As we celebrate Black History Month in February, I wanted to cover a critically important topic on bias, racism and diversity and equity. A big thank you to the input of many people, including our residents Drs. Carmela Carrasco (see her wonderful RCP on implicit bias), Shannon Marrero and Peter Metzger, faculty Shaquita Bell and residency coordinator Kashena Konecki. These issues have been at the forefront of our national dialogue recently, and given everything going on in our nation, it's more important than ever that we use our roles as physicians to address bias and racism. We must honor the important work that has come before us, and acknowledge that we have much more work yet to do.

Materials for this week (this is a really big topic. I'd suggest trying to read at least one of the articles that is most important to you. In clinic, I suggest you watch Dr. Jones' or Dr. Roberts' TED talks and talk about how you all have seen racism affect health in patients)

Take-home points for this week – structured as a charge to each of us, as outlined from the article by Hardeman et al. in the NEJM

  1. Learn about, understand and accept racism – in ourselves and in our institutions. As Hardeman et al, describe "Most physicians are not explicitly racist and are committed to treating all patients equally. However, they operate in an inherently racist system. Structural racism is insidious, and a large and growing body of literature documents disparate outcomes for different races despite the best efforts of individual health care professionals. If we aim to curtail systematic violence and premature death, clinicians and researchers will have to take an active role in addressing the root cause." Those who have had white privilege must be able to understand and recognize what that means to see the effects of racism in our society. Watch Dr. Camara Jones' TED talk above with a focus on the gardener story and affect of differential preference over time.
  2. Understand how racism has shaped our narrative and the rhetoric we have used in medicine to erroneously relate race to biologic differences. Read this article highlighting how med students at Brown have addressed the curriculum to better deconstruct race as a social rather than biologic construct. Also, watch Dorothy Roberts' video on medical language and race in our research as a surrogate for genetics.
  3. Define and name racism – develop consistent definitions and use accurate vocabulary – Dr. Jones defines race as the “social classification of people based on phenotype” — “the societal box into which others put you based on your physical features.” Racism is a "system that encompasses economic, political, social and cultural structures, actions and beliefs that institutionalize and perpetuate an unequal distribution of privileges, resources and power between White people and people of Color." (Hilliard, 1992). Advocates have suggested shifting our focus in medicine and health research from identifying race to identifying racism so its less about individual responsibility and more about societal infrastructure and the effects on health. We also need to name and discuss the concepts of race and racism with our children, especially white children, who tend to hear less about race in their lives. Great article about this in the Washington Post by a child development professor who also is in a mixed-race family. Most children by the ages of 5-6 have developed some sense of racial identity. We have found children's books about characters of different races throughout history to be a great way to broach the conversations at our house.  
  4. Provide clinical care and conduct research that contributes to equity – As physicians we have opportunities to be change-makers and it starts with therapeutic alliances with patients and becoming aware of the resources available to us as pediatricians. We must continue to educate ourselves about our societal and institutional structural racism and approaches to address this through writers such as Ta-Nehesi Coates, Rembert Browne, and UW-trained sociologist Robin DiAngelo (a few of us in GME got to hear a workshop with her last week and it was fabulous). PBS' Black Culture Connection features writers, community influencers, and movies/documentaries.
  5. Be aware of and join local efforts. UW President Ana Marie Cauce launched a Race and Equity Initiative in 2015 for the UW community to acknowledge and confront bias and racism at all levels. The Department of Pediatrics has been considered a leader within the UW School of Medicine to address diversity and equity, thanks in part to the leadership and vision of many, including our residency's Diversity Committee. There are so many ways to continue to inform ourselves, and here are a few more: