Since my very first patient encounters at Harvard Medical School, I’ve seen how social inequity can limit the extent of medicine’s healing.
I’ve seen patients forgo brain imaging due to financial challenges and defer a colonoscopy because of lack of transportation. I’ve seen patients’ health — and my ability to support these patients — deteriorate under the pressure of towering structural barriers.
Overwhelmingly, these patients have been racial and ethnic minorities (I believe minoritized might be a more accurate term), LGBTQ, undocumented, disabled, and/or low-income. The United States’ history of oppression follows patients through the doors of every hospital across the country — and the hard blow of its impact is felt at every level, from the systemic to the interpersonal.
After decades of advocacy, major medical associations are finally starting to recognize how these interlocking systems of oppression limit what doctors and trainees can do for their patients.
For example, recently the American Association of Medical Colleges (AAMC) released guidelines outlining ways that doctors and trainees can promote diversity, equity, and inclusion in medical school and continuing education. The 36-page document, curated by nationally renowned medical scholars, provides a primer on how to enhance educational programs so that physicians can better recognize and combat the structural oppression affecting their patients’ lives.
It seems the medical institution is finally waking up. But a growing number of fearmongering “anti-woke” detractors are pushing back.
In response to the AAMC’s document, The Wall Street Journal editorial board published a piece proclaiming that a “woke curriculum” and social justice training are “about to infect” medical education. Such language is mirrored in a recent article in City Journal and a book that each describe antiracism as an impending plague that will take over medical schools.
Antiracism opponents are so agitated by these concerns that an organization called “Do No Harm” has been launched with the nebulous mission of “fighting against identity politics.” The group rented a truck that drove around Harvard Medical School’s 2022 graduation displaying anti-woke messages. It has also sued to block a health-equity mentorship program and filed complaints with the federal government against several medical schools with programs that provide additional financial support for low-income and minority students to complete clinical rotations.
These efforts seem to center on the idea that prioritizing antiracism in medical education will make our society more divisive and make medical education less rigorous.
As a medical student, future physician, and patient advocate, I disagree. In fact, I believe antiracism training makes us better doctors, improves our relationship with patients, and could be the saving grace of our health care system.
To understand why, look no further than the abundant instances of medical racism today.
There is systemic segregation at medical facilities, including Boston’s elite hospitals, due to federal policies that determine health insurance coverage. The diagnosis of Lyme disease can be delayed for Black patients because physicians generally haven’t been trained to recognize the typical bullseye rash on darker skin. Medical trainees tend to believe that Black patients have a higher pain tolerance. Physicians have a propensity to call security on Black patients in the emergency room. Medical devices such as blood-oxygen sensors are less accurate on Black patients. Black patients, including a physician and the tennis star Serena Williams, have taken to social media to share their experiences about how medical racism put their lives in danger.
The observation of these disparities isn’t new. As early as 1906, sociologist W.E.B. Dubois astutely observed the connection between social inequality and health in a seminal paper, “The Health and Physique of the American Negro.” In 2002, the National Medical Institute published “Unequal Treatment,” a book of more than 700 pages highlighting persistent health disparities across medical specialties. It’s long past time for doctors to gain the agency to act on these trends.
Most folks might agree that health disparities are bad but question whether lessons about these topics take away from medical training.
The short answer is no. Antiracism opponents fail to recognize that health equity is an enhancement of and not a substitute for the biomedical core competencies of trainees and physicians. Medical education consists of four years of medical school followed by at least three years of residency, with the option of additional training through specialization and fellowship. Each of these stages comes with exams and competency assessments that require standardized knowledge of a variety of health topics ranging from ethics to endocrinology.
Antiracism education does not replace any of these. Instead, competency guides like the AAMC’s provide recommendations on how equity can be integrated into lessons about medical care to best serve our patients. In practice, this means conversations about, say, the pathophysiology of heart failure include discussions of how to reduce racial disparities in heart failure outcomes. Understanding both of these things is what my classmates and I need to provide the highest level of care for our future patients.
Opponents of antiracism programs in medical school also say that if medical institutions admit to racism, they will make Black patients more distrustful. That argument is misguided at best. Black folks have always had to be critical users of America’s institutions as a means of survival — and this includes and always has included medical institutions. I get phone calls from my family members whenever they visit a doctor. In many instances I’ve been their safety blanket protecting them from the all-too-common mistreatment that Black Americans face during doctors’ visits. A recent poll by the Pew Research Center found that 56 percent of Black Americans report they’ve had negative experiences with medical doctors such as “having to speak up to get the proper care and being treated with less respect than other patients.”
Some may fear that admitting to medicine’s history of oppression may decrease trust among the Black community, but I believe it will have the opposite effect. Our community knows about medical racism because we’ve lived — and continue to live — through it. To ignore this truth is to contribute to the erasure of our community’s pain; to recognize it is to set us on a path of healing. Doing so will improve the health of all patients.
The recent AAMC guidelines describe ways to mitigate not only racial inequities but also inequities that affect patients with various marginalized identities. For example, numerous studies have shown that many LGBTQ people forgo medical care due to fear of mistreatment. Similarly, patients with disabilities may have worse reported health outcomes due to physician bias. By recognizing such blind spots and gaps in medical education, physicians will be better prepared to treat and advocate for our most vulnerable populations.
It may also combat what many expect to be medicine’s impending Great Resignation. A recent survey found that in 1 in 5 physicians plan to leave medical practice within two years. Physician burnout is listed as the primary reason. The term “burnout” as applied to doctors has become associated with their discontent with insurance companies, paperwork, and long hours. But the word was coined in 1974 by a psychologist who specifically pointed to the challenges faced by physicians with limited resources and education on how to truly help when caring for marginalized patients. Today, training in health equity and antiracism will allow physicians to feel more empowered when biomedical sciences alone are unable to resolve the ailments of their patients.
Most important, these teachings will simply make us more humanistic and whole health care providers. Physicians who can not only treat diabetes but understand the challenges patients face in affording their insulin. Physician-researchers who work toward a cure for Alzheimer’s while ensuring that the cure will be accessible to everyone. Public health advocates who promote the importance of vaccination but understand the sociopolitical history that drives medical mistrust.
Some say woke doctors will diminish the future of medicine. But the doctors who refuse to wake up — despite all the evidence around them — may be the ones who will be unprepared to holistically treat our patients. The medical institution must keep up its progress toward antiracism if our goal is to do no harm to the marginalized patients still living the nightmare of health inequity.
LaShyra “Lash” Nolen, a fourth-year medical student at Harvard, is also pursuing a master’s degree in public policy at the Harvard Kennedy School of Government. She is the founder of the We Got Us Community Empowerment Project. Follow her on Twitter @LashNolen.