Here we are in the midst of two pandemics. COVID-19 is acute, far-reaching, and devastating. It has gripped the world’s attention, slowed its rhythm, and is unequivocally viewed as the enemy. Racism’s ills – rooted in the social construct that tiers human dignity, worth, and power – are ubiquitous and dehumanizing. Yet, racism has persisted, and its existence and impact are minimized or outright denied by many. How can this be?
The murders of George Floyd and Ahmaud Arbery were both captured on film in broad day light, highlighting an uncomfortable truth that had long gone ignored by most Americans. The seemingly unapologetic nature of these deaths further amplified other equally tragic deaths of those such as Breonna Taylor, Elijah McClain, and a litany of other names. Perhaps in the wake of COVID-19, America had no choice but to give this her full attention.
Together, we are working to come to terms with the pervasiveness of racism in our world and also in medicine, which impacts our patients by way of significant health inequities. This includes taking the time to talk about how racism renders Black physicians and others underrepresented in medicine (UIM) wounded, isolated, and unseen.
A recent #JHMChat, “A Conversation on Racism in Medicine,” engaged two academic hospitalists and recently published Journal of Hospital Medicine authors to lead the discussion among colleagues on Twitter. Many of the tweets articulated the ways in which racism in medicine is manifested. Below are reflections from the four topics discussed during the chat.
Topic 1: Experiences with racism in medicine and medical education
I went into quality and safety because of a very early experience with my young sickle cell patient who complained of some blurred vision, her complaint was discounted, she ended up with a stroke and died…a situation that could have easily been turned around if only… #JHMchat
— Payal Parikh, MD, FACP (@Payalia320) June 30, 2020
Dr. Payal Parikh’s tweet drives home the point for which the evidence is indisputable: Racism kills—and is disproportionately killing Black people. What is so unfortunate is that this often goes unrecognized by health care professionals. Interactions with Black patients and other marginalized people of color are informed by the attitudes and ideas held about specific racial groups. These attitudes and biases inform the diagnostic and therapeutic approaches which impact outcomes in our patients. False narratives are reinforced in medical education; we teach our students and trainees illness scripts that are rooted in the fallacy that race is biological in origin. Racist stereotypes are reinforced by the accepted language we share as a medical community. Terms like “frequent flyer,” “noncompliant,” and “difficult” are often used to describe Black patients and families. These terms completely ignore the barriers Black patients face – barriers birthed out of structural racism.
Unfortunately that is a conversation that is happening a lot. It’s hurtful. I’ve had to explain that it isn’t that someone “took” a spot from you. It’s that we were never in the running and now we are.
— Kimberly D. Manning, MD (@gradydoctor) June 30, 2020
Wow… there is so much captured in Kimberly’s tweet. To be a Black student, trainee, or physician in medicine is to have our very existence in the space scrutinized. It is to constantly have to prove to patients, peers, and/or other colleagues that we belong. We fight against the racist notion that more worthy candidates were displaced from the seats of opportunity to make room for Black people and other UIMs, who are generally viewed as less qualified. During the chat, several participants shared several similar accounts and the discussion reinforced how much work we have to do to dismantle these ideas.
Topic 2: How do we address our diversity problem?
A2
>Take deep critical look at assessment, recruitment, selection systems
>Match your BIPOC trainees for residency/fellowship
>Hire your BIPOC trainees for faculty positions
>If you are losing BIPOC trainees from your system at each stage, you need to seriously ask why#JHMChat— Jon Lim, MD ?????? (@JonLimMD) June 30, 2020
A physician workforce that reflects the patient population it serves needs to be a primary driver of admissions and recruitment in medicine. Dr. Jon Lim and several other participants highlighted the power of representation and the importance of pipeline programs. These programs offer early exposure to the field of medicine and help students develop strong relationships with mentors. However, addressing the dearth of Black and other UIM physicians must include addressing economic, and education inequities that give other groups a leg up. Finally, as Dr. Lim so eloquently states, the “leaky pipeline” cannot be ignored. The leaky pipeline may be a reflection of the lack of a clear and intentional strategic plan to recruit, retain, promote, and support UIM students and physicians. Institutions should develop an intense preoccupation with learning why Black physicians and other UIMs choose to leave academic medicine.
Topic 3: How do we cultivate an inclusive environment?
Silence is violence and in many ways microagressions are just products of racism and I almost feel guilty using the term sometimes as I feel it softens the blow of what’s actually happening. #JHMChat
— Vignesh ‘Vig’ Doraiswamy MD (@DoctorVig) June 30, 2020
A3. As we create spaces for us all to bring our full selves to work, I think that’s a great place for us to start. Being your full self (speaking for Black people in these spaces) permits others to do the same–and reduces “othering.” #JHMChat
— Kimberly D. Manning, MD (@gradydoctor) June 30, 2020
Inclusivity in our professional environments allow us to thrive and feel seen. However, it is not uncommon for Black physicians to feel isolated within academic medicine due to microaggressions and other forms of racism. Dr. Vig Doraiswamy’s tweet really hit home…silence is indeed violence. It is a call for all of us to be brave and speak up against racism in all its forms. His tweet aligns with Dr. Kimberly Manning’s reminder that “support is a verb” – words to live by. We need to create an environment within academic medicine where all individuals can be celebrated for being their authentic selves. This would mitigate the “othering” that occurs in medicine as Dr. Manning points out in her tweet.
Topic 4: Institutional steps to address racism in medicine
T4 You can tell what’s important to a department and institution by looking at where the money goes. Those in power must advocate for the $$ to support change. #jhmchat
— Jeff Dewey, MD, MHS (@DeweyLovesNeuro) June 30, 2020
The chat was filled with insightful thoughts and action steps. Data transparency to promote health equity and the importance of amplifying the voices of our Black patients and families were common themes. One important sentiment shared by many including Dr. Jeff Dewey, was the need for true investment in diversity, equity, and inclusion (DEI) initiatives by academic institutions. This is such a critical point – inferences about institutional values can be made based on an institution’s financial investments. This idea relates to the concept of the “minority tax” many Black physicians and other UIMs face. The expectation to do diversity work without sufficient financial support, protected time, and resources completely cheapens the work and sends the message that DEI is not a priority.
Notes:
*Don’t miss Dr. Manning’s session, “When Grief and Crises Intersect: Perspectives of a Black Physician in the Time of Two Pandemics,” at HM20 Virtual, beginning August 11. Learn more and register here.
*Listen to Dr. Unaka on the Explore the Space podcast discussing racism in medicine here.
Leave A Comment