Adil Haider, MD, MPH, describes his role as director of BWH’s Center for Surgery and Public Health as his dream job. A prominent health services researcher and trauma surgeon, Haider has trained in the fields of surgery and public health, and his passion for both helped lead him to the Brigham.
The Center for Surgery and Public Health is a joint program with Harvard Medical School and the Harvard School of Public Health, founded in 2005 by Executive Director Michael Zinner, MD, BWH Surgery chair. Its mission is to advance the science of surgical care delivery by studying effectiveness, quality, equity and value at the population level, and to develop surgeon-scientists committed to excellence in these areas.
Haider recently shared his insights with BWH Bulletin.
Your research on disparities in patient outcomes forces us to confront our biases. What did you find when you looked at the data?
Implicit bias or unconscious preference—the attitudes or stereotypes that may affect our interactions—is not something you would typically associate with my area of medical practice (trauma surgery). But there are plenty of disparities in terms of patient outcomes in fields such as cancer care, where early access to care may differ. But what could possibly explain differences in outcomes after trauma surgery?
In our first paper on the subject, we found differences in outcomes for children after surgery; minority children had worse outcomes in their ability to eat, talk and walk after having an injury than white children. When we looked at a larger database of adults, we found that for black patients, risk of death after surgery increased by about 20 percent, and for Hispanic patients, risk went up by 50 percent.
We all knew something was going on; we wanted to understand why.
What accounts for these disparities?
I believe that people don’t go into trauma surgery or any other field of medicine to treat people differently, but individuals may have an unconscious preference without even realizing it.
That’s why we started looking at unconscious bias as one of several potential mechanisms. We raised this as a question, and we’re now trying to answer it.
Are there other mechanisms that might explain differences in patient outcomes?
An additional mechanism we’re studying are differences in empathy. How we relate to a person based on how they look may influence the degree and extent of our involvement in their care. We are trying to quantify that. We are also looking at mindfulness—the difference between telling someone to “eat more fruits and vegetables” before sending them on their way and inquiring about their home environment and community to understand their ability to access fresh produce. By getting to know my patients, I’ve learned so much about myself.
How did you become a trauma surgeon with an interest in public health?
When I was 6 years old, I wanted to be a trauma surgeon because of a TV show called “Trapper John,” a spinoff from “MASH” about this guy who could fix anything. Later on, I also understood the impact of public health, which is why I pursued a master’s of public health degree right after medical school.
During my trauma fellowship, I went to Africa and spent many nights operating nonstop. I loved it and thought I was making a big difference and began to make plans to work overseas. But when I got home to Baltimore, my mentor said, “You don’t need to go to Africa to take care of people who could use your help. They are right here.” I started getting to know my patients better. And that’s when I started thinking about disparities and solutions to eradicate them.
Why did you accept the position of kessler director of the Center for Surgery and Public Health?
Meeting the team here was extremely inspiring; everyone cares about making a difference, and we have the right combination of resources and will to truly have an influence on the art and practice of surgery to impact the health of millions, from Boston to Botswana. Our institution’s history is also extremely compelling; the founding documents of the Brigham proposed building a hospital for patients who are in indigent circumstances. That’s our founding principle, and it’s reflected in so many of the hospital’s priorities. BWH’s commitment to global equity and surgery extends from President Betsy Nabel, MD, throughout the institution. The opportunity to lead a center charged with doing this work felt like a true calling, and I’m thrilled to have been chosen to do it.