Opinion: Do Black Lives Matter?

Do Black Lives Matter?

NORMAN T. REYNOLDS, MD Distinguished Life Fellow of the American Psychiatric Association

SUMMARY

Racism is systemic in American society and culture. The field of medicine is no exception. Unconscious prejudice or implicit bias toward minorities undermines adequate medical care for them. In order to create a more just and equitable medical culture for minorities, all parts of the medical system must admit to past mistakes toward minorities and embrace valuing diversity. To do so requires deliberate efforts and should not be left to chance or taken lightly. This must be done in order to make Black Lives Matter.

INTRODUCTION

I am ashamed to admit that when I first heard the phrase “Black Lives Matter,” I thought: “Of course, Black lives matter. All lives matter.” I consider myself someone who is fair-minded--not tolerant or color blind on racial issues but embracing of diversity. So how could I think that?

Well, I am white. I grew up in a culture dominated by whites--white thinking and white attitudes. I was educated using public school textbooks, authored by whites, and taught by white teachers. The white perspective presented in textbooks is guilty of omissions more than commissions about the history of African Americans in America. Unfortunately, it is hard for any of us to see what has been made invisible. Tragically, no matter how hard I try, I cannot rid myself of the racism that I have been brainwashed to accept without question.

Thankfully, I did not verbalize my thought. Thank God, I understanding of African-American history would help whites saw news of people taking to the streets to protest the killing understand and empathize that Black Lives do Matter. of George Floyd. Thank God, I saw documented footage of the suffocation, “Please, I can’t breathe.” Rather quickly, I got it. HowHISTORY OF RACISM IN THE MEDICAL PROFESSION ever, that does not dismiss my initial response--a response that Although medicine is held in high regard by the public, even so easily discounts the message intended by Black Lives Matter. considered a noble profession, it too is part of American culture. Unfortunately, black lives do not matter in a society that treats Deeply embedded in the culture of medicine is a long history them as second-class citizens—inferior to whites. That is a reality of overt prejudice against blacks—explicit bias, not implicit bias. that we can no longer ignore. The 1910 Flexner Report resulted in the closing of many black

I also recall my feeling from years ago when I heard Malcolm X medical schools at that time, and thereafter the conditions of speak in anger. At the time, I thought he was overly militant—an American culture made it difficult to establish others to generate opinion shared by many whites. Really? At the time, I did not numbers of black physician in proportion to the general or preunderstand the significance of his statement: “That’s not the chip dominately white population. on my shoulder. That’s your foot on my neck.” It was as true then For generations, black physicians have been underrepresented as it is now. Just substitute “knee” for “foot” on George Floyd’s in medicine. (Only 5% of US physicians identify as black, while neck in 2020. 13.4% of the population is African American.)

Tragically, George Floyd is not a one-off exception. Remember Professional organizations marginalized black physicians. For Rodney King. In his case, add police batons and kicking him example, the American Medical Association (AMA) did not perwith their feet. And, there are many more incidents—too many mit black physicians societies to join their membership. In 2008, more. Without film footage, would white people believe a black the AMA formally apologized for more than a century of AMA person’s complaint over the word of a trained white police officer policies that excluded African-American physicians from the hired to enforce the laws of the land against those committing AMA. The AMA pledged “to right the wrongs that were done by offenses or suspected of violating the law? our organization to African-American physicians and their fami-

Some whites may take solace that our society has made pro- lies and their patients.” gress. Racism today may be more subtle than in the past. But The US government participated in experiments on blacks. The nevertheless, it exists Tuskegee Experiment and is very real for the (from 1932 until 1972) black people who live their daily lives under “Knowing is not enough; we must apply. involved studying the natural course of the domination of a white society and culWilling is not enough; we must do.” syphilis in poor black men afflicted with the ture. Prejudice is difficult to root out. AlGoethe disease. Black men were given free treatthough it is no longer ment, but never told of politically correct to openly express some blatantly racist words their syphilitic condition and, even worse, not treated for it. In or ideas, e.g., the N-word, in fact, being politically correct can 1997, President Clinton issued a formal apology acknowledging force overt racism to go underground. Disguised, insidious racism “The United States government did something that was wrong— makes it more difficult for people to have insight into their failure deeply, profoundly, morally wrong.” He proposed measures to to understand and to recognize the harm it does to the misunder- protect blacks from future abuses. stood and mistreated. The eugenics movement endorsed the sterilization of “undesir-

Lack of education about racism makes it difficult to empathize ables.” Involuntary sterilizations were implemented by the govwith the plight of black people. Racist values begin early in the ed- ernment in many states. In California alone, approximately 20,000 ucational process. Education of children is a requirement by law. individuals in state institutions were sterilized from 1909 to 1979. Getting an accurate education is not a requirement. Throughout Involuntary sterilizations were performed on those deemed “unfit my education, I benefited from my whiteness without realizing to reproduce,” predominantly persons of color. It was not until it. During my medical education and professional development, 2014, that California banned forced sterilization of imprisoned I did not notice the absence of blackness—the absence of black women as a means of birth control. In 2015, the US Senate votphysicians and very limited exposure to black patients. ed unanimously to help surviving victims of forced sterilization.

How would white people respond if textbooks were written North Carolina and Virginia paid monies to surviving victims of by blacks, and the content expressed black viewpoints and ex- eugenics sterilization programs. Reparations have not taken place periences, and the courses were taught by black teachers and in California. professors? Some well-meaning persons might object, claiming FAILURE TO EDUCATE PHYSICIANS ABOUT RACIST that the content was un-American or undermining of national PRACTICES pride. Hopefully, the majority of whites would welcome having I don’t know about you, but this kind of information, such as the facts and a less bias interpretation of them. Having a better that noted above, was not part of the curriculum in the schools

and training institutions that I attended. And, there is a lot more history of discrimination toward blacks that is a part of medicine’s history and identity. Failure to include this information in the medical curriculum perpetuates racism among white physicians and undermines the power of black physicians to have a meaningful place in the profession. Today, Implicit bias training is available improve communication.

RACIAL DISPARITIES IN HEALTHCARE

Racism continues to plague the culture of medicine. The Covid pandemic has made apparent the disparities in health care for minorities. The well-publicized statistics reveal the disproportionate toll that the Covid pandemic has taken on minority populations including the black population. Covid is a new illness, but its demographics are just one more example of the longstanding disparities in healthcare for minorities.

In 2003, the Institute of Medicine published its report on racial and ethnic disparities in healthcare. “Stereotyping, biases and uncertainty on the part of healthcare providers can all contribute to unequal treatment.” White physicians who do not intend prejudice “typically demonstrate unconscious implicit negative racial attitudes and stereotypes.” The report created quite a stir and some controversy. Subsequently, other studies have reported the impact of implicit bias on patient care. • Communication between African

American patients and white health care providers has been shown to be • of poorer quality when compared with race-concordant patient-provider communication. Interpersonal communication between patients and clinicians is of key importance to the delivery of equitable, high quality care. The quality of communication is linked to patient satisfaction, adherence to treatment recommenda© Can Stock Photo / Gelpi tions, and health outcomes. • African American and other ethnic minority patients have been found to receive poorer interpersonal communication, including lower levels of affective behaviors such as rapport-building and overall affective tone, and greater physician verbal dominance, less patient centeredness, and shorter visits, compared with white patients. • Race concordance between patients and physicians has been linked with longer visits with more positive patient affect, high levels of patient trust, greater patient satisfaction and ratings of visits as being more participatory. • Physicians’ positive emotional tone is associated with higher trust, particularly in the visits of African American primary care patients.

REMEDIES

Following the Institute of Medicine report of 2003, the culture of medicine has been changing, initially slowly and more recently with increased momentum.

Training modules are available to help participants to understand the science of implicit bias and its effect on patient health. Participants learn to become more self-aware of implicit biases and demonstrate commitment to incorporating mitigation of strategies into practice.

The US Department of Health and Human Services has published core concepts and principles of cultural and linguistic competence in health care.

Many professional organizations have declared their commitment to address implicit bias and racism. For example, the American Academy of Family Physicians (AAFP) recommends educating physicians about implicit bias and strategies to address it in order to support culturally appropriate, patient-centered care and reduce health disparities. In August 2020, the Association for American Medical Colleges (AAMC) and the National Medical Association (NMA) announced a joint effort to convene an Action Collaborative that will address the under representation of African Americans in medicine. Some regulatory bodies and medical boards have begun to address racism. For example, beginning in 2020, Michigan medical professionals will need to undergo implicit bias training as a condition of licensure. Currently in California, “a physician and surgeon is required to demonstrate satisfaction of continuing education requirements, including cultural and linguistic competency in the practice of medicine.” As of January 2022, the curriculum of all CME must include “specified instruction in the understanding of implicit bias in medical treatment.”

CONCLUSION

Because racism is systemic, all entities must participate in the process of rectification. This includes all components of the medical system. For the black community, actions speak louder than words. It takes more than rhetoric; it takes not one, but an ongoing track record of positive actions to gain trust. Rooting out racism is doing the right thing. It is a call for action from the white establishment. Doing so is a matter of conscience. Hopefully, the suffocation of George Floyd will awaken the nation, including the medical system, to see that Black Lives Matter--to finally do the right thing and to take action on many fronts to root out racism.

Roderic Pettigrew, PhD, MD offers an important spiritual message to align us with our stated democratic ideals:

When people learn that our shared humanity binds us one to the other, that differences which do not involve character actually bring character to our communal lives, that is when our society will honor its stated commitment to life, liberty and the pursuit of happiness of all.

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