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Yale Psychiatry's Calhoun Asks: Is The Medical System Safe for Black Children?

February 16, 2021
by Jordan Sisson

During a recent virtual career panel, Amanda J. Calhoun, MD, MPH, Second-Year Resident in the Albert J. Solnit Integrated Adult/Child Psychiatry program, found herself unable to promise Black teenagers that they would be safe in the medical system.

It was an experience, she said, that overwhelmed her with sadness.

“As doctors, we are trained to identify mechanisms,” Calhoun said. “We are trained to write patient assessments that address the root of a symptom. We don’t stop until we understand the primary driver of a process. We are trained to locate the lesion and pontificate about the pathophysiology. We are trained to understand that aggression in a child is a symptom, not a diagnosis. Yet, we are trained to cite poverty, lack of access to health care, and lack of education as our explanations for persistent racial disparities in children. But, just like aggression, these are symptoms – these are not diagnoses.”

For the second consecutive year, Calhoun was the only resident among a select group of speakers chosen to share their narrative stories about the patient experience and working as a doctor at the Feb. 3 Marjorie Rosenthal Pediatric Stories Grand Rounds. This year’s presentation was held virtually via Zoom. Calhoun’s speech, titled “Sour,” centered on her experience as a woman of African descent working in the medical field.

Shortly after Calhoun delivered her 2020 speech, the COVID-19 pandemic swept across the country and the world, highlighting racial disparities in health care. In the months that followed, police brutality against Black Americans skyrocketed into the national spotlight. In an interview following her speech, Calhoun shared that her uncle was turned away from the emergency department and later died from COVID last year.

“In many ways, I feel that racism robbed me of my uncle, who was one of my biggest supports,” she said. “All of that fueled me to write about the lack of safety of Black people in the medical system. Sadly, the last year honestly only affirmed my fears. We are in the midst of a double pandemic: COVID-19 and racism. The former is new, but the latter is centuries old.”

During her 2020 presentation, Calhoun spoke about how being a Yale Psychiatry resident and an underrepresented minority was like looking at life through two different lenses. She used anecdotes of times she experienced racism in both her personal and professional lives, interspersed with statistics to illustrate evidence of racism in the medical system.

This year, Calhoun took a similar approach, bookending examples of racial health disparities with her story about how, when presenting at a virtual career panel for Black high schoolers, a student shared: “I really want to be a doctor, but I’m terrified to be a patient.”

“I believe that storytelling gives a window into your life. And I wanted the audience to feel how I felt at that career panel when I could not tell Black teenagers that they would be safe in the medical system,” Calhoun explained. “Writing this piece, like last year, required me to put my heart out there, but I do it because I hope that it will touch folks in the audience, so that racism does not continue to be perpetuated in the medical system. I do it because I want to be able to promise Black children, one day, that they will be safe in the medical system. I have the hope that maybe hearing this speech will make a physician think twice about rolling their eyes at a Black child in pain or think twice about why there are racial disparities and begin to cite racism as the root of these issues.”

Calhoun emphasized that often, medical education does not provide context for these racial health disparities. She said students don’t learn about studies showing that doctors have more positive attitudes towards white patients compared to Black patients when learning about the studies that show Black people are poorer and sicker than white people, or that Black children are more likely to live closer to toxic waste facilities — a concept known as environmental racism — when learning that Black children have higher asthma rates than white children.

In her speech, Calhoun told the audience: “Medical education is skewed — shaped by who defines the narrative, just like history classes.”

“It is inaccurate — a slap in the face — to explain away racial health disparities by citing poverty or lack of health care access without acknowledgement of the impact of racism. Because this suggests that Black people are just poor and inferior to white people, without acknowledging the centuries of racist barriers intentionally placed in our way,” she said.

Calhoun said since delivering her speech she has received positive feedback that audience members felt empowered to affect change in the medical system and fight racism.

“I think we talk some about Black adults, but the fact that my piece really focused on Black children and how they are also devalued in the medical system, touched really close to home for many,” Calhoun said after her speech. “Of course, it is always a risk as a Black woman to speak out about racism. It brands you as an activist and some people may not want to hear what I have to say — and I think that fuels me to keep speaking out. Black voices need to be heard. And I will continue to speak my truth and help as many children as I can. I will always be both a physician and an activist.”

Submitted by Jordan Sisson on February 15, 2021