John Henryism and African American physicians during COVID-19


As an anesthesiologist, you are trained to not only perform but to thrive and act in emergency situations. Four years of residency builds psychological resilience, which is defined as the ability to mentally or emotionally cope or return to pre-crisis status quickly. These crises often occur when a patient’s heart stops beating, or a patient is unable to breathe. Anesthesiologists have seconds to respond to a crisis and prevent a bad outcome. A four-year anesthesiology residency program teaches skills to lead a clinical team and support other personnel (and families) to cope and persist in emergency situations, whether it be the anesthesiologist in a trauma case or the intensivist in a busy intensive care unit.

Being an African American in the United States forces you to build resilience. Many African Americans face racism, discrimination, and microaggressions on a daily basis. In fact, Kessler and colleagues reported that 91.2 percent of non-Hispanic blacks experience discrimination on a daily basis. For an African American to excel in highly regarded professions like medicine or engineering, they must meet the same expectations as their white peers, while simultaneously coping with daily microaggressions and the impact of unconscious biases that come from superiors, peers, patients, and the general public.

As an African American physician, the first few months of 2020 have been very troubling. Social media, print media, and most major news outlets have consistently drawn attention to the tremendous racial disparities in COVID-19 cases and deaths. COVID-19 is ravaging through the African American community, resulting in the death of entire households in some cases. Further exacerbating the stress and trauma that African Americans face during this pandemic are cases like Ahmaud Arbery. We continue to witness extrajudicial killings in African American communities. The risk of police-involved death is three times higher among African Americans compared to whites; police officers are more likely to shoot African American suspects even after taking into account racial differences in community-level criminal activity.

Witnessing the excess mortality in our community, whether its due to COVID-19, the extrajudicial killing of African Americans, or the widening gap in healthcare access and associated mortality during the COVID-19 pandemic, has added another layer of stress, frustration, and heartbreak. Although we have developed coping strategies as African American anesthesiologists, the unending activation of coping strategies takes a toll. Dr. Sherman James defined this coping phenomena as John Henryism, the prolonged, high-effort coping to chronic stressors like racism and discrimination. This high-energy coping combined with high perceived stress has been associated with a range of negative health outcomes in African Americans, including hypertension. Our frustration and the frustration of many of my African American physician peers stems from the helplessness we feel to honor the commitment that drew us to medicine in the first place, namely to improve the health and well-being of African American and underserved communities. Many African American physicians come from communities, much like the ones we seek to impact, and we feel helpless to do what we were called to do.

Where do we go from here? As minority physicians, we cannot fight this battle alone; we need support from our physician colleagues, despite their race, ethnicity, or national origin.  We need professional societies and national organizations to rally with us. We have identified three actionable steps:

1. There needs to be strategies and programs to support African Americans who are unduly burdened by discrimination and microaggressions, simply because of their race or ethnicity.

2. Given the early evidence that implicit biases impact patient outcomesmedical school admission, and residency selection, we are calling on national organizations to require implicit bias testing and training for all academic faculty, physicians, and trainees. This could also be extended to include police departments and other human service agencies.

3. Professional organizations and medical centers must support and enhance pipeline programs to address existing barriers to medical school admission for minorities. Underrepresented minority physicians are more likely to practice in medically underserved areas, help improve learning outcomes, cultural sensitivity, and interpersonal skills for other clinicians, and are associated with improved patient care and satisfaction.

This collective of African American anesthesiologists is creating a call to action; the time to act is now.

Adam J. Milam, Steven Bradley, Nate Hughes, TomMario Davis, and Marcus Mitchell are anesthesiologists.

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