Building an Antiracist Medical Practice

The Centers for Disease Control and Prevention has recognized racism as a serious threat to public health.(1) Building an antiracist medical practice is part of the cure. This article presents some ways to do that.

Recognize that diversity is a matter of life and death.

A George Mason University study that found that Black newborns, plagued by infant mortality, are three times more likely to die when cared for by white doctors than by Black doctors. (Whether a white infant had a white or Black doctor did not affect its likelihood of dying.)(2) Although physicians of every background can provide excellent care, minority physicians have a positive, empirical impact on patient outcomes. So when hiring medical personnel, recruit from historically Black colleges and universities (HBCUs), Hispanic Serving Institutions (HSIs), and Tribal Colleges and Universities (TCUs), as well as the minority students’ associations of predominantly white schools. Post job opportunities to professional organizations for people of color, such as the American Association of Physicians of Indian Origin or the Black Healthcare & Medical Association.

Understand that colorblindness can kill.

Don’t assume a non-white body is simply a white body with more melanin. Manifestations of systemic racism—including disparities in access to healthy food and unpolluted air and stressors such as police harassment—cause people of different ethnic backgrounds to age and sicken differently. That means, for example, that a physician needs to be on the lookout for chronic disease in a Black patient a decade earlier than he or she would in a white one(3) and be mindful of the fact that a Black woman is at greater risk for maternal mortality than her white counterpart.(4)

Relatedly, recognize that race affects your patients’ ability to heal. Don’t assume that all patients of color are poor, but do realize that, in America, the median white family has 22 times more wealth than the median Latino family . . . and 41 times more wealth than the median Black family.(5) In fact, the average white family has 10 times the net worth of a non-white family.(6) Poverty affects how people can care for themselves.

Be mindful of racial disparities and strategize with patients about how to overcome them to achieve better health.

When you tell a patient of color to eat a diet rich in fruits and vegetables, take into account that many communities of color are food deserts. When you urge a non-white person to exercise, keep in mind that because of housing discrimination, banking discrimination, and environmental racism, he or she might live in an apartment too cramped for cardio in a neighborhood so polluted that being outside can trigger an asthma attack. Be mindful of racial disparities and strategize with patients about how to overcome them to achieve better health.

Continue your medical education by making sure you’re equipped to treat all people.

Most dermatology textbooks don’t include pictures that show what skin disorders look like on non-white skin.(7) An antiracist dermatologist seeks out pictures of disorders on a range of skin tones to ensure he or she doesn’t miss or misinterpret symptoms. Similarly, a conscientious physician knows to test children with sickle cell disease—who, in the United States, are mostly Black—every year for risk of stroke. Although the test has been around for decades, lack of attention to diseases that afflict non-whites and lack of care given to their health often mean children aren’t routinely screened—with predictably devastating results.(8) Accept that your medical training may not have prepared you to meet the needs of patients of color. Be proactive about researching information on the afflictions non-whites suffer and the treatments they need.

In addition to not being colorblind, don’t be “color mute.”

After you do your research, don’t keep what you learn a secret! Talk to your colleagues. Spread knowledge about best practices. Give CMEs on caring for multicultural patient populations. Or, more informally, offer casual trainings at your facility. Create an antiracist physician reading group—each month, each member would be responsible for studying a different medical journal article about an issue facing people of color and sharing the findings with the larger collective.

Conduct a checkup on yourself.

In 2016, a study found that half of white medical trainees falsely believed ideas such as that Black people’s skin was thicker than that of whites or that their nerve endings weren’t as sensitive. It is no surprise, then, that Black patients are less likely to be given pain medication that whites.(9)

Reflect on your own sentiments. Do you believe some races of people are less sensitive to pain than others? Do you treat expressions of agony from a patient who is white as legitimate but from one who’s non-white as feigned?

But don’t just reflect—track. Note and review how much—if any—pain medication you give to patients of color and whether you would have given a similarly situated white patient more than you gave the patient of color.

Examine yourself for other biases. For example, Black patients in pain from sickle cell disorder commonly are wrongfully thought to be drug-seekers.(10) When you see a Black person in distress, do you suspect him or her of being an addict trying to work the system to get drugs?

Surrounding yourself with diverse colleagues is a good way to check and go beyond your prejudices

Ask yourself whether—even unintentionally—you stereotype certain races as lazy, unintelligent, uneducated, freeloaders, or violent. If you assume a patient is lazy, you may not recommend a rigorous therapy, even if it’s the best one. If you take for granted that a patient is unintelligent or uneducated, you might fail to explain her condition and options for treatment in depth because you don’t think she would understand. You might conclude that a patient from a “freeloading race” is well enough to work but would prefer to be on disability or that a bruised baby of a culture you considered violent is a battered one.

Recognize that biases exist in our society and in the medical world and be vigilant against them infecting your soul. But recognize that this is a task you need not pursue alone. Surrounding yourself with diverse colleagues is a good way to check and go beyond your prejudices. After all, you may see drunken slurring and staggering while your colleague recognizes stroke.

Take care of yourself and your colleagues.

Doctors of color face prejudice—from having patients refuse their care to having them refuse to believe that they are physicians at all.(11) If you are a doctor of color, take care of yourself. If you aren’t a doctor of color, take care of your colleagues . . . and, of course, you have colleagues of color because you diversified your practice as suggested, right?

The time to determine how to handle a racist patient is not when that patient is sitting on the examining table. Have a plan in place for how your practice will proceed in that situation. Read works such as “Dealing with Racist Patients” in the New England Journal of Medicine to prepare.(12)

What will you do if a patient doesn’t want care from an Asian doctor? What will you do if the situation is an emergency? If it isn’t? What will you do if a child comes in with a racist parent? Do you know how to respond if someone refers to your colleague, directly or behind his or her back, using a slur? Have you studied how to be an “active bystander” and intervene?(13) After the incident is over, does everyone pretend that nothing happened or is there a debriefing?

It should go without saying that racism is demoralizing and stressful. It impacts quality of life and a physician’s relationship to his or her practice. Thus, its effects must be treated just as those of a pathogen would be.

Doctors may make the worst patients, but if you and your peers want to be around to heal, you must heal yourselves. You know what to do: eating healthy, exercising, minimizing stress, meditating, and spending time with loved ones are practices that give physicians of color the resilience to help the people who don’t recognize them as human. White physicians can support their non-white colleagues by recognizing that racism against doctors and other health professionals exists, acknowledging it when it happens, supporting their colleagues when it happens, enforcing a code of conduct (for example, by declining to serve a bigoted primary care patient), and being empathetic.

Recognize that having an antiracist practice isn’t all about the care you provide.

You must buy your clinic’s soap from somewhere. Someone must fix the sinks when they clog. Even the cookies or carrot sticks in the staff kitchen have a source. Create a racial justice budget and support non-white vendors by purchasing goods and services from them.

Laysha Ward, executive vice president and chief external engagement officer at Target, counsels leaders to recognize that:

Purchasing power is one important way to address issues of wealth creation and jobs. Assess your supply chain from multiple angles and design a supplier diversity program that reflects your brand, your racial equity strategy, and the communities you serve. Ensure the right mix of BIPOC [Black, Indigenous, People of Color] and local vendors—not just for raw materials or products but also for services like legal, marketing, and IT.(14)

So, draft a racial justice budget. For example, you could make your spending reflect population parity. Thus, since Latinos make up 18% of the United States population, your practice might plan to spend 18% of its outflow with Latino vendors, and so on and so forth for other racial groups. But don’t just plan—balance the books. To manage diversity effectively, you must hold people account for metrics, so it’s not enough to intend to support vendors of color. Someone should be held just as accountable for ensuring that your organization didn’t go under budget in terms of racially just spending as he or she is for ensuring it didn’t go over budget in terms of finances in paying for goods and services.

And when engaging white vendors, choose those who support diversity. How can you tell whether they do? Definitely not by checking for a diversity statement on the company’s website or social media. Look for hard data. For example, in the United States, many businesses are required by law to fill out EEO-1 reports that disclose race and gender demographic data for different job categories. Such reports are “the ‘gold standard’ for diversity disclosure.”(15)

Even your waiting room can be an antiracist space. Why not place works with catchy titles, such as Noel Ignatiev’s nonfiction adult book How the Irish Became White, or irresistible covers, such as the fictional picture book We Are Water Protectors by Carole Lindstrom, which is inspired by 21st-century indigenous environmental activism against dangerous oil pipelines, among the fashion and golf magazines? Why not keep kids occupied with crayons and pages from Civil Rights–themed coloring books (the kind that have historical fact captions) as well as other creative materials such as civil rights leader and congressman John Lewis’ graphic novel?

By taking steps such as these, you are on your way to building an antiracist practice.

References

1. CDC.gov . Racism and health. www.cdc.gov/healthequity/racism-disparities/index.html . Accessed October 20, 2021.

2. Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician–patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sciences. 2020;35:117.

3. Assari S. Why is it so hard to close the racial health gap in the US? Statnews.com . www.statnews.com/2017/01/09/racial-health-gap-united-states/ . Accessed October 21, 2021.

4. Working together to reduce black maternal mortality. CDC.gov . www.cdc.gov/healthequity/features/maternal-mortality/index.html . Accessed October 21, 2021.

5. Collins C, Asante-Muhammed D, Hoxie J, Terry S. Dreams deferred: how enriching the 1% widens the racial wealth divide. Inequality.org . https://inequality.org/wp-content/uploads/2019/01/IPS_RWD-Report_FINAL-1.15.19.pdf . Accessed October 21, 2021.

6. Poverty and racism: overlapping threats to the common good. Catholiccharitiesusa.org . www.catholiccharitiesusa.org/wp-content/uploads/2020/08/Poverty-and-Racism-2020_FINAL.pdf . Accessed October 21, 2021.

7. Rabin RC. Dermatology has a problem with skin color. The New York Times. August 30, 2020. www.nytimes.com/2020/08/30/health/skin-diseases-black-hispanic.html .

8. Kolata G, Panich-Linsman I. These sisters with sickle cell had devastating, and preventable, strokes. The New York Times. May 29, 2021. www.nytimes.com/2021/05/23/health/sickle-cell-black-children.html

9. Sabin JA. How we fail black patients in pain. AAMC.org . www.aamc.org/news-insights/how-we-fail-black-patients-pain . Accessed October 21, 2021.

10. Addison H. Stigma and sickle cell. Johns Hopkins Nursing. https://magazine.nursing.jhu.edu/2018/10/stigma-and-sickle-cell/ . Accessed October 21, 2021.

11. Margolin E. Black female doctor: Delta discriminated, barred me from sick passenger. NBCnews.com . www.nbcnews.com/news/us-news/black-female-doctor-delta-discriminated-barred-me-sick-passenger-n666251 . Accessed October 21, 2021. Olayiwola JN. Racism in Medicine: Shifting the Power. Annals of Family Medicine. 2016;14(3):267-269.

12. Kimani P, Smith A, Lo B, Fernández A. Dealing with racist patients. N Engl J Med. 2016; 374:708-711.

13. Terry R. How to be an active bystander when you see casual racism. The New York Times. October 29, 2020. www.nytimes.com/2020/10/29/smarter-living/how-to-be-an-active-bystander-when-you-see-casual-racism.html

14. Ward L. What an anti-racist business strategy looks like. Harvard Business Review. https://hbr.org/2020/11/what-an-anti-racist-business-strategy-looks-like . Accessed October 21, 2021.

15. McGregor J. Urged to back up pledges for racial justice, 34 major firms commit to disclose government workforce data. The Washington Post. September 29, 2020. www.washingtonpost.com/business/2020/09/29/corporate-diversity-data-pledge/ .