How strong a role did your childhood play in your career?
It played a huge role. Although I grew up in a privileged household, I saw a lot of poverty and many children who were sick. I always thought I’d be a pediatrician and I went to medical school with that in mind. But I didn’t like pediatrics, watching children suffer so much. I did like the variety of internal medicine. It was intellectually interesting, and I liked getting to know people over many years.
I also knew I wanted to do something that wasn’t just clinical practice, so I got a master’s in public health. I didn’t think I was going to be a researcher, frankly. I thought I might be an activist or maybe a public official. I thought research was something that took you away from people, and I wanted to interact with people.
When did you become aware of racial and ethnic barriers in health care?
I grew up in Liberia and never felt like I was a minority. There was socializing across racial groups, and I went to international schools. When I came to the United States for college [at Emory University in Atlanta], things were separate. There were black sororities and white sororities. It was a little different, but I felt comfortable because there were similarities between my cultural background and that of many of the African-American students.
When I got to Baltimore for my residency [at the University of Maryland], where most of our patients were minorities, I noticed that there was mistrust of the health care system in the surrounding community. Patients would say, Some doctor told me to take this medicine, but he didn’t tell me how much it would cost or where I’d get it, then I couldn’t afford it and I didn’t know what it was for anyway. Patients would use vernacular language and I was expected to interpret, because most of the people delivering the care were not minorities. The differences between the patients and the staff were pronounced and, while I think most people were well meaning, there were misunderstandings and a lot of assumptions being made.
And this led to your research?
I came here as a fellow knowing I wanted to help patients on a broader level than just one on one. I was interested in different cultures, but I didn’t know I wanted to make it a career. I was keeping my options open because I’m a generalist by nature. As I talked to the faculty about research, I realized it was a way I could make a difference—I could look at why things weren’t working well for certain people in the health care system.
My mentor during my fellowship was Dan Ford, now the vice dean for clinical investigation, and he helped me formulate my first research project. We discovered that minorities are more likely to seek help for depression from a primary care doctor than from a mental health professional. Later, we found that African Americans viewed depression as a spiritual illness and, therefore, were less inclined to take medication for it. Also, we found that African Americans rated their relationships with primary care physicians as the most important factor in their decision to get help for depression. This led me to pursue my next line of inquiry, the patient-physician relationship, with the goal of overcoming racial differences in care more broadly. We found that when patients see doctors of the same race, they feel more involved in decision making. We published those results in JAMA in 1999, which was a pivotal point for my work in the area we now call disparities research.
What are you working on now?
I’m the lead researcher on two randomized controlled trials. One examines whether teaching communication skills to doctors and patients with hypertension affects adherence to treatment. The other is looking at how teaching doctors patient-centered care affects African-American patients with depression.
As the first black female professor at the School of Medicine, do you feel a sense of responsibility?
As a person blessed with opportunities, I have always felt responsible, that I was going to need to give back. I assumed that was going to be in Africa, but the political situation kept me in the States. My sense of giving back to the community is still there, whether it is to other health professionals in the pipeline, particularly people from under-represented backgrounds, or to the patient populations whose needs I am trying to make a priority.
Do you have any notion of why you were first?
I didn’t take the typical career path to become a professor, in that my research is more population-based and policy-oriented. As to why I was first, I think partly that was due to my mentors, having people who really believed in me and invested time in me. It may also have happened because I began doing this work at a time when our society and medicine as a profession were both poised to use it.
Do you think Hopkins’ efforts in diversity have been successful?
There’s a lot more work to be done. Even though we’ve had success among medical students, where 12 percent to 14 percent of the class is now under-represented minorities, the numbers start to drop off from residency to fellowship to faculty, where the number is 5 percent or less, depending on the department.
Why is that?
Minorities don’t stay in academia for a variety of reasons. One is financial. To have an academic career, you have to put off financial gratification for quite a while. Another is the perception that the environment is not welcoming. But we’re working on that. I chair the Diversity Council for the Department of Medicine and work on school-wide efforts as well.
How do we make things better?
By connecting people with good mentors, making sure they’re part of a network, making sure they feel valued and are contributing to the clinical, research and teaching missions. Leadership behaviors are important, as well. People in decision-making roles need to be made more aware of how they set the tone for others.
Tell me what happened when you had to leave Liberia.
It was my 17th birthday and I was home from school on Easter break. I awoke to what sounded like firecrackers, but it was gunfire. There was a military take-over of the government that day. It felt surreal, almost like Sept. 11 felt here—you can’t believe this is happening. Someone called my father, who was the president’s personal physician, in the middle of the night and told him the president’s life was endangered. The next morning we found out the president had been assassinated. Within a couple of weeks, they rounded up the Cabinet and shot them by firing squad on the beach. Many of them were my friends’ parents. It was the most horrendous thing. I left for the States to be with my older brother. Later, my parents did make it out safely.
Now you’ve won a MacArthur fellowship, a $500,000 grant to use in any way you choose.
I still don’t know how I will use the money. I’m somewhat overwhelmed. I became a full professor on June 1, I got married on Aug. 5 and then I got this phone call in September. At first he said he was a reporter checking on a rumor that I was getting a MacArthur. Then he told me who he really was and I asked him to spell his name. I looked him up online. Still, I thought it might be a hoax. But he told me I’d get a package by FedEx and when I did, it began to sink in. This has been an incredible year!
—Mary Ellen Miller