5 Lessons the Black Lives Matter Movement Can Teach the Health Care Industry
A physician checks herself and her profession
I have always been a humanist. I was raised Buddhist, don’t typically buy into bipartisan politics, and work hard to resist the reflex of “othering” those who have different opinions. I have been challenged recently, however, to understand how peacefulness can be a slippery slope to complacency.
As many sectors of society show humility during a global call for racial justice, the field of medicine (my domain) is frustratingly vain. The health care industry as a whole could stand to take a page from this moment in history. The following list of lessons is by no means exhaustive. Inspired by the Black Lives Matter movement, it is a handful of reflections I’ve had as a health care worker within an industry built on inequality.
1. Our patients are not safe
As a women’s health physician, I often ask my patients about intimate partner violence. I ask, “Is there anyone in your life who is hurting you, threatening you, or trying to control your body or your decisions?” When a patient answers “yes,” my next questions assess her level of safety. “Do you live alone? Is there anyone you go to for support? Have you gone to the police?” My question about involving law enforcement rests on a series of assumptions I’ve made about the police based on my own experience as a privileged Asian American. Coming of age, I generally felt that cops would protect me from harm, and didn’t realize until later in life that my experience is not generalizable.
Failing to advocate for our patients will always be medical negligence. Until there is equality in who we protect and how we protect them, our patients will never be safe.
In their homes, many of my patients live under an assault of poor infrastructure, food insecurity, threats of physical violence, mental illness, and lack of community. They face multiple barriers to seeking care. Many, due to threat of arrest or deportation, are coerced into unsafe living situations without an ability to seek protection. Worse, if they seek protection, they may inadvertently risk their lives or the lives of others.
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When I worked at a hospital in central Brooklyn, I was often the first physician a patient had seen since childhood. Anyone who works in medically underserved areas can attest to the host of chronic and acute disease that accumulates over a life of traumatic experiences, denial of opportunity, and/or poverty. Devaluing human life through structural racism will therefore always be a medical problem. Failing to advocate for our patients will always be medical negligence. Until there is equality in who we protect and how we protect them, our patients will never be safe.
2. The system is intentional
The fantasies of equitable justice, social service, and health care systems in America are being disrupted. Many of us have long romanticized our country offering equal opportunity for all; our legal systems keeping us safe and maintaining justice; and our health care system providing quality treatment regardless of race, ethnicity, and ability to pay. These stories of our systems, told to us when we were children, became the basis of our social contracts as we trusted our paychecks to state and federal taxes, our worth to loan purveyors, our safety to local law enforcement, and our bodies to health care.
I admit that prior to this year I didn’t question my lack of participation in local politics, or even broader conversations about racial justice, because I didn’t feel personally affected. My assumption was that they weren’t my stories and I, therefore, didn’t have a seat at the table. I have since realized the danger of this disregard, the kind of complacency that allows for democracy to deteriorate.
After a long history of oppression and only selective participation in our democracy, we are left with systems that rely on the exclusion of ethnic minorities. Anguish over our disparities is not evidence that systems have failed to adapt to more progressive times; the disparities themselves are evidence that equality never actually existed.
As we investigate our shameful past, we start to uncover the pillars that hold the structure for institutionalized racism. In real estate, the intentional exclusion of Black communities from property ownership and economic growth is known as “credit rationing.” In our justice system, the principle that government officials are not held to the same legal standards as ordinary citizens is known as “qualified immunity.” And in health care, the hospitals serving the greatest low-income populations have the least resources because they are simply “safety-net hospitals.”
I think we are capable now of speaking to a new narrative, understanding concepts like credit rationing, qualified immunity, and health care safety nets as euphemisms for intentionally harmful or knowingly inferior services. If medical (human) errors can be the third leading cause of death in the U.S., our choices might certainly be the reason why ethnic minorities are dying. As protest signs and politicians have emphasized: “The system is not broken; it is working just as intended.”
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3. We are the products of our biases and traumas
One morning I was listening to a radio interview with a police officer from New Jersey, as the department sought to reform the way it responds to nonviolent complaints. As I listened to the officer speak regrettably about how he was trained to be violent, I felt shamefully empathetic. In medicine, and especially in obstetrics, we are taught to envision the most dangerous, worst-case scenarios. This “prepare for the worst, hope for the best” mentality is critical to patient safety. Catastrophe is not rare in obstetrics, and being prepared for emergency situations could mean the difference between life and death.
The pressure to make decisions without complete information allows for our imaginations to run wild and our biases to cloud our judgment.
Labor and Delivery floors everywhere work intimately with blood banks, anticipating maternal hemorrhage. Rural birthing centers will always have a major hospital affiliation and a plan for helicopter or emergency vehicle transport. We know that regardless of how normal a pregnancy may be, there is always a possible need for a crash cesarean section because anything can happen at any time. We apply our best science, our best technology, and pray. In that way, obstetrics can feel less like medicine, and more like divinity.
This cautious way of thinking keeps physicians and health care providers sharp, but it also makes us paranoid. The pressure to make decisions without complete information allows for our imaginations to run wild and our biases to cloud our judgment. We may advise a patient to deliver by cesarean, for example, because of a prior bad experience, a gut feeling, and an imagined catastrophe developing in our heads. We might give antibiotics preventively, and order tests not because we think there is disease, but because of the health risks we associate with missed diagnoses. These are not benign decisions.
Rewind to the police officer. When I heard him say he was trained to react in the most extreme way because hesitating could cost a life, I understood exactly what he meant. Say what you will about the differences between doctors and police officers, but I see similarities.
We took different oaths, hold a different contract with society, and are subject to entirely different measures of accountability. And yet, we’re both expected to act. Although physicians rarely commit overt murder, we certainly hold weapons. Acknowledging that we are products of non-patient-centered training, biases, and traumas could be the first step in inspecting where we are vulnerable to negligence — and at risk of causing harm.
4. Burnout leads to negligence
Reassessing our expectations of law enforcement has, I think, been a remarkably productive outcome of the Black Lives Matter movement. The fact that police officers, mostly trained to respond to violent offenses, have been tasked with addressing motor vehicle violations, substance use disorders, mental health crises, and homelessness seems to reflect the inadequacy of our public services.
Additionally unrealistic is the expectation of any public service professional — police officers, firefighters, first responders, physicians — of being superhuman, as is the expectation of glory that many have when entering these fields. Having high expectations of oneself only to push paper at a desk is a recipe for burnout. I know many of my colleagues can relate. Having to complete massive amounts of documentation while providing very little patient care is cited as one of the main reasons for physician burnout. When sacrifices for such a job include time spent away from family and endangering one’s own health, it’s easy to become resentful of patients, and the public at large.
In the nadir of my own burnout, I would have been relieved to ignore the page, to walk away, to not call a patient’s family, or to avoid full disclosure. When you are not well, sometimes it feels like you have nothing left to offer. It’s important to note that negligence isn’t always making a bad decision; for someone responsible for others’ lives, simply not caring enough to be attentive can also be deadly. In these times, we need to reevaluate not only how we care for patients, but also our expectations of work and how we care for ourselves along the way.
5. We are capable of finding solutions
The Black Lives Matter movement effectively turned public attention to our nation’s shameful history. It has asked us to scrutinize how we’ve participated, who we choose to police, how we police, and why. It is also an opportunity for the American health care industry to admit to its own history of racism. The systematic closing of hospitals in Black neighborhoods and diversion of resources, minds, and technology to white neighborhoods has created our present-day crisis of safety-net hospitals — unable to address the volume of health needs of a population we have knowingly made sicker.
We are capable of building a reality in which a police officer can offer more than a bullet, and a physician can offer more than a prescription.
Here sits an opportunity to define our values. The way we reward physicians, reimburse procedures, and support our public hospitals are a reflection of how much (or how little) we value the health of specific populations. Recently, the administration at my hospital decided to discontinue cancer treatment services for the women in our community because, in these times of financial constraint, the service was simply not lucrative enough. Our residents led a resounding call to action, advocating for equality of care to the media, health care administrators, and local government officials. The decision was reversed, and the hospital community is now waiting to see how services will resume or be reformed.
Still, our hospital, the central referral center for all of central Brooklyn, lacks a cardiac catheterization lab, which is the standard of care for anyone with a heart attack.
Undoubtedly, this year has revealed vulnerabilities within our health care system. We can examine the system further to see how medical care has blossomed in some areas at the cost of neglecting other populations entirely. There is an opportunity now to build a model of inclusion, in which the complex needs of an individual are not ever exclusively criminal, or exclusively medical. We are capable of building a reality in which a police officer can offer more than a bullet, and a physician can offer more than a prescription.
Imagine a system in which patients, community health networks, nonprofits, legal services, social services, and policymakers work with health care providers to reform the way we provide care. I mentioned earlier that I was raised a Buddhist and a humanist, which these days makes me an optimist. My hope for the field of medicine is that we recognize our own hypocrisy, understanding that we have systematically devalued Black lives while preaching principles of equity and justice to our medical students. Maybe with this recognition, we, as health care professionals, can start to heal.