Hi everyone,
Here's how I was taught to present patients: "Mr. Smith is a 65-year-old Caucasian man," "Mrs. Lee is a 44-year-old Asian woman," "Mrs. Jones is a 59-year-old Black woman," and so on. Ever the obedient medical student, I dutifully reported my patients' race. That's how it was done.
Over time, race reporting faded from chart notes and presentations, presumably to avoid harmful framing. Occasionally someone would ask—typically a senior physician seeking clues to uncommon diagnoses like sarcoidosis, Behcet’s, or Familial Mediterranean Fever—but for the most part, race reporting was frowned upon- “it’s just a social construct,” we were told. In effect, the medical community closed its eyes.
Unfortunately, the tendency to ignore race has probably done more harm than good, because ignoring race obscures the many ways racism hurts our patients.
The medical profession is burdened by a history of racism that is both long and shameful. During the 19th century, the physician James Marion Sims performed experimental surgery—without anesthesia—on enslaved women and children. During the 20th century, Black men were denied essential treatment for syphilis in the infamous Tuskegee study.
Though racism in medicine may be less explicit today, it remains harmful. Compared to whites, Black people experience higher maternal and infant mortality, are less likely to get state-of-the-art treatments, and live shorter lives. Racism is embedded into the structure and practice of our profession in ways that elude attention if we don’t open our eyes. For example, during the COVID pandemic, many physicians were shocked to learn that pulse oximeters routinely overestimate oxygen saturation in Black patients, though this technical problem has been known for 30 years. Earnest efforts to make ICU triage scores “race-blind” ended up making discrimination even more likely.
What’s clear is that if we want to achieve racial equity in medicine, we can’t ignore how racism continues to plague our field. This Thursday morning, we’ll have an unparalleled opportunity to wrestle with this issue when our wonderful Chief Resident, Jana Christian, delivers Medical Grand Rounds. It’s been a privilege to preview her talk, which promises to be compelling, courageous, and crucial for all to hear.
We can’t fight racism with our eyes closed. Please join us as Jana guides us through this difficult but essential topic. Hope to see you there.
Have a good Sunday, everyone,
Mark