It took a viral cellphone video to convince society of the gravity of police violence against Black Americans. But Black Americans are not treated fairly behind hospital walls, either. And although we cannot readily re-create the viral sensation of the May 25, 2020, clip of Minneapolis police officer Derek Chauvin placing his knee on George Floyd’s neck and murdering him, I, as a Black physician know the truth: Sometimes healthcare providers cannot even effectively report racist acts we witness.
So how are we ensuring widespread accountability in a largely White medical field? We aren’t.
Ironically, a rule intended to protect patient privacy serves as a barrier to bystanders intervening when Black patients are mistreated: I call this medical brutality. The Health Insurance Portability and Accountability Act prohibits healthcare providers from pulling out their cellphones to record evidence of racist treatment at the hospital. They cannot record staff unnecessarily restraining a Black patient. They cannot record a medical team undertreating a Black child’s pain. They cannot record an all-White staff watching, and not intervening, when a White patient calls a Black patient the n-word.
Need more examples? Black children are more likely to be physically restrained in emergency departments than White children, according to a study I co-authored in the Journal of the American Medical Association. Black newborns are more likely to die when cared for by White physicians. And it has long been shown that Black patients are less likely to be referred for further testing than White patients.
Sometimes these delays in care are not fatal, but sometimes they are. Even if healthcare providers witness such a delay in care, they could never film it. But a patient could.
Over a year ago, Dr. Susan Moore filmed herself on Facebook just weeks before she died of COVID-19 in a suburban Indiana hospital. In a viral video, she discussed racist treatment from staff, including delays in her care, devaluing of her symptoms, and undertreatment of her pain.
Just as a White policeman can kill an unarmed Black man, claiming he was a threat, so, too, can Black patients die because the doctor neglected to treat them adequately, thinking their symptoms were not worth follow-up.
As with underreported police killings, we may never know how many.
Medical brutality looks different from police brutality. This kind of brutality kills Black patients by neglect. It kills them by delaying surgery on my friend’s brother after he sustained a traumatic brain injury and bled out. It kills them by not bothering to aggressively treat my grandmother’s breast cancer and letting her die, leaving behind eight children; the youngest was 11. It kills them by not investigating when a Black woman says she is bleeding too much from postpartum complications and hemorrhages to death.
Violent erasure of Black existence
Medical racism is not just an abstract historical system that unfairly disadvantages Black patients. This kind of racism is also the violent erasure of Black people’s existence, figuratively and sometimes literally. Doctors don’t carry guns, but their racist decisions can kill. They carry a set of skills that Black patients are forced to trust in their most vulnerable moments — like the policeman we are forced to trust in the most dangerous moments.
To be sure, medical malpractice lawsuits exist, but they are time-consuming and expensive. Even when medical brutality results in death or lasting damage, families may not be aware of exactly why — or able to prove it. If Black patients die due to racist negligence, doctors can argue the patient would have died anyway. After all, patients die in hospitals.
The Commonwealth Fund recently released an issue brief highlighting the high rates of discrimination Black Americans face in the medical system and outlining a number of policy recommendations, like a racism reporting system and antiracist medical school curricula. We, undoubtedly, need systems to report instances of medical racism, and there are some medical schools across the country, like Harvard University and the University of Washington, that have reporting mechanisms for racist events, known as “bias reporting tools.”
But we need more. It is known that racist situations are prevalent in the medical system, yet they are vastly underreported due to fear of retaliation. We need people who are experts in addressing medical racism and its downstream effects, including retaliation against individuals who report such incidents. Then, as the brief suggests, these reports of racism should be made public. To my knowledge, there are few, if any, hospitals or medical schools that do. Black patients and physicians are left to whisper among themselves and pass information secretly about which hospitals are the most racist — and might kill you.
Taking our medicine without the racism
There has been some movement on how future doctors are being trained, though these interventions are just the beginning:
▪ As a psychiatry resident of the Yale Department of Psychiatry, I am aware of the current and historical underpinnings of medical racism that are embedded in my course materials. The Social Justice and Health Equity curriculum, a comprehensive educational program with four tracks (structural competency, human experience, advocacy, and history of psychiatry), is now mandatory for all residents across our four years of psychiatry training.
▪ Dr. Aderonke Pederson, Harvard Medical School assistant professor and director of research equity at Massachusetts General Hospital Clinical Trials Institute, is committed to teaching cultural competency to researchers. When she was at Northwestern University, she taught a class on social determinants of mental health and would often hear students trying to equate anti-Black racism with everything else: “Well, this is just like my White immigrant parents, they worked hard and made a better life, so anyone can.”
▪ The U.S. Food and Drug Administration recently highlighted its focus on improving representation of underrepresented racial groups in clinical trials.
▪ Boston University School of Medicine conducted an internal assessment to revamp its curriculum and reimagine an antiracist medical education.
There are many more cultural competency courses being taught around the country, although there is still much room for growth. In the end, antiracism education is still not a required part of standardized medical education.
Bring accountability to medicine — stat!
Televised violence inflicted upon countless Black Americans by law enforcement has brought police brutality to the media forefront, forging a modicum of accountability: $14 million recently was awarded to individuals injured by Denver police while protesting George Floyd’s murder. And then there’s former Minneapolis officer Chauvin’s lengthy prison sentence, which, in this caustic racial climate, was not a given.
As we have with policing, we need to stop tiptoeing around racism in the medical system, using language that excuses healthcare providers whose racist decisions harm — and sometimes kill — patients. We need to address the systems and people who uphold and protect racist treatment. We need to stop assuming all healthcare providers value Black lives when history up through the present shows us something different. We need to empower Black Americans to question their medical teams and invest in a fund for medical malpractice and discrimination lawyers that Black families can access when harmed.
Most important: We need to start holding healthcare providers truly responsible for their racist treatment of Black patients.
Dr. Amanda J. Calhoun is an adult/child psychiatry resident at Yale Child Study Center/Yale School of Medicine.