In non-pandemic times, Dr. Zeke McKinney’s work in clinical occupational and environmental medicine (OEM) centers on assessing the hazards of workplaces and helping workers recover from work-related ailments. Understandably, his practice has evolved as schools and places of business face new environmental dangers that haven’t been felt at this level in a century. Safely going to work might never look quite the same.
During recent months, McKinney has worked on writing digestible guidance based upon CDC recommendations so that first responders and other essential workers can stay operational. “Everyone is doing this to some degree,” the 2020 Minnesota Monthly Top Doctor says. “It’s just how much help are they getting to do it? Opening the gates is a little bit scary. Right now, it’s a great time for people like me to exist.”
McKinney grew up in North Minneapolis, and he and his older brother were the first doctors in his family. Along with a University of Minnesota medical degree, McKinney earned master’s degrees in health informatics and public health (also at the U of M). He is a faculty physician in the HealthPartners OEM Residency, a HealthPartners Institute research investigator, and an affiliate assistant professor at the University of Minnesota School of Public Health. His extensive research includes a paper showing higher rates of injury among Hispanic workers than non-Hispanic workers. He’s working on a national/international COVID-19 drug trial for which HealthPartners is a site. Part of its focus is to get communities enrolled who are more affected, including Black, Hispanic, Southeast Asian, and particularly Somali, Hmong, and Karen.
On top of all that, he’s the chief medical editor of Minnesota Medicine magazine. In his editor’s note from the July issue, he takes on the topics of equity and reform within medicine following the killing of George Floyd. “We have an ethical responsibility to build, promote, and protect the health and safety of our Black communities,” he writes. He has also used the space to advocate for doctors to be better listeners, anxieties felt by patients of color, and the additional importance of trust building in medical settings in the time of COVID-19.
What counts as occupational medicine?
Probably 80-90% of clinical occupational medicine is musculoskeletal injuries, such as lifting something at work. There are lung diseases from exposure to silica, beryllium, asbestos—things you’d see in the Iron Range. A lot of skin diseases, like dermatitis. People get splinters and shards in their eyes when they’re cutting down trees or grinding metal. We do a lot of neurologic injuries, like nerve damage from vibrational tools or concussions. I deal with environmental toxicology, mainly—when someone’s had a longer-term, low-level exposure to dusts, chemicals, or molds. They’re not dying today, but they’re concerned about it.
We have to be very broad. We’re like primary care doctors, but we also have to understand preventive medicine, and the medical and legal aspects of worker’s compensation. We’re also experts on public health, and have training in emergency preparedness, risk management, and hazard communication. A lot of people in my specialty work as corporate medical directors for big Fortune 500 companies. 3M has five or six of us.
How has the pandemic influenced occupational medicine?
The pandemic’s horrible. I’m not happy that people are getting sick and dying, but it has done a lot for my field. People are saying, “Hey, we need doctors who know about these things.” I already had a weird job setup. Part of my job is clinical, and the other is research and academic. I’m spending more time doing part-time medical directorships and legal consulting helping institutions figure out how to return to work.
If you’re talking about a large grocery store chain like Cub, I’m guessing that they’ve talked to somebody like me and have written some protocols for wearing masks and other regulations. Where you run into problems is when you talk about your little community grocery store, especially when it’s one that serves a community that isn’t primarily English-speaking. Sure, they know coronavirus exists, but they can’t understand and engage the same way, or they don’t have the resources to put up plexiglass shields and to buy masks.
How is health equity tied to your work?
I grew up in North Minneapolis and saw things firsthand that impacted people in that community more than what you would expect. In public health, they’re called social determinants of health—everything from where you live to your socio-economic status. External factors affect health to a greater degree than a physician’s ability to treat you.
With occupational medicine, we’re worried about people going to work when they’re sick. People of color and lower socioeconomic status are more likely to be in high-risk jobs—with higher COVID-19 exposure risks—and less likely to have insurance or paid time off. People say, “I’ll just power through it and I don’t have to worry about it.” With COVID-19, we’re in a time where that’s absolutely not what you want to do.
How has the social justice uprising following George Floyd’s killing been influential in medicine?
One of medical ethics’ four principles says physicians have a responsibility to fight for social justice. Even as somebody of mixed ethnicity, I have to ask myself every day if I’m being racist or sexist. You can’t go to one diversity training and suddenly be 100% educated. I shouldn’t give anyone special treatment in the exam room, but justice goes way beyond the exam room. Physicians, good or bad, do have a higher degree of social stature and financial status. I would argue that they point to a responsibility on our part to do something about this, and even more important for someone like myself who has experienced some of this more than others.
With George Floyd, it was particularly egregious in nature. The outrage that came out of it is a good thing. This incident opened people’s eyes in the way that they weren’t opened before. So that will be a good thing, too. The intersection of all these things is a good area to consider, too. How do social determinants of health and systemic racism contribute to what we’re seeing with the police, with doctors, and all aspects of life? Are we done talking about it? No. Are we even done fixing it? No. But it’s made it a little more acceptable to have these conversations.
What kinds of conversations should be had regarding who gets to become a doctor?
Here’s an example: University of Minnesota Medical School. There are about 165 people per class, making it one of the biggest medical schools in the country. What’s the proportion of Black people in Minneapolis? [19.4%, according to census data.] When I was a student there, I might have been the only student in my graduating class—maybe there were one or two others—who was the descendant of Black people who were slaves. What does that say about our school representing this community if we don’t have the people represented in it?
We’re seeing that across medicine. Whether that’s Black and white, men and women, and a whole bunch of other metrics of underrepresentation. And so, what can we do? We can try to fight these systems by making sure the pathways to get into college and to have exposure to the health profession exist. It’s making sure that college students who need to take the MCAT for medical school and have to shadow doctors have the resources available to them. It’s really a step at every level.
There are a lot of inequities in the costs of medical licensure. You have to take three exams in medical school, and all of them cost more than $1,000 apiece. Sometimes, you have to fly somewhere to take an exam. During residency and medical school, you have to fly to a lot of places. So, if you’re somebody who’s really wealthy, that’s easy. If you’re somebody who has never left your local area, it not only can be expensive, but also can be a bit of a cultural barrier as well.
How much of your job is coaching patients to be advocates for themselves when they go back to work?
Workers often do not know what their rights in the workplace are as it pertains to their health. Supervisors often don’t either. It happens on both sides. Instead of a physician-patient relationship, it’s more of a triangle where you have an employer at one end and employee at the other. If you get the impression that your employer is not concerned with your health and safety, I’m not okay with that. Similarly, if workers are trying to game the system—which is generally not true—I’m not okay with that, either. Generally, everyone has the same goal: Get the person healthy, and get them back to doing what they normally do at work and at home.
But people have to advocate for themselves. Under worker’s compensation, we can provide people with work restrictions which, by law, have to be accommodated if they can be. For example: if someone goes back with work restrictions and then they tell me in clinic that they’re doing more than their restrictions. “I didn’t want my coworkers to think I was slowing them down,” they’ll say. “I didn’t want my boss to think I wasn’t trying hard enough.” Or, “My boss wants me to work at the same rate as everyone else, but they say they want to accommodate the restrictions.” It’s a whole mixed bag. People do have to be willing to have these conversations. If we could have a patient advocate, social worker, and a behavioral health professional involved in every clinical visit for the history of time, that would be worthwhile. Do we have the resources to set that up? No.
As it relates to work, what good can come out of the changes to society made during the pandemic?
There have been some good unintended consequences. Like, for example, everybody stopping driving. People in L.A. and Beijing were able to see the sky for the first time, and porpoises swimming through the canals in Venice. That’s amazing. As an environmental health doctor, that’s stuff that really matters to me. We demonstrated that we are having a significant impact on the environment really fast.
It gave us a chance to think about more dynamic ways that people can work. A building is full from 8 a.m. to 5 p.m. and then sits empty the rest of the time. What about splitting up workers across three shifts so that there are not as many people in terms of physical distancing? Many jobs don’t have to happen between 8 a.m. and 5 p.m. You could do it at 8 p.m. and it wouldn’t make a difference. I wish the bank were open at 10 p.m. I don’t know if we’re there yet.
There were a lot of people who could’ve worked from home this entire time. People, as employees, love that benefit. There are huge environmental impacts to drive everywhere, of owning those office spaces, paying for electricity, paying for computers—it’s both costly and not very environmentally friendly. If we’ve moved that needle even a little bit, that’s an amazing change that is for the better for workers.
Read more of Dr. McKinney’s recent work:
Institutional racism in medicine from Minnesota Physician
Lead exposure remains an environmental health concern from Minnesota Spokesman-Recorder
You May Be Using Hand Sanitizer All Wrong from HuffPost
- Workplace Temperature Checks Aren’t Effective On Their Own. Here’s What Else We Need. from HuffPost
Follow Dr. McKinney on Twitter at @ZekeMD