Last month marks one year since the killing of George Floyd, and over that often-tumultuous timespan of public outrage, nationwide street demonstrations, and protest, Americans have been forced to take a critical and introspective look at ourselves as a nation of a diverse citizenry.
In the last year, we have confronted how racism in the day-to-day practices of our police and overall criminal justice system impacts the Black community. At the same time, the COVID-19 pandemic has dramatically highlighted the ignominious and thus disconcerting reality that longstanding racial inequities in our institution of medicine are as commonplace and intact as they were before the Civil Rights Act of 1964. And as we approach Juneteenth, the annual holiday to commemorate the end of slavery, I’ve been forced to reconcile that Blacks in America cannot truly achieve freedom and liberation if medical racism still exists. For those of us who have experienced it firsthand, racism in medicine is as violent, dehumanizing, and socially destructive as wanton police brutality against African-Americans and other peoples of color in this country.
Like the George Floyd Justice in Policing Act of 2021, the institution of medicine requires a civil rights and physician reform act to combat physician misconduct as it pertains to racial bias and structural racism in medicine. History has repeatedly shown that laws backed up with enforcement and sanctions for violations can change behavior, such as school integration laws. Medical racism is an age-old practice that sorts and ranks people into hierarchal racial groups that predictably results in the allocation of quality care and resources and other favorable social rewards disproportionally to white patients to the maleficent neglect of its citizens of color.
From a public policy perspective, the Medical Practice Acts are state laws set in place to regulate the practice of medicine to ensure that patients are not injured or harmed and instead protected. These laws vary from state to state, and the behaviors typically deemed professional misconduct for physicians range from inadequate record-keeping to physical abuse of a patient. While these statutes may be successful in regulating the scope of work in medicine and professional conduct, there isn’t anything in these laws that define professional misconduct when it comes to racial discrimination in medicine, including treatment bias and medical neglect. Thus, the foremost objective of legally regulating physician conduct in the form of racism and treatment bias would be to change any discriminatory or potentially harmful behavior on the part of physicians.
Recent epidemiological data from the U.S. Center for Disease Control shows that Black patients have disproportionately higher morbidity and mortality rates from COVID-19 than their white counterparts. Some of us might be tempted to suggest that these contrasting and disparate health outcomes are secondary to chronic disease, income, or access to care barriers. However, research shows that even with adjustment for these factors, Black patients still have much higher death rates from various medical conditions. The 2019 National Healthcare Quality and Disparities Report show that from 2000 to 2018, 95% of the quality care measures for which a disparity of care existed for Black patients remained the same over the years, meaning that there hasn’t been a significant change in addressing this issue. This data suggest that quality care has not improved for Black patients despite the countless anti-racism conferences, diversity training, and racial climate surveys employed for physicians by medical institutions. Even when faced with compelling evidence that differential racial treatment in medicine is widespread, we continue to ignore this problem and fail to demand accountability from medical care providers.
As physicians, we take an oath to provide quality care to all of our patients regardless of race. Yet, the goalpost for quality and standard of care shifts when some physicians care for Black patients, which results in higher death rates. The deaths of Dr. Susan Moore and Dr. Chaniece Wallace were not isolated incidents. Several other Black female physicians, such as Dr. Aysha Khoury, Dr. Stella Safo, and Dr. Uché Blackstock, have gut-wrenching stories that are firsthand testaments of the impact of medical racism on Black lives.
Based on my own lived experience as a clinician and educator in institutional leadership for over thirteen years, I can assure you that these are not isolated incidents.
Like other Black physicians, I’ve been forced to witness and endure the excruciating trauma of racism in the workplace every day from the asphyxiation of an institution’s metaphoric knee on our necks. If our medical degrees as Black physicians cannot protect us against medical racism, the general Black public is particularly vulnerable.
While most physicians I’ve encountered genuinely believe in their oath to uphold the ethical standard to do no harm, the COVID pandemic has revealed that some physicians continue to abuse the privilege of practicing medicine and legally inflict harm on Black people. Medical racism, which leads to pervasive health disparities, is a health care and public policy emergency that stifles the liberation and freedom of both Black patients and physicians. It is a crime against humanity and will not change until it is treated as a crime in courts of law.
It is time to take a legal stand against such medical inhumanity. Like the George Floyd Justice in Policing Act, we should demand from our state legislatures that the Medical Practice Act includes policies to regulate racism, treatment bias, and discrimination for what they are: another form of professional misconduct and physical abuse of patients.
Princess Dennar is an internal medicine-pediatrics physician.
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