Unlike Governor Northam, East Virginia Medical School (EVMS) issued a statement acknowledging that the photo published in the 1984 yearbook was "shockingly abhorrent" and that "racism and discrimination in any form is not acceptable."[1] Further, EVMS went on to state:
We cannot change the events of the past, but we can use these events as reminders of the importance of our ongoing work toward diversity and inclusion. This is a time for self-reflection and humility. On behalf of our beloved EVMS, I sincerely apologize for the past transgressions of your trust. We recognize the need to address and rectify any issues of racism and discrimination that arise, at any point - and will continue a long tradition of action to build a strong culture of diversity and inclusion. [2]
This is the right approach. As an African-American woman with chronic medical conditions and the victim of unconscious bias built upon stereotypes reinforced in medical schools across this nation, I encourage other medical schools to engage in the same self-reflection and commitment to address and rectify issues of racism and discrimination.
In 2016 a study by the University of Virginia found that white medical students who believed stereotypes about biological differences in pain tolerance between African Americans and whites. Oh you know, like how our skin is thicker than white folks or how our nerve endings aren't as sensitive. [3] In the study, they talk about how these false beliefs impact pain management outcomes for minorities. They cite a study examining pain management among patients with cancer which "found that only 35% of racial minority patients received the appropriate prescriptions-as established by the World Health Organization guidelines-compared with 50% of nonminority patients (4)". I am a living example of that outcome.
Beginning in late 2014 I began feeling pain in my back and down my right leg. I sought medical treatment for the pain as it increasingly got worse. By April of 2015 I was in so much pain that I began using a cane and by late August I was hardly able to walk. I had MRIs, x-rays, given some steroid shots and no diagnosis. I was visiting my sister in D.C. and had a bout of pain so bad that I could not sit, stand or lay-down. It was excruciating, she drove me to Howard University Hospital, a historically black Medical School. The doctor on call in the emergency room looked at the pain meds that had been prescribed to me and said they weren't strong enough to relieve the pain I described. He immediately prescribed very strong pain medicine. About 20 minutes later, he came back by and looked a little puzzled. The doctor asked If I had been given the pain medication he prescribed, I answered yes. He then asked me had the pain subsided and I responded that the medication had taken the edge off the pain. He then became very concerned because the dosage he prescribed should have knocked me out. He then ordered an MRI and x-rays. Turns out I had cancer and the tumor had eaten half my right hip and was pressing against my sciatic nerve. If you ever had sciatic nerve pain imagine what that feels like. The doctors, residents and medical students at this HBCU correctly diagnosed my cancer in 72 hours. Just saying.
Unconscious bias may have caused me to suffer months and months of pain and delayed my treatment by at least six months. Fortunately for me, the tumor pressed against my sciatic nerve and my cancer was discovered in the early stages. I am practically pain-free and in remission, others may not have been so lucky. Unconscious bias has real consequences for minority patients.
The participants in the UVA study were not racists, they were not students who went around in Blackface or KKK robes, these were 222 medical students who consciously were in fact anti-racist and actively supportive of diversity and inclusion. Stereotypes alleging biological differences between African Americans and whites are deeply ingrained in the American psyche as the study by UVA and countless others have repeatedly shown.
The type of racist and bigoted behavior exhibited by Governor Northam and his classmates was not some long-held custom of the university, after all, it was founded in 1970 and accepted its first class in 1973. The school was founded during the earliest commitments to civil rights and affirmative action. Governor Northam engaged in overt racist behavior, he is being disingenuous in his explanations and denials.
Many medical schools are similarly tone deaf to the invidious systemic and institutional racism baked into the system, They offer Northam type explanations when asked to explain why studies involving Medicare and Veteran Healthcare system recipients show the same levels of racial disparities as other studies. [4]
I encourage medical schools and healthcare systems to make a genuine commitment to diversity and inclusion. Medical schools must make the commitment to examine their policies, practices, and curricula to identify and eliminate any systemic barriers to equal access to quality patient care. Medical schools must identify ways to recruit and retain African American and Hispanic students, faculty, and staff. Medical schools must further make a commitment to provide training on unconscious bias throughout the entire professional development process. Healthcare providers must make a commitment to monitor patient outcomes and take remedial actions where necessary to improve quality care.
I want to applaud EVMS for its commitment to supporting and creating a culture of diversity, inclusion and social equality and to recruiting, educating and training a culturally competent healthcare workforce. [5] The racist actions revealed by Governor Northam's photos found in the 1984 medical yearbook have provided us with an opportunity to discuss disparities in healthcare outcomes and the role both explicit and unconscious biases play.
[1] Statement from President Richard V. Homan, MD, on February 2, 2019. https://www.evms.edu/about_evms/leadership/president_provost_dean/statement020219/
[2] IBID
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