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Heal The System: Medicine Must Be Anti-Racist

Discussion in 'Hospital' started by The Good Doctor, Jul 25, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    My maternal grandmother, Susana, was one of the most important women in my life. I was named after her. At least, that is what I thought for many years.

    I had gone by my grandmother’s name until I transferred high schools in the suburbs of Chicago, and the registrar asked me to confirm my name. I told her, and she said, “No, your name is Susan. It’s on your birth certificate.”

    I was stunned; it didn’t feel right. I went home and asked my mother. She thought it had said “Susana” as well.

    Later a friend who is a consultant in diversity and inclusion said I was “an example of how someone can be impacted by racism in medicine even at birth.”

    I knew she was right — racism had impacted me from birth. As a first-generation Mexican American, my experience is far from unique. And it has impacted millions more historically for centuries and every day since.

    A recent Journal of the American Medical Association podcast is an example of how unknowingly ingrained racism and structural racism are in medicine. The podcast and subsequent social media received strong criticism from the medical community, particularly those involved in diversity and inclusion. The podcast questioned whether the term “racism” should even be used.

    Shortly after, the editor-in-chief of JAMA, Howard Bauchner, MD, announced that he would step down. Holding publications and organizations accountable for keeping DEI efforts imperative is just a start.

    As a woman physician of color who teaches medical students and residents about health disparities and inequities that are a result of racism, there is no other word for it but racism.

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    There is no denying that it exists when the National Institutes of Health has a web page called “Ending Structural Racism.” Race is a social construct that affects not only health care practitioners. Race is also taken into account in several medical calculations that can impact patient care.

    The National Football League recently agreed to drop its “race-norm” bias policy on compensation for Black players concerning dementia claims, following a lawsuit by two top players who called the practice “classic system racism.”

    Another example is the racial correction factor in determining kidney function. In this calculation, if a Black patient is entered as Black, their kidney function looks slightly better than their white counterpart. This results in Black patients not being considered for certain medications or consideration for a kidney transplant if their kidney function looks better than it actually is.

    So why do health care providers consider race in calculating kidney function? One misguided explanation is that Black individuals release more creatinine in their blood because they are supposedly more muscular.

    But those studies were done in the 1960s and 1970s and have been dispelled since. Racial differences in health care are not genetic. They are related to social determinants of health — the conditions in the environments where people are born, work, live, learn and socioeconomic status.

    Social determinants of health are simply other words for racism and the results of racist policies.

    During a pandemic that has highlighted and exacerbated health inequities, it is critical that those in medicine unlearn the racist ideologies that have impacted communities. Medicine needs to become actively anti-racist.

    The American Medical Association had been working on a strategic plan to address racism since 2018. Still, due to pressures from the pandemic and the backlash of the JAMA podcast, the AMA released its plan.

    Addressing racism in medicine will need to involve more than improving education to those involved in patient care like students, residents, and faculty. Administrators of medical schools, hospitals, health care facilities, and all community centers need to address the racism that is pervasive throughout medicine and has become part of its structure.

    And then, they must act upon these needs by not just holding conferences and panels but by investing in research, developing processes from that research and demanding to report of outcomes to allow for accountability.

    It is urgent to learn the history that was not taught in schools and unlearn the racist concepts propagated there. Physicians such as Dr. Brandi Jackson and her twin sister, Dr. Brittani James, are working to address racism. Dr. Jackson stated, “We’re teaching how to see it and how to undo it.”

    Racism impacts how people interact with each other and think about disease. It impacts every moment of patient care.

    Racism has impacted me and my name since birth. Racism by any other name is racism. Call it what it is.

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