We are meant to be so much more.
When the COVID-19 vaccines became available, a distant cousin asked me to give a talk on the vaccines to my extended family and distant relatives. In my preparation for that presentation, I realized that I had to discuss black people’s medical mistreatment by (white) physicians. There were to be 40 to 50 black people on this zoom call. Some of whom were adults before the advent of modern medicine, and they suffered at white physicians’ hands.
My research led me to a book called Medical Apartheid by Harriet A Washington. Let me summarize one of the book’s significant concepts with this idea: Before the 1970s, medical doctors were like cave dwellers trying to make fire. Unfortunately, black bodies, whether alive or dead, functioned as the branches, twigs, and dried grass.
One white physician, Marion Sims, practiced on the Alabama plantations. After medical school, he felt out of place and thrown to the wolves just like I did. However, instead of having well-researched medical literature to guide his decisions, he had nothing. Like other physicians of the era, he conducted studies, experimented on people, and created his own medical theories. He is now known as the father of gynecology.
He revolutionized the field of gynecologic surgery by experimenting on black slaves from the Alabama plantations. He operated without anesthesia, without pain control, and often without permission from the patients. With permission from the slave owners, the slaves could not refuse and had no recourse if the experimental treatments failed.
Doctors don’t practice that way anymore. There are massive multi-institution, international research studies that rely on ethical review boards tasked with eliminating unfair or unjust conditions. Now, researchers must inform study participants of the risks and possible benefits of participating in research. Researchers often pay, too. The result of this significant shift in medicine and medical research is a vast body of knowledge that the medical community can read, examine, and critique.
So when I didn't know what was going on with a patient, I could always read the information in textbooks, then verify that information with well-conducted research. I could ask a senior member of the team or one of the practicing physicians as well. That way, I learned the medicine and the standard of care.
Recently a black friend of mine was searching for a pediatrician. That friend of mine is also of African descent. So while chatting with the pediatrician, my friend says,” can you talk to me about your thoughts on systemic racism and medicine? And how (do) you acknowledge that in your practice.” Then she waited.
It was clear no one had ever asked him that, nor had he thought about it before. He provided a response citing his training in a large medical center stationed in a large metropolitan area. He also mentioned that there’s only one standard of patient care.
That's bull. To treat black patients, doctors need to understand the context. The medicine and the standard of care are essential. Still, they need to know how to apply that standard of care in a specific situation.
To illustrate, If a teen asked you how to drive a car, how would you respond?. You'd probably explain the gas pedal, brake pedal, and steering wheel. You may mention mirrors and turn signals, too. Though true, those fundamental aspects don’t tell you how to drive.
To drive a car, you perform a set of behaviors appropriate for the particular situation. You drive differently in bumper-to-bumper traffic than you do on the superhighways of Houston or Atlanta. You would drive differently on a small side street with only one lane of passage than you would on a two-lane highway between two rural towns. What about parking and turning?
So when I say black people should not be doctors, I mean black people should not just be doctors. We must be more. Western medicine tries to simplify healing as a purely physical endeavor. Eastern medicine does a much better job at recognizing the mental, spiritual, and physical aspects of recovery. Eastern medicine then uses context to apply appropriate therapies. This is how black doctors should practice because it is what black patients require.
Black patients need their doctors to understand the medicine. That’s obvious. Most black patients want reassurance that the doctor understands the implications of black struggle. Patients need to feel confident that their doctor understands the communities that they come from and the households in which they live. Doctors need to understand the financial and potential economic struggles.
Black patients need their doctors to understand that people wearing white coats desecrated the black body’s sanctity. Black bodies were poked, prodded, and mutilated for centuries. So those doctors who treat black patients need to be expressly aware of the tenuous relationship between doctors and black patients.
Most doctors hate considering the social problems of their patients. What they don’t recognize is that it matters for everyone; white people too! Social, economic, racial, and gender-based contexts ALWAYS matter because they define who we are and how we interact with the world. Healing is more than treating disease. It's about helping people feel cared for. My medical school's motto was "we also treat the human spirit,” and every physician should live by that mission.
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Until next time my people.