this position since elementary school and it is not something that I relish in or take pride in. I'm not the only smart, Black girl and there are many who can do what I can do. There are even some who can do what I can do much better. 

As a pharmacy leader and one who is often in a position to make hiring decisions, it is my job to illuminate and champion why we owe it to our patients and ourselves to build a diverse workforce in healthcare.

In one organization, I hired one particular young lady as a pharmacist and I only gave her an interview because she was an HBCU grad. She didn't have the depth and breadth of experience as some of the other candidates, but I was committed to making sure my team was diverse and inclusive. I offered her interview and ultimately, she got into that interview and knocked it out of the park. 

She was an excellent candidate beyond what her resume told us and she was selected by the committee for the role and became a valued and trusted member of the team. The way she cared for people and our patients was phenomenal. 

I shared with her later my thoughts, hiring process and the reason why I granted her the interview. I also implored her to pay it forward when she was in a position to do the same. I thought it was important enough to give her that opportunity because our patients deserve a chance to receive care with them in mind and is not implicitly biased against them. 

When we have an inclusive workforce, everyone wins. 

Trust, respect, rapport and comfort with your healthcare provider is integral to better outcomes. It gives our patients a certain level of comfort.  They can ask more questions. They can feel better about the fact that the provider is advocating for them. 

I have my own personal experience with a scary diagnosis that I know for a fact would not have been caught if my OB/GYN was not a Black woman and my friend. 

My own outcome could have been very different but that level of comfort that we had between us from one Black girl to another made sure that I had the best outcome possible. I always want to keep this principle at the forefront, even if I'm not the person making hiring decisions as a part of the leadership team. I'm always going to advocate for diversity and inclusion.  It is necessary as we aim to deliver culturally appropriate care and create a welcoming environment for all our patients.  It honors our commitment to serving all people with special attention to those who are poor and vulnerable.

What YOU can do: If you are in a leadership role in healthcare, make sure you champion diversity and inclusion. When evaluating candidates, look beyond the technical skills and look at additional factors when determining who should join your team. 

A diverse and inclusive team will outperform a homogenous team at every endeavor. 

If we are going to improve health, alleviate health disparities, increase hope and advance healing for all, we must celebrate the diverse backgrounds, cultures, and experiences of our patients and colleagues alike and we have to relish in the opportunities to learn and grow from new perspectives.  That's if we want to be of service in the best way possible.  Representation matters.

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Katasha S. Butler, PharmD, MBA, is the Coordinator for Medication Use and Regulatory Compliance at Eskenazi Health in Indianapolis, Indiana. The Danville native also owns The Conciergerie, a special event agency and is the former owner of Social, an event venue and banquet hall in downtown Danville. She studied Chemistry at Spelman College in Atlanta and went on to obtain her Master of Business Administration in Leadership and Doctor of Pharmacy degree at Butler University.

2 Comments
  1. Cynthia says

    Good Morning , Dr.Katsha Butler
    To Read This Is To Believe This
    To Know you is To Love You Black Woman
    To Trust You!!
    I remember as you shared with me
    This is just as effective as this medication
    I Wouldn’t recommend anything like I wouldn’t recommend to my own Mother…( you said this)
    Representation is much need weather some see and are yet to appreciate ….
    You made the trust of you as the Black Health Care Professionalisms Caring for the poor as the wealthy .
    Be felt Deep & Trusting…
    Thank You Black Woman… in Love & Gratitude
    Forever Blessing for your Career
    cgroves-Grant

  2. Jeff Welch says

    Representation does indeed matter!

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