Confronting Racism Special Section
COMBATING MEDICAL RACISM: THE CASE FOR COMPULSORY PHYSICIAN TRAINING Jeffrey B. Ritterman, MD Re ce n t eve n t s h ave e n co u ra g e d m a ny o f us to challenge our personal racism and to uproot the racism within our institutions. This is a national project, long overdue. Despite the rigors of medical school education and years of Continuing Medical Education, few of us know much about medical racism. We may know the bare outlines of the Tuskegee Syphilis Study and we may know about the origin of HeLa cells from Henrietta Lacks’ cervical cancer without her knowledge or approval. But we know little else. Medical racism still permeates the ongoing practice of medicine. The American Heart Association called structural racism “a fundamental driver of health disparities.” The editors of Family Medicine Journals issued a statement “Systemic Racism and Health Disparities” in which they said that “racism is associated with poorer mental and physical health outcomes.” The American Academy of Pediatrics issued a similar statement. The medical and lay communities were shocked when we viewed the video of Dr. Susan Moore struggling for breath and explaining how she had to beg for pain relief and for adequate treatment during her recent bout with COVID-19. Attended by a white physician she complained that “He made me feel like I was a drug addict…if I was white I wouldn’t have to go through that.” She died from COVID. The undertreatment of pain due to racial bias is also seen in children presenting to the emergency room with appendicitis, and with long bone fractures. Physician misperception of a patient’s pain is due in part to ignorance and stereotyping. A recent study showed that half of the medical students and medical residents tested had the misbelief that Black patients are less sensitive to pain than white patients. They would have undertreated Black patients in a clinical situation.
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SAN FRANCISCO MARIN MEDICINE APRIL/MAY/JUNE 2021
Perhaps no illness demonstrates the intersection race and health care more than sickle cell anemia. Undertreatment of pain is a major problem. Sickle cell patients, who are predominately Black, wait significantly longer during emergency room visits than other pain patients. The authors of a study on this phenomenon concluded that: “The AfricanAmerican race of the SCD patients, and their status as having SCD itself, both appear to contribute to longer wait times for these patients. These data confirm patient anecdotal reports.” The anecdotal reports are striking: “Every time, it’s a battle,” one patient said about her ER experiences. She complained that staff members suspect her of faking her condition in order to score opiates and view her as a non-emergency because she only has pain. “I always dress professionally,” said a retired school administrator. “Nice shoes, interesting earrings, every hair in place, and Vogue-worthy makeup. It’s crazy that you, as an African-American, have to do this so you aren’t treated like a drug addict.” The Institute of Medicine was asked by the federal government to do a comprehensive review addressing unequal medical treatment. Their findings confirmed unequal treatment and unequal health outcomes. This was true for cancer and cardiovascular and renal disease. The algorithms used for calculating renal function are also biased against Black patients, making it more difficult for them to get dialysis and transplantation. Similar race-based algorithms are used in obstetrics to determine if a C-section is needed and in emergency medicine to help diagnose kidney stones. Each has been challenged as biased against Black patients. Significantly higher death rates have been noted among Blacks from hypertension, diabetes, septicemia, kidney disease, hypertensive renal disease, cardiovascular disease and infant mortality. WWW.SFMMS.ORG
