Medical racism persists beyond historical facts to become a current tradition, and inequalities can only be magnified by the circumstances of an emergency. How many more opportunities for widening health care disparities has COVID-19 given us?
By Racquel Reid, MD
As the population from the United States doggedly dragging through endless months of the uncontrolled spread of COVID-19, my tenuous confidence in the practice of medicine in that country is dwindling in nature. This confidence has been unstable since before I even finished medical school, due to learning about the disparities in healthcare within lecture halls and then having to observe them in action in the middle of hospital hallways. . Unequal Treatment, a 2003 consensus study report by the Institute of Medicine, details existing racial inequalities in American medicine as well as the dynamic factors behind their persistence. Yet despite his call to action, I know as a healthcare professional that not much has changed. Black, Indigenous and Hispanic communities have been disproportionately affected by COVID-19, researchers rightly explain why, according to CDC data. But I never needed the CDC to tell me who was diagnosed with the virus, who was treated until recovery, and who died.
Almost ten years after graduation, I sift through research papers and COVID-19 alerts in a quiet office, and think of my patients. I met them in offices, in hospital meeting rooms. I hovered near them as they lay in overly bright rooms on noisy units, scared and seeking refuge, scared of their condition, of pain, and sometimes of me. And how could they not be? Medical providers can, will and have denied their expressed concerns, whispered hushed suspicions about their presentation behind closed doors. Their demographic information might make a doctor unwilling to progress down the differential diagnoses. Policies have left providers and patients with impossible choices and deaths that could have been avoided otherwise. The collective belief among providers, unfortunately, is that grieving too often or too long over a patient’s circumstances is a personal failure, or that the loss of empathy is a natural progression of medicine. There are countless institutional failures that I myself have never been able to explain.
All of this is apparently subtle, providing my colleagues and health systems with plausible deniability, suggesting that the inequity may simply be the fault of a few healthcare providers with unconscious biases; rare and correctable medical error in an otherwise fair and productive health care system. I convinced myself that I could make a difference if I only crept into the side corridors to rebut the staff’s assumptions, or if I dealt with the questionable direction a patient’s treatment plan took after taking the history. But medical racism persists beyond the historical fact to become a current tradition, and inequalities can only be amplified by the circumstance of an emergency. How many more opportunities for widening health care disparities has COVID-19 given us? From the first days of our training, doctors learn four ethical principles: beneficence, non-maleficence, respect for autonomy and justice. They must be fundamental in our work, but I find that too often justice does not receive the attention it deserves.
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Medical degrees cannot erase socialization in a society ready to get rid of its most vulnerable populations. Who will support the care of impoverished, immigrant, heterosexual, disabled and gay patients if the advocates necessary for their safety are by necessity avoided to prevent the continued viral spread? What happens on admission to hospital if and when these patients fail to ‘show value’ to those caring for them, to those who determine the severity of their symptoms, or when their condition is hopeless for a cure? And then you have to consider the recent dismissal of Dr Princess Dennar from her post at Tulane after battling her own discrimination, the death of Dr Susan Moore at the hands of her own colleagues. The fact that Henrietta Lacks cells were used to study the virus. The fact that COVID-19 vaccines exist, but black people wanting to be vaccinated have not been able to receive them or get them at rates below the population.
I think of Tessica Brown, nicknamed “Gorilla Glue Girl” in a tragic play about the circumstances of her mistake and the position of her darkness, and how she suffered because of her insecurity and then endured misogynistic ridicule when she eventually tried to seek treatment. . How she received only accessible, compassionate, inexpensive treatment from a healthcare provider who understood the intricacies of dark hair and performed her pro bono procedure. I am considering my own medical training; how my blackness shaped it, how choosing psychiatry allowed me to prioritize my patients and their social situation so deeply, but it was not easier to subvert the damage under the practice guidelines from most systems of care. The ways that I probably did wrong.
I argue that medical education must also include the analysis of racial capitalism. In the absence of this analysis, we reify the existing oppressive structures, and the entrance to the hospital is not a border preventing their abuse. If medicine is a practice, then the study of any peer-reviewed article is as necessary as the examination of abolition, anti-capitalism, black feminisms, and liberation. It requires looking at rising rents, stagnant wages, black women being the primary breadwinner in a significant number of their homes, and recognizing that medical debt is a common reason many Americans file for bankruptcy. This means understanding that the misogynist is the ribbon and string that binds the treatment of black women, even as providers. That my medical degree is not necessarily a defense against my own mistreatment, knowing that my darkness and disability could prevent an accurate assessment of my worth.
I always strive for a world where care is comprehensive and without preventable harm, but bridging the gap is revealing and necessary work. While I cannot guarantee that the work I do – the institutions in which I practice – do not promulgate violence, this dedication makes my approach patient-centered, conscientious and enveloping. So, in this gap, I highlight institutional contradictions, stress the importance of patient support groups, take extra time with my patients, and sometimes, if I cannot provide honest care to my principles , I leave the organizations. I recognize that even with good practice I might not always win, but the fight against inequality continues and I intend to fight it.
Dr. Racquel Reid, MD, is a community child, adolescent and adult psychiatrist practicing in Los Angeles, California. Her work focuses on patients from marginalized populations, guided by the principles of collective care and well-being. She is in the process of establishing her own medical practice and can be found on Twitter at @imaginemh.
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