“What do we owe to each other?” If you watch television, you may recognize that as a quote from the show The Good Place; if you’re a philosophy buff, you may recognize the work of T. M. Scanlon on contractualism. Either way, it’s a good question. It comes up frequently, in one form or another, when we think about what it means to have a truly just society. June is Pride month. I’ve written before about what Pride means to me as an out bisexual doctor, particularly coming from a rural area. I grew up experiencing the violence of homophobia. There are other, specific forms of violence directed against bisexuals, which I also experienced. Consciously and many times over, I made a commitment to myself and to my community that I would fight that violence, however I could, because I feel I owe it to the generations to come to help make a better world for them. That helped drive me to return to medical school, even though I loved my work in the research world. I wanted to create a health care environment where people like me would feel safe and supported. That commitment has meant learning a lot of things over the years that I didn’t know when I started out. I don’t think I even heard the word “transgender” until I was in college. (Granted, that was a long time ago.) I try to stay abreast of the developments in discussions in the larger LGBTQIA+ community so that I can treat my friends and my patients the way they want to be treated, even as our understandings of identities change. Respecting patients is critical to creating a healthy environment for them. Now it’s time to ask: What do white LGBTQIA+ people owe to the black community? What do we owe to our black LGBTQIA+ colleagues, friends, patients, neighbors? What does Pride mean this year, in the thick of COVID, in the midst of protests around racist police brutality? This year, more than ever, Pride is an opportunity to push for change. This is the perfect time to look at how we work with the most vulnerable populations: Is your clinic safe for black trans patients? If it’s not, how can you change that? Are your front desk staff trained to use trans patients’ pronouns correctly? As a physician, do you have the power to push your administration for that training? Can you ask your administration to officially adopt a Black Lives Matter position? Do you have black colleagues who face racist challenges within your organization, and how can you push to change that climate and remove those challenges? If you don’t have black colleagues, how can you push for your organization to change their recruitment and hiring policies to make it a more attractive and supportive place to work? How would your clinic (or hospital) look different if it was designed to care for the health of black patients? We work in a field with known, shameful disparities. It’s not just that patients living in poverty get less care and worse care. Black patients, even when all other factors are controlled for, receive worse care than white patients. Black patients are denied pain medication because of racist beliefs about them and about their perception of pain. Black maternal mortality rates are catastrophically high—three to four times higher than those of white patients—not because of factors intrinsic to black mothers, but because of racism. As white providers, we have both the power and the responsibility to push ourselves and our institutions to do better. As Ijeoma Oluo wrote, “The beauty of anti-racism is that you don’t have to pretend to be free of racism to be an anti-racist. Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And it’s the only way forward.” The white LGBTQIA+ community, like health care, has a long and shameful record of racism. It’s not enough to work only for the liberation of white LGBTQIA+ people; that “liberation” alone will not create a more just society or a better world. We have to dismantle the systems of racism that keep the injustice rolling forward. What does Pride mean to me this year? That it’s time to move white LGBTQIA+ stories out of the spotlight and focus on supporting the Black Lives Matter movement. You do not have to renounce your focus on LGBTQIA+ health to do that. You can choose to focus your commitment on helping the black LGBTQIA+ community, and recognize that requires more from you and in different ways than a typical Pride month, where white gay men are often the face of the movement, at least in the media. What do we owe to each other? As much as we can give. Time, money, our effort in learning how to have difficult conversations with the other white people in our lives, the safety of our bodies at protests, our loud and privileged voice in a manager’s ear. This year, make Pride a true protest again. Make a better world. Kristin Puhl is a family medicine resident and can be reached on Twitter @kristinpuhl. Source
