Addressing racism and health inequities: a call to action

AFP Editor-in-Chief Dr. Sumi Sexton's online letter, "We're Listening and Taking Action on Racism and Health Inequities," outlines AFP's plan to "to take a deep dive and understand what transformations will be necessary for the journal going forward." We can each follow Dr. Sexton's lead to transform our own practices to eliminate health disparities, improve health outcomes for our Black patients, and support our Black colleagues.

First, family physicians must learn to recognize how different conditions may present in persons of color, especially dermatologic diagnoses. A recent letter to the editor re: the AFP article on "Erythema Multiforme: Recognition and Management" asserts that 

Family physicians must learn how dermatologic conditions present in skin of color to serve our increasingly diverse patient population better and to avoid incorrect or delayed diagnoses. Any article about dermatologic disorders...must include how the skin disorder presents in skin of color.

Dr. Lin's response to this letter includes a reference to the 2013 AFP series on "Dermatologic Conditions in Skin of Color" (Part I and Part II). Educating ourselves - and improving our educational structures - to consider all skin types is imperative to accurate diagnoses in persons of color.

Another letter to the editor this past week criticized "the use of race in guiding the selection of antihypertensive medications without acknowledging that race is socially constructed" regarding this hypertension treatment article. Dr. Lin and Dr. Sexton replied that, "[u]nfortunately, the literature contains many examples of the uncritical use of Black race in clinical decision-making," and "we need research that explores the complexities of health disparities and their effects on clinical outcomes so that we can encourage our authors to include these types of studies in their qualitative reviews of the literature." As readers, we need to critically question the use of race in clinical studies, and researchers need to heed Dr. Lin and Dr. Sexton's call to expand their scope.

The Annals of Family Medicine's website is featuring two articles from its archives on its website that can help us broaden our perspective on racism. The 2016 article "Racism in Medicine: Shifting the Power," written by Dr. J. Nwando Olayiwola, a Black female physician, outlines her experience of hearing a rant of hateful language, including a racial slur, from a white patient during an office encounter. Reading this account can be uncomfortable, but we must lean into that discomfort, acknowledging that this incident is only one of an innumerable multitude:

Black women (and other professional minority women) have to justify professional qualifications that should speak for themselves. We have to be “twice as”…good, smart, talented, aggressive, outspoken, witty, etc than everyone else in our professional or work environments; proving that we are not “imposters;” biting our tongues and tempering our words because we don’t want to appear “angry;” being passed up or looked over, underpaid, undervalued, and under-appreciated.

The 2018 article, "White Privilege in a White Coat: How Racism Shaped my Medical Education," written by Max J. Romano, a white medical student, provides a poignant contrast. Unlike Dr. Olayiwola, who is constantly aware of racism, Mr. Romano recognizes that he is not:

Most white doctors do not think race affects them or their clinical decisions and are taught to ignore their own racial privilege in favor of a meritocratic social myth. However, multiple studies reinforce the existence of racial bias among physicians and its negative implications for patient care.

If we are to provide optimal patient care for our Black patients, we must confront our role in maintaining the systems that reinforce racism. Those of us who are white must undertake the work to recognize the privilege our skin color has afforded us and understand our implicit biases. We must reach out to our Black colleagues and patients with genuine caring; we must also take care, however, not to expect them to educate us about the racist structures that pervade our society, as resources already exist for us to educate ourselves. Let us each commit to do so; our Black patients and colleagues deserve nothing less.