After seeing multiple medical professionals down-play the role racism played in the death of #DrSusanMoore, I have been thinking of how to describe the logistics of how racism manifests in medicine. One way is what I will, in this thread, call "cumulative de-prioritization." 1/
2/ Lay people may think medicine is a panacea of limitless resources, but (especially in a pandemic), that's not true. Medical providers are CONSTANTLY triaging and prioritizing which patient gets which test / drug / family meeting at all times. Prioritizing must be done quickly.
3/ Imagine there are three critically ill patients in the ER and one current ICU bed. Which patient gets the ICU bed?

Imagine there are three patients all with symptoms of PE (blood clot in lungs), but there is only one scanner available to make the diagnosis. Who gets the scan?
4/ Imagine you urgently need open beds and there are three patients who are almost ready for discharge. Which patient gets discharged when marginally ready?

Imagine you have three families who need extensive communication about their loved ones' illness. Who gets the most time?
5/ Imagine you are the charge nurse. Which patients get assigned the most experiences nurses and who gets the nurses right out of orientation?

Imagine three patients need to be intubated and there is only one team available. Who gets intubated last?
6/ Imagine you are a nurse. One family is quiet, reserved, and (rightfully) distrustful. They ask questions because they want to make sure optimal care is being provided. And one family is smiley and easy and they also happen to look like you. Which room do you visit more?
7/ When docs and RNs are forced to make multiple, quick prioritizations in a day, FOR SURE implicit bias and deep subconscious beliefs about who matters and who is more valuable / dispensable creep in. This is a hard thing to know (as a patient) and admit (as a doctor or nurse).
8/ Racism in medicine manifests as cumulative de-prioritization over many small decisions. No one person is overtly racist. No one says "we provide less care to Black patients."

But this is one (common) way Black patients receive different care: cumulative de-prioritization.
Even I, a Black MD, know I have internalized anti-Black bias from growing up in USA. 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, #DrSusanMoore would not be a hashtag.

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More from @TamorahLewisMD

25 Jun
It's 2020.

Words matter.

I hope to use my privilege and platform to change the way we discuss health inequities (while I stand on the shoulders of giants who have been in the trenches of this work).

Following is a 🧵on #RacismNotRace

#MedCrit
#MedTwitter
In medicine, we must change our language when teaching students, discussing with colleagues and publishing about racial health disparities. The primary pivot is AWAY from pathologizing Black patients and TOWARDS pathologizing systems that hurt Black patients. 2/
For example,

Don't say "Black children are at risk for worse asthma outcomes."
Don't say "Black women have higher rates of preterm birth and perinatal mortality." 3/
Read 7 tweets
16 Jun
I will try to find the words that strike the right balance between hope & frustration.

Hope : How amazing that all my colleagues are waking up to the fact that racism and racism in medicine is real.

Frustration : This feels like a nightmare.

..a 🧵
No exaggeration, I have had > 10 separate offers in the past two weeks to “give my perspective” on racism in the medical setting. Peer groups, division meeting, departmental, school of medicine, state level, national level..it goes on. Private entities and public entities alike.
For the past six years as academic faculty , I have promoted DEI as a side job in academic medicine because it was seen as just that.. an afterthought or side thought to whatever primary issue was at hand. How much I would have loved to be invited and given a platform - THEN.
Read 5 tweets
3 Jun
The number of physicians I see on Twitter absolving themselves from change and action by saying “my anti-racist act is taking excellent care of each of my patients” is alarming and points to a major part of the problem.

A thread..
2/ Medicine and health is in no way confined to the four walls of your hospital ward or clinic. Although generations of physicians may not have received formal teaching about SDOH does not mean we can pretend they don’t exist today.
3/ Even if you provide optimal care to your Black patient, they return to a life of racism and injustice. Inequity at every stage of life - perinatal outcomes, education, access to jobs / wealth, incarceration, food access...I could go on.
Read 5 tweets
14 Feb
Thread :

I am on a search committee for leadership position at our academic hospital. Final meeting today. I am the only non-white person in the room.

I felt fear.

It’s strange to call it what it is. I had rehearsed many times what I would say about diversity and equity. 1/
I even lay awake in bed today from 5-6 AM planning out just the right words so people could hear me, understand the important, not get offended.

During meeting, I had to do silent pep talk. “If I don’t say it, who will?”

Waiting for the “right time” to interject. 2/
I said my piece. It came out (almost) as smoothly as planned.

I am still worried what people will say about my comments as they walk from the meeting.

This is what your minoritized colleagues are feeling when they discuss the taboo subjects of race and racism in medicine. 3/
Read 4 tweets

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