By - May 04, 2023
When she was in medical school in China, Yi-Hua Chen, MD, discovered an interest in pathology, which was further fostered during residency and hematopathology fellowship at Northwestern Memorial Hospital (NMH) in Chicago. Now a hematopathologist and serving as director of the Hematopathology Division and Medical Director of the Hematology Laboratory at NMH, Dr. Chen shares her thoughts on her career in the laboratory, and needed changes in healthcare to better serve the AAPI community.
I am a hematopathologist currently serving as the director of Hematopathology Division and Medical Director of Hematology Laboratory at Northwestern Memorial Hospital (NMH) in Chicago. My interest in pathology dates back to my medical school days in China where the pathology course was taught through both lectures and microscopic sessions in the lab. The rigorous AP/CP residency and Hematopathology fellowship training at NMH further enhanced my understanding of the critical role of Laboratory Medicine in patient care. Witnessing the rapid advances in laboratory medicine has been truly exciting. For example, multicolor flow cytometry immunophenotyping, cytogenetics/FISH, microarray analysis and next-generation sequencing have become integral parts of clinical workup for patients with hematologic malignancies, not only for diagnosis but also for risk stratification, evaluation of minimal residual disease and therapeutic targets. I have found working in this field tremendously rewarding, especially as a member of the patient care team, working closely with laboratory staff and clinical colleagues.
Asian Americans and Pacific Islanders (AAPIs) are one of the fastest-growing racial and ethnic groups in the U.S. However, they face several systemic healthcare challenges that negatively impact their health outcomes. These challenges include lack of health insurance, language and cultural barriers, limited access to healthcare services and lack of representation in healthcare leadership. AAPIs are less likely to have health insurance than other racial and ethnic groups, which limits their access to preventive care and timely medical treatment. This is particularly true for those with limited English proficiency, low-income and undocumented immigrants. Language and cultural barriers also make it difficult for AAPIs to communicate with healthcare providers, leading to misunderstanding and inadequate care.
The lack of representation of AAPIs in healthcare leadership also contributes to a lack of understanding of AAPI healthcare needs and disparity. Additionally, lack of cultural awareness among health providers further compromises AAPI’s healthcare. Studies have shown that Asian Americans are less likely to receive counseling about lifestyle or mental health issues, more often feel lack of understanding of their cultures from their physicians, and are less involved in decision making about their medical care. Despite the fact that AAPI is the fastest growing community in the U.S., it is one of the most understudied and underrepresented racial groups in clinical research and clinical trials. The COVID-19 pandemic and unprecedented level of anti-Asian hate crimes have further widened the disparities in health and healthcare among AAPI population.
Systemic and multilevel interventions are needed to reduce the health disparities and inequities in the U.S. Clinical laboratories can play key roles in bridging the gap and improving health equity. We need to raise awareness and have open discussions on health disparity within our own workforces, identify targets that laboratory intervention will have a direct impact on to reduce health disparities, and partner with clinical departments and community organizations to develop an actionable plan.
For example, cancer is the leading cause of death among Asian Americans. Chinese American immigrants have significantly higher incidences of H. pylori infection and stomach cancer than many other ethnic groups. Cervical cancer is also prevalent in certain subpopulations of AAPI women, but the Pap smear screening rate is much lower in these populations. Joint efforts of pathologists and laboratory staff with clinical colleagues and AAPI community organizations to develop outreach programs to address the importance of preventive medicine, such as screening tests to identify cancers at early, curable stages, will contribute to reducing disparities in cancer care in this population.
Another area of focus in clinical laboratories in recent years is the differences in normal reference ranges among different racial/ethnic groups. Studies have shown that reference intervals in Asian Americans are shifted to higher values in globulin and total protein and to lower values in creatinine, hemoglobin, and hematocrit. Incorporating racial/ethnicity factors into the consideration of establishing laboratory reference intervals may also have a significant impact on improving quality care.
As the percentage of racial and ethnic minority groups in the U.S. population continues to grow, our patient population and healthcare workforce have become more and more diverse. It is crucial for healthcare leadership to reflect this diversity at all levels. A diverse leadership team is more likely to have a deep understanding of the unique healthcare needs of diverse patient populations, and to develop programs and services that cater to these needs. While there is limited data on diversity in the leadership of clinical laboratories, healthcare systems in general continue to be predominantly led by white males in the U.S. Increasing diversity in healthcare leadership, not just in race and ethnicity but also gender and religion, will help ensure that healthcare services are delivered effectively and equitably to all patients.
At Northwestern Memorial Hospital, for example, about 60% of the Hematology laboratory staff come from minority groups. A diverse leadership team in pathology and laboratory medicine can foster a greater sense of relatedness, improve communication between leadership and laboratory staff, increase employee engagement and willingness to share their views and ideas, promote motivation for career development and advancement, and ensure that larger efforts are made to reduce healthcare disparities and inequities through laboratory services. This, in turn, will strengthen the laboratory workforce, increase employee retention and productivity and improve laboratory quality.
Director of Hematopathology