I want to begin by expressing solidarity and support of my black classmates and friends. I, alongside numerous others, grieve for the families of Breonna Taylor, Ahmaud Arbery, George Floyd, and the many people whose names we don’t know. These senseless murders are now included in an already long list of occurrences of police brutality that disproportionately targets communities of color.
A much-needed conversation. A persisting problem. So, let’s talk about it.
George Floyd desperately cried out, “I can’t breathe.” When a patient cries out, “I can’t breathe,” people don’t hesitate to run into action. The ABC protocol (Airway, Breathing, Circulation) is launched immediately. Healthcare providers scramble to save the patient. To my fellow pre-meds and physicians alike, it should anger you that the basic human necessity for air, for oxygen, was denied to him. He was robbed of breath—the very thing we wish our dying patients to have more of.
But why is it that addressing issues associated with social inequity is an uncomfortable proposition for many physicians?
Maybe these complex problems are assumed to extend past the boundaries of the medical profession. Maybe it’s assumed that physicians’ primary commitment should be only to the care of individual patients, and that it may be inappropriate for doctors to engage in controversial topics. To anyone in the healthcare profession, this is why we must speak up:
The COVID-19 pandemic is just one of the most recent examples of structural racism due to the disproportionate number of cases and deaths for people of color. Before the pandemic, for instance, persistent health inequities contributed to higher rates of stroke death in African-Americans. Black men are disproportionately affected by HIV. Black women are 3 times more likely to die from pregnancy complications than white women. Life expectancy for Black men and women is almost four years shorter than that of whites.
Even in clinical care and research, Black patients are underrepresented or excluded. How are we supposed to assess the risk of kidney and heart disease among Black patients if its research was only done with white patients? Utilizing an outdated modality of measuring kidney function may result in inequitable transplant outcomes, just because of one’s skin color. How is that fair at all? Moreover, research on medical conditions that predominantly affect the Black community, such as sickle cell disease, remains underfunded. Meanwhile, cystic fibrosis, a predominantly white disease, has 400 times more research funding than sickle cell disease. Such striking discrepancies in research priorities shouldn’t be ignored.
As pursuing physicians, it’s our duty to speak up on the systematic racism that’s embedded in our nation and medical practice alike. Clinicians cannot be silent. We must recognize that medical education and training at large have historically or presently participated in acts of injustice. Traditional medical school curriculum needs to include social justice training and advocacy skills to address the health inequities and the root causes of a broken health care system.
As a pre-medical student, I recognize that racial bias affects African-American students even before they enter medical school. I see our medical system’s failure to recruit and retain a diverse and representative physician workforce. I notice a white-centered curriculum and culture in our medical schools. I acknowledge that research has exploited and excluded black and brown people throughout history.
However, I also recognize the valuable role physicians-in-training can play to fight racism. This means transforming the hiring practices in our health centers and ensuring diversity through the highest levels in our institutions. It means reframing our medical school admission practices and mentoring high school and college students to account for the blatant racial disparity within the medical community. It means reflecting on our own implicit biases within.
Much of the medical field culture is about remaining impartial or being professionally civil. But racism impacts patients, it impacts colleagues, and so, it impacts you as a doctor. In a field that’s about placing the patient first, black patients are dying because of racism at all levels. A doctor’s profession does not detach us from the events of the world. It doesn’t separate us from the social and political factors that shape the people most important to us: patients.
We have an ethical obligation to seek societal change to address these “non-medical” yet prevailing influences on our patients’ health, no matter how difficult and uncomfortable doing so can be. Illuminating the adverse social determinants on patients is the only way to treat the whole person in this profession.
If you have had the benefit of the white privilege that comes with the white coat, I invite you to use your voice for public health education, health care reform, and social justice.
Black lives will not begin to matter until Black health matters.
To every physician: thank you sincerely for spending the last six months trying to help patients breathe in the face of COVID-19. But your work must extend beyond the inside of the hospital. It needs to involve fighting the injustice that prevents patients from breathing, battling the structural racism that makes it more likely that black patients will suffer from COVID-19, and raising your voice against the racism that puts a knee on the neck of a Black man.
When the Black people of our nation shout, “I can’t breathe,” it’s our duty as physicians to hear them and respond.