First, do no harm: Let’s eradicate the inherent racism in medicine
It was August 2011. I walked into the patient’s room, a bright-eyed young medical intern ready to put those grueling years of medical school to good use. This was my first emergency room shift since graduating from medical school.
I brushed off my freshly laundered scrubs and entered the patient’s room, ready to gather her medical history. As I entered, the patient looked up from the book she was reading and asked, “What’s for dinner?”
I paused, puzzled by the question. She sighed loudly and asked in a much slower and exasperated tone, “Do you have the menu?”
I realized she thought I was one of the hospital’s kitchen staff. Even though the “M.D.” on my badge was prominently visible, she did not see a young doctor who had entered the room to perform an examination.
Even with the presumed societal status assigned to those two letters on my badge, I could not break down her preconceived notions of who I was as I entered her room.
As a Black man in America, I was not and could not be her doctor.
The recent killings of Rayshard Brooks and George Floyd — as well as the scores of other unarmed Black men and women killed at the hands of police — have highlighted the continued inequity and systemic racism that is pervasive in our society.
Despite the 1954 decision in Brown v. Board of Education, Black and brown children remain segregated from their white counterparts. Despite the abolition of slavery, African Americans remain imprisoned at a rate more than five times their white counterparts and receive higher sentences for the exact same crime.
The 15th Amendment granted voting rights to all races, yet minorities in several states, such as Georgia, still face hurdles even in 2020 trying to exercise their basic right to vote.
The racist building blocks that formed the country we call home are not only manifested in educational disparities, lack of voting rights, an increased rate of imprisonment and the killing of unarmed Black men and women, but they also remain present in medicine and science.
In medical school about half of future physicians are white. About 7% are Black or African American compared with 13% of the general population. More than 6% identify as Hispanic or Latino compared with 16.7% of the general population.
Medical school curriculum continues to teach race-based facts, including that African Americans have a higher incidence of diseases such as stroke and hypertension and Hispanic Americans have a higher rate of diabetes. Certain high blood pressure medications are recommended as “first line” based on a person’s race.
Scientific studies have sought to answer the why to these facts based on various racial categorizations. In studying why African Americans have a higher incidence of stroke and hypertension, organizations including the American Heart Association have issued blanket statements, saying such things as blood vessels in the brain “may differ from those of Caucasians” and African Americans “may be” somehow more predisposed to developing an enlarged heart.
This focus on race has always puzzled me, as there remains an inherent flaw in focusing on race alone in attempting to seek answers to the differences in health between African Americans and the general population.
Race is a social and cultural construct. It is a grouping of humans based on physical appearance, and this grouping often differs depending on the country and society of which one is a part. There remains no scientific definition of race. The concept of race was introduced with the advent of colonialization and eventually the racialization of slavery.
DNA sequencing has shown that there is vast genetic diversity within particular races, regions and countries. Research shows that two members of the same race may be more genetically similar to someone from an entirely different race than they are to each other.
Recommending different medical drug treatments to a specific race or assuming a higher rate of disease based on the color of one’s skin alone ignores the socioeconomic factors that disproportionately affect certain races in America.
These recommendations by various health and scientific organizations ignore the fact that these health care disparities exist in our society not due to skin color but due to the treatment and continued segregation of races by those in positions of power. It continues to ignore DNA evidence that we are more similar genetically than we are different.
African Americans do have a higher incidence of stroke and hypertension. But this information must not ignore the fact that African Americans, due to a history of redlining and continued disinvestment in Black communities, often live in urban food deserts. In these predominantly Black neighborhoods, grocery stores are scarce and there is little access to healthy food options.
African Americans have been dying from COVID-19 at three times the rate of their white counterparts. Republican Ohio state Sen. Steve Huffman, a physician, asked if the “colored population” was more susceptible to the coronavirus due to a lack of hand-washing, lack of social distancing or a lack of wearing masks. He was later fired from his emergency room job over the remarks.
The answer is that African Americans are “more susceptible” to COVID-19 due to a systemic lack of access to health care, lack of testing and being disproportionately representative in jobs that do not allow the luxury of working from home.
This focus on skin color, and continuing to attribute to it some arbitrary biological significance, often results in a cause and effect between race and disease. The more likely cause and effect of inequity and disease is ignored.
Weary of such inane questions, I long for an America where, as a Black man, no one is surprised if I am a physician. I long for a country and a world where anyone can become anything they want to be, go anywhere they want to go and have the same opportunities as everyone else.
I long for a world where I am not afraid of the flashing blue lights of a police car and wonder if today is my last day on Earth. I long for a world where racism has no place within hospital walls, medical textbooks or in spoken words from physicians or patients.
I long for a world where Black Lives Matter and racism is not automatically on the menu.