Medical racism persists beyond historical fact to become current tradition, and inequalities can only be magnified by the circumstance of an emergency. How many more opportunities for widened healthcare disparity has COVID-19 given us?
By Racquel Reid, MD
As the population of the United States trudges doggedly through endless months of uncontrolled COVID-19 spread, my tenuous trust in the practice of medicine within this country wanes in kind. This trust has been unstable since even before I completed medical school, owing to learning about disparities in healthcare within lecture halls, then having to observe them in action amid hospital corridors. Unequal Treatment, a consensus study report published in 2003 by the Institute of Medicine, details the existing racial inequalities in US medicine as well as the dynamic factors behind their persistence. Yet despite its call to action, I know as a medical professional that little has changed. According to CDC data, Black, Native, and Hispanic communities have been affected disproportionately by COVID-19, with researchers aptly explaining why. But I never needed the CDC to tell me who has been diagnosed with the virus, who has been treated to recovery, and who has died.
Nearly ten years after my graduation, I sift through research articles and COVID-19 alerts in a quiet office, and I think about my patients. I’ve met with them across office desks, in hospital meeting rooms. I’ve hovered near them as they’ve lain in too-bright rooms on noisy units, scared and seeking refuge, frightened by their condition, by pain, and sometimes by me. And how could they not be? Medical providers can, will, and have denied their voiced concerns, whispered hushed suspicions about their presentation behind closed doors. Their demographic information could prompt a physician’s unwillingness to progress down differential diagnoses. Policies have left providers and patients with impossible choices, and deaths that could have otherwise been prevented. The collective belief among providers, unfortunately, is that grieving too often or too long over patient circumstances is a personal failing, or that vanishing empathy is a natural progression in medicine. There are countless institutional failures I myself have never been able to explain.
It’s all seemingly subtle, providing my colleagues and health systems plausible deniability, suggesting inequity may simply be the fault of a few medical providers with unconscious bias; infrequent and correctable medical error within an otherwise fair and productive care system. I convinced myself I could make a difference if I only slipped into side corridors to refute staff presumptions, or addressed the questionable direction a patient’s treatment plan had taken after gathering history. But medical racism persists beyond historical fact to become current tradition, and inequalities can only be magnified by the circumstance of an emergency. How many more opportunities for widened healthcare disparity has COVID-19 given us? From the early days of our training, physicians are taught four ethical principles: beneficence, non-maleficence, respect for autonomy, and justice. They are to be foundational in our work, but I find that too often, justice is not given the attention it deserves.
Medical degrees cannot expunge socialization into a society willing to discard its most vulnerable populations. Who will uphold the care of impoverished, immigrant, gender-diverse, disabled, and queer patients if the advocates necessary for their safety are shunned by necessity to prevent continued viral spread? What happens upon hospital admission if and when these patients fail to “demonstrate value” to those charged with caring for them, those who determine the severity of their symptoms or when their condition is without hope for recovery? And then, we must consider the recent removal of Dr. Princess Dennar from her post at Tulane after fighting against her own discrimination, the death of Dr. Susan Moore at the hands of her own colleagues. The fact that cells from Henrietta Lacks have been used to study the virus. The fact that COVID-19 vaccines exist, but Black people desiring to be vaccinated have been unable to receive them or obtain them at rates below the population.
I think of Tessica Brown, dubbed “Gorilla Glue Girl” in a tragic play on the circumstances of her error and the positionality of her Blackness, and how she suffered because of her lack of insurance then endured misogynoirist ridicule when she finally attempted to seek care. How she only received accessible, compassionate, and low-cost treatment by a medical provider who understood the intricacies of Black hair and did her procedure pro-bono. I contemplate my own medical training; how my Blackness shaped it, how choosing Psychiatry allowed me to prioritize my patients and their social circumstances so profoundly but made it no easier to subvert harm within the practicing guidelines of most care systems. The ways I’ve likely enacted harm of my own.
I assert that medical training must also include analysis of racial capitalism. Absent this analysis, we reify existing oppressive structures, and the hospital entrance is no boundary preventing their abuses. If medicine is a practice, then study of any peer-reviewed article is as necessary as the examination of abolition, of anti-capitalism, of Black feminisms, and liberation. This necessitates examining rising rent costs, stagnant wages, Black women being the primary breadwinners in a significant number of their homes, and acknowledging that medical debt is a common reason many Americans file for bankruptcy. It means understanding that misogynoir is the tape and string binding together the treatment of Black women, even as providers. That my medical degree isn’t necessarily a defense against my own mistreatment, knowing my Blackness and disability could preclude accurate assessment of my worth.
I’m forever striving towards a world where care is complete and without avoidable harms, but bridging the gap is revelatory and necessary work. While I cannot ensure that the work I do—the institutions I must practice under—don’t enact violence, this dedication makes my approach patient-centered, conscientious, wraparound. So, in this gap, I highlight institutional contradictions, stress the importance of patient peer support groups, take extra time with my patients, and sometimes, if I cannot provide care honest to my principles, I leave organizations. I acknowledge that even with good praxis, I may not always win, but the struggle against inequality continues, and I intend to fight it.
Dr. Racquel Reid, MD is a community-based child, adolescent, and adult psychiatrist practicing in Los Angeles, CA. Her work centers patients from marginalized populations, guided by principles of collective care and wellness. She is in the process of establishing her own medical practice and can be found on Twitter at @imaginemh.
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