Racism in medicine manifests as cumulative deprioritization over many small decisions
Beyond the Rhetoric: This is how Black people die
Harry Alford | 1/11/2021, 11:28 a.m.
Are all doctors and registered nurses racist? Not overtly. “But this is one (common) way Black patients receive different care: Cumulative deprioritization,” writes Physician Scientist, Tamorah Lewis. Cumulative deprioritization is when implicit bias unconsciously affects decisions — It is deadly.
Bias can play a role in whose COVID-19 symptoms are taken seriously, like Dr. Susan Moore. Moore was a Black doctor who died of COVID-19 after complaining of racist treatment. “He made me feel like a drug addict,” Moore said, accusing a white doctor of downplaying her complaints of pain and suggesting she should be discharged. Bias cost Moore her life. “Her medical degree did not save her from the racism that she endured while battling for her life,” tweeted Dr. Omolara Uwemedimo.
From my experience this year, she’s absolutely right.
Last year, when very little was known about COVID-19, my dad was admitted to the intensive care unit (ICU). He would be diagnosed with flu and pneumonia. After a week, the hospital released him still with fluid in his lungs. Over the course of several weeks, my mom would find my dad unresponsive three times in their bed. Three times she called 911. He would continually be diagnosed with pneumonia again and again and again.
During the previous two hospital admissions, his blood pressure was allowed to soar, and his sugar glucose levels were high. It’s important to note that although my dad had diabetes and heart trouble in the past, he had no evidence of diabetes or heart disease in the most recent years.
When the cardiologist spoke to my dad for the third admission for the very first time, he said demonstratively, “So you are here because you do not take your meds regularly.” What!? We knew then that we had to advocate for dad as much as possible. My mom, twin brother, and I created a 24-hour shield, working from the hospital by day on our laptops. We wore logos of all the schools we attended to show we are an educated family. We spoke openly about our dad, so the staff knew he leads a purpose-driven life. At night, my brother and mom alternated sleeping in the chair or on the bench. I went home at night to care for my toddler and pregnant wife.
We knew that if they allowed our dad to go home that night, that he might not wake up the next morning. We demanded to speak to every leader on the floor, insisting he receives a sleep study — a medical treatment without being admitted to a hospital — while still in the hospital. With every clarifying question asked, we were met with a demeaning valuation of his life.
In Moore’s Facebook post, she chronicled her discharge from the hospital, her return home, and her condition's worsening. “I was home for less than 12 hours. Spiked a temperature of 103 and my blood pressure plummeted to 80/60 with a heart rate of 132. I’m back in the hospital, a different hospital, Saint Vincent Carmel.” (Ironically, my brother and I were born in this hospital.) Moore said that she was diagnosed with pneumonia but that she received “compassionate care” and the pain medication she needed at her new hospital. In her last update, Moore said she was being transferred to intensive care. Moore maintained that if she were white, she wouldn’t have received such poor treatment explaining, “This is how Black people get killed. When you send them home.” She died on Dec. 20.
Death by COVID-19 or not, there is nothing insignificant about life, especially when taken from us. To our immense delight, we brought our dad home, and he is doing well. He’s able to blow socially distant kisses to his two grandsons from his driveway.
We saw firsthand how deep subconscious beliefs could deprioritize Black life. As a society and in our respective professions, we must do a better job of being socially aware of our own biases. As Dr. Tamorah Lewis advised, “I unlearn it & actively fight against it in life and every patient encounter. But first, I had to admit it and look for it. If all in medicine followed suit, #DrSusan Moore would not be a hashtag.” I am amplifying Dr. Moore’s story and I’m doing something about it.
Harry Alford is co-founder of Humble Ventures, a venture development firm accelerating tech startups in partnership with large organizations and investors.
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