In our Academic Medicine article,1 we discuss how medical curricula perpetuate inequity by describing racial differences as matters of scientific fact. As medical students, we have seen lectures demonstrating biological differences rooted in race—a social construct—including that Black people have increased risk for developing glaucoma.1 We have seen race used in medical curricula to teach us and our classmates heuristics in order to guide our thinking. However, these mental shortcuts (used to direct a diagnosis or make a treatment plan) promote racism within medical culture at best and do harm to Black patients at worst. Our conversation about race being used as a coefficient in medical algorithms,3 particularly to calculate kidney function (eGFR), only scratches the surface of the history of a racialized science.
Black people are fighting to reclaim our humanity, but the United States at large, including its health care system, remains blindfolded to systemic racism. The disproportionate poor health outcomes of Black people—like the high mortality rates of Black patients diagnosed with COVID-192—are seen as the result of unfortunate predispositions rather than the byproducts of systemic racism. This false narrative overlooks the critical history of how medicine has been practiced in the United States. Modern Western medicine was shaped by a privileged few who built the field through unethical practices, including the Tuskegee syphilis experiment.1 Our racist past has inevitably impacted our training and medical practices today. In medical education, systemic racism manifests as a blurring of the lines between race and biology.
The belief that medicine is apolitical has for too long allowed us to avoid honest conversations about our field’s history. Many health care professionals are on the front lines of the fight for social justice, but their efforts are limited by deeply ingrained institutional racism and a host of barriers meant to maintain the status quo. Western medicine was driven by renowned doctors consciously and deliberately attempting to prove White supremacy as a natural consequence of medical fact.3,4,5 We should not ignore that our history has influenced how physicians practice today.
In order for medicine to move forward, we first have to grapple with our history by teaching it in medical school with the same emphasis that we teach physiology. Our history should be taught by content experts, not physicians, and integrated throughout and alongside the traditional medical curriculum. Ultimately, the burden of changing a racist system should not fall on the shoulders of Black trainees and clinicians, as is often the case. To move forward, medical educators must reckon with the fact that many aspects of our training promote racism and perpetuate the disproportionate share of poor health outcomes endured by the Black community. Only once these acknowledgements are made can real action be taken.
By: Paul D. Schumann and Naomi T. Nkinsi
P.D. Schumann is a third-year student, University of Washington School of Medicine, Seattle, Washington.
N.T. Nkinsi is a third-year MD-MPH student, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0002-0504-696X.
References and Further Reading
- Nieblas-Bedolla E, Christophers B, Nkinsi NT, Schumann PD, Stein E. Changing how race is portrayed in medical education: Recommendations from medical students. Acad Med. 2020;95:1802-1806.
- Wood Daniel. As pandemic deaths add up, racial disparities persist – And in some cases worsen. NPR. https://www.npr.org/sections/health-shots/2020/09/23/914427907/as-pandemic-deaths-add-up-racial-disparities-persist-and-in-some-cases-worsen. Published September 23, 2020. Accessed December 15, 2020.
- Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight – Reconsidering the use of race correction in clinical algorithms. N Engl J Med. 2020;383:874-882.
- Roberts D. The invention of race. In: Roberts D. Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century. New York, NY: The New Press; 2012.
- Chadha N, Lim B, Kane M, Rowland B. Toward the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research, and Practice. Institute For Healing and Justice In Medicine.https://www.instituteforhealingandjustice.org/. Published 2020. Accessed December 15, 2020.