To be a Black physician is to constantly wear multiple hats at once. It is to be both healer AND advocate. It is to know medicine AND history AND politics AND psychology AND sociology AND communications. It is to be an expert in complexity science & an innovations savant.
1/
It’s barely 1/2 the day rounding on a Monday on a new team & in addition to taking care of patients & teaching, I already had to:
1️⃣Disabuse my team of race-based medicine aka scientific racism as they tried to use race to determine blood pressure medications for a patient
2/
2️⃣Advocate for patient autonomy & the right for one of our patients to obtain certain information about his care so he can be aware of what’s happening in relation to his health and make certain informed decisions & to not be put in potential harm’s way.
3/
And
4️⃣Educate the team on the difference between “equality” & “equity”. As in, yes, in a pandemic given current stats, for public health & safety it makes sense to haves 0 inpatient visitor policy - Equality. But, for our most medically & socially vulnerable patients....
4/
....especially those with (intellectual) disabilities whose needs are best served when their caregiver/advocate is present, how equitable is this policy in order to achieve the best health outcomes for them? A just & equitable system, just & equitable policies...
5/
...meet different groups where they are to ensure the best results. It is not a one-size-fits-all because all are not the same size.
6/
So, I had to advocate for another patient of ours to make accommodations for her caregiver to either be present in the hospital or we adjust her care plan to get her home sooner, where I believe she will be best cared for.
7/
This is Just Medicine. It is advocacy & teaching & pushing & constantly communicating & risking & building all to ensure that the most marginalized are prioritized. And it takes time, energy, & internal resources.
By 2pm, I’m super exhausted, but gotta keep going.
8/
But, on 2nd thought, it’s not really Just Medicine, is it? Justice is structural. It is a system. Even as it is a practice. Even as it is a policy. Medicine that is just & equitable would be universal & super affordable & accessible to even then”least of these”.
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It would be human centered, humble, compassionate, & kind to patients & practitioners in its infrastructure, culture, norms, values, & and expectations. It would take care of the multifaceted needs of its practitioners & reject toxic outdated ways of being & doing.
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It will center healthcare as a human right & recognize the interdependence of human health and that of the planet & animals. With a “health in all” lens, it will integrate social and structural determinants of health as part of the evaluation & management of patients ...
11/
...and communities and identify social innovations as medical interventions - 2 sides of the same coin.
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We are a long way from Just Medicine as the norm, but every day, Black physicians practice medicine justly, wearing multiple intersectional hats, bearing multiple intersectional burdens, for our patients, communities, & our very selves.
Reflective 🧵 1/ Oftentimes when asked to give a talk or when writing a paper, there is a significant expectation, pressure even, to also incorporate solutions.
"What can we do to change this problem".
It's like, "Don't leave us with this dreadful feeling. Uplift us.
2/ Help us "feel better".
TELL US WHAT CAN BE DONE!
And I've always felt uncomfortable with this.
Why this rush to ram through a problem so as to jump to solutions. How do you solve what you don't understand. Especially if it is a problem you yourself participate in.
3/ In his work, "Rage and Hope", Paolo Freire argues that without reflection, there can be no commitment to transformation, action is empty. Critical reflection is "critical" to transformative praxis. Reflection/Introspection must form the core of action for sustainable change.
As a doctor, there are a few things more therapeutic than to sit quietly with a patient while they grieve.
While they sorrow.
While they hurt.
Just be present.
As an empathetic witness.
And quietly affirm their humanity.
And yours.
1/
We do not always have to have the answer.
We do not always have to “fix” it.
That’s ok.
But we can always connect.
And be in relationship.
And be in community.
With our patients.
And each other.
And our own selves.
2/
I had to remind myself of this yesterday as I bore witness to the grief of a patient
Who lost all her property in a house fire.
None of her family was stepping up to help.
She was in physical, emotional, and spiritual pain.
And she was angry.
Rightfully so.
3/
You know when you wake up and your day starts with violence?
1⃣So, received an email asking me to speak on implicit bias for a major organization. "No worries", I say. "Let me check my iCal for availability. But, in the meantime, what is your budget for speaker fee/honorarium?"
2⃣"Oh, I don't know...none of our previous speakers have asked and it's only for an hour and virtual."
***Cue music change to violence
"Only 1 hr" and "virtual"?????
Chiiiiiiiiiiiiiiile! But for the grace of GAWD!
3⃣So, I had to lovingly & kindly remind friend that
🔅1 hr is not "only"
🔅In 1hr, I can see patients, do an interview,
teach/coach/mentor, and put out 3 fires - all of which
are compensated labor
🔅Speaking is labor
🔅Compensation isn't just for the time per se...
I need it to be clear that this pathological intentional fear of brown skin is not a commentary about anything being wrong with us - our bodies, our minds, our ways, our joy.
It is rooted in this pathological invention of the identity/idea/ideology of whiteness.
1/
Intrinsic to this idea/ideology/identity of whiteness is the need to turn everything that is not white into an “enemy” to be feared and therefore destroyed/conquered/controlled.
2/
Intrinsic to justifying this way of being is to establish non-white “others” as inherently (biologically & culturally) inferior, in fact, sub-human. Thus, deserving of genocide, terrorism, destruction, rape, desecration, murder, poverty, hunger, pain, suffering. Bombs.
3/
1️⃣Black History moment: Dr. Charles Drew, A Black doc, invented the blood banking system we use today which has saved millions of lives & directed the nation’s first blood bank, mobile blood bank units, Red Cross’s pilot blood program excluded Black donors until 1942, 79yrs ago.
2️⃣So their are living Black folks today who remember a time they were not allowed to donate blood because their blood was considered inferior. When Black folks were allowed to donate in 1942, our blood was segregated from white blood. Till 1950.
3️⃣And it is told that Dr. Drew himself was not able to benefit from own innovation, dying from injuries sustained in a car accident and refused care for white hospitals due to segregation.
🧵🧶🧵 1/ I respectfully push back VERY strongly against the “play the game” & “change from the inside” crowd. Emmm...since when? When has that happened? What is the historical evidence to show that that is how the vast majority of change occurred? The inside, keh? In medicine?
2/ Most people I know that played the game to get in, rationalizing that they’ll change the system once they got in, got stuck playing the game forever & never developed the tools for changing the system which they thought they would naturally be able to do once “in”.
3/ The code switching never ended.
And they severely underestimated the resultant wear and tear on their bodies, minds & souls for the constant codeswitching, perpetual guarding, fighting, advocating, etc that we endure in this predominantly white spaces.