Racism In Medicine: Wrestling With Our Conscience
Faculty Mentor: Marisha Burden, Division Head of Hospital Medicine, University of Colorado School of Medicine, Aurora CO
As 8 PM approached on a crisp June day, the nursing staff rushed to finish tasks and sign out their patients. There was an increased need for timeliness, as New York City was about to start its 8 PM curfew, its first since 1943. The deaths of George Floyd and Breonna Taylor, an EMT and an aspiring nurse herself, had shocked the public consciousness. The city beleaguered by COVID, in which people of color were twice as likely to die, now faced a reckoning of racism in its institutions. Although the city was filled with unrest, my commute was mainly punctuated by police officers chatting with Upper East Siders sipping margaritas on the sidewalk and the sound of distant helicopters surrounding the home of my neighbor, the mayor. Young people of color however faced a very different reality.
My 12-hour shift had been particularly taxing, as one of my patients had died shortly after being admitted. She arrived from a nursing home after experiencing a cardiac arrest, and although the resuscitation had been successful, she remained unstable despite our best efforts. Throughout the day I had spoken with both the son and daughter about her poor prognosis, and the risk of COVID infection should they visit. “She’s been sick for quite some time,” her daughter informed me. Even so, the arrest had been a shock, and her daughter was not able to arrange for childcare to visit. Her son traveled from Pennsylvania and arrived about an hour after her death. He declined a Spanish interpreter, preferring instead for his sister to translate by phone. After explaining next steps, I left my phone with him so that he could be with his sister while he visited his mother. I then sat down to perform a task I never thought I would have to perform as a physician: write a letter explaining why this man had to break curfew to travel across state lines in case he was stopped by police.
I hoped this task would ultimately be unnecessary but understood that it was essential. Primed by far too many cases of guiltless victims of police brutality, I felt visceral horror at the prospect that this Hispanic man should be interrogated by law enforcement on the night of his mother’s death. How do I balance his privacy with conveying to the officers why empathy is needed? Had I given him the answers he needed, factoring in our language barrier?
In 2003, the Institute of Medicine published Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. The authors described evidence for systemic racism leading to disparate outcomes among racial and ethnic groups even after controlling for confounding variables. The differences in health outcomes were broad, stretching from infant mortality to acute coronary syndrome. They concluded that the solution would require a systemic, collaborative approach that included increasing representation of among healthcare workers of underrepresented minorities, elimination of divisions of health plans along socioeconomic lines, tracking of racial and ethnic disparities as quality metrics, and strengthening of civil rights law. Unfortunately, little progress has been made since this report, and indeed the Institute of Healthcare Improvement issued a white paper in 2016 declaring health equity as “the forgotten aim.” As racism in policing has risen to an issue of national salience, discourse about racism in medicine lags despite having the same outcome: an unacceptably high number of deaths on the basis of race.
There is little doubt that truly advancing health equity will require advocacy by healthcare providers that rivals the current efforts of Black Lives Matter protestors to garner the political will for systematic reform. However, this fact does not render the everyday practices of physicians moot. My experience writing a doctor’s note to attempt to shield this patient’s son from injustice provided me with clarity about the power of my voice as a physician and the role of empathy in combating internalized prejudices. As I found myself at the crossroads of law enforcement and medicine, I looked within.