May 15, 2023
What to know before you see a gastroenterologist
Coverage is proud to publish columns featuring the perspectives of Black women physicians who belong to the Diva Docs network in Greater Boston. Today, Dr. Adjoa Anyane-Yeboa — a gastroenterologist at Massachusetts General Hospital, and an instructor in medicine at Harvard Medical School — shares her thoughts with Dr. Philomena Asante, leader of Diva Docs Boston, founder of The Black Women MD Network and creator of the award-winning Diva Docs series for Coverage.
I always knew I wanted to work with people, interact with people, and have an impact on people’s lives, and that’s what led me to medicine. I was inspired by my father, a physician who specializes in clinical genetics.
My first and most formative mentor was a Black gastroenterologist who I met during residency. She was the first of a line of Black women who have continued to mentor me throughout my career and even today. Working with her, and with others in gastroenterology, I knew I had found my people. I still feel that way today.
As a young resident, when I knew that my mentor saw me and cared about me as an individual, cared about my family, and what I do and who I am outside of the hospital, that allowed me to build a connection that enabled us to get closer. I needed to feel seen as a person, as a human.
Now when I work with others as a mentor, a mentee or collaborator, I try to develop these relationships because I know how important they are.
Where are the disparities?
A gastroenterologist treats all the symptoms and diseases affecting the digestive system, including the esophagus, the stomach, the pancreas, the small intestine, the large intestine, and rectum.
My work focuses on health equity in gastroenterology, specifically in colorectal cancer and inflammatory bowel disease, which include both ulcerative colitis and Crohn’s disease. Inflammatory bowel disease affects about 1% of adults in the U.S. and is associated with higher rates of a broad range of chronic and autoimmune conditions.
We see racial and ethnic disparities in access, treatment and outcomes for many gastrointestinal diseases, and there are no genetic or biological reasons for that. They stem from barriers to care with deep roots in structural racism
Inflammatory bowel disease can be treated with medication, surgery, or a combination. But Black IBD patients are less likely to be under the regular care of a gastroenterologist compared to white patients with IBD. Black patients with IBD are more likely to be seen in the ER, likely because they don’t have regular access to specialist care. They are more likely to be hospitalized and have longer hospital stays and higher readmission rates. Some research has suggested that Black IBD patients may also have more severe disease.
Colon cancer is the second leading cause of cancer death, and Black individuals have the highest incidence and mortality from colorectal cancer of all racial and ethnic groups. Risk factors for colorectal cancer include being overweight, low physical activity, high fat, low fiber diets, smoking, and alcohol to name a few. All of these risk factors are linked to social determinants of health, such as lower incomes, difficulty accessing good medical care, a lack of health insurance and neighborhoods that are in food deserts or have limited green space.
When to see a physician
First, it’s important for everyone to have a primary care provider to share in making decisions about your health care, help prevent your disease from developing or progressing, and help you choose the treatments most appropriate for you.
In terms of gastrointestinal issues, you should speak to your PCP if you have:
- Blood in your stool
- Frequent bouts of diarrhea
- Abdominal pain
- Nausea or vomiting
- New bouts of constipation
- Weight loss that’s unexplained
Your PCP may then refer you to a gastroenterologist for a colonoscopy to look at the bowel, and perhaps an endoscopy to look at the upper part of the digestive system.
Screening for colorectal cancer
As a physician, I’ve seen an increase in questions about screening since the tragic death of “Black Panther” star Chadwick Boseman. These kinds of conversations are so important – and it’s important to have them early.
When you reach the age 45, you should talk with your PCP about screening for colorectal cancer. And if you have a family history of colorectal cancer or advanced polyps, talk to your doctor about whether you should be screened earlier.
Keep in mind that there are many options to screen for colorectal cancer. Ask your PCP about stool-based testing that’s just as effective as a colonoscopy and can be done at home.
Your first visit with a gastroenterologist
In preparing for your first visit, think about the timeline of your symptoms:
- When did they start? Have they been consistent, or do they come and go? Are they getting worse?
- Are you losing weight?
- What physicians have you seen? What treatments have you tried? What’s worked and what hasn’t?
- If you’ve had tests or procedures done, bring records showing the results.
- Know your family history. Talk with your family members so you are aware if anyone in your family has had cancer or other issues that would put you at higher risk.
As a patient, it’s always important to know that you have a voice. You have power. You are your own best advocate. If you have any concerns, speak up!
Addressing health inequities
The medical community can help address the inequities in care that affect our patients.
For instance, we can be strategic and creative about how we deliver specialty care. We can meet patients where they are, including community health centers and community events, rather than just academic medical centers. My gastroenterology division sees patients at community health centers where there is also a cardiologist, a nephrologist and a pulmonologist – a creative and atypical model.
We should also ask patients about barriers they are facing and connect them to resources. We can start by asking questions like, “What matters to you? What do you want to talk about today?”
We can work to be aware of our own implicit biases. For example, an “implicit association test” can help us recognize our biases so we can actively work to counteract them in clinical encounters with our patients.
We can work to increase diversity in the medical field. Medical schools should evaluate how our value systems can lead to bias and disparities in who we are and are not recruiting
We should be mentors. Although Black gastroenterologists make up only 4% of our field, in our division at Mass General Hospital, we have four Black female attendings and three Black female fellows, living examples of the power of mentorship.
We have worked with other Black gastroenterologists in the field to create an organization called the Association of Black Gastroenterologists and Hepatologists or ABGH. That kind of community can help us build a more diverse pipeline into medical school, and provide mentors, sponsors and role models for the people coming after us. We give career advice and provide mentorship and research opportunities. We are lifting up and supporting the next generation of gastroenterologists.
The barriers we face are not insurmountable. Working together, as clinicians, educators and patients, we can overcome them