Health justice in medicine
Race is not a risk factor. Racism is.
Structural racism in health care is an issue that goes back centuries. Implicit and explicit biases, race-based calculations, and outright discrimination have negatively influenced health care for people of color and created barriers for those who aspire to become doctors, leading to an overall underrepresentation in medicine, including hospital medicine.
Black physicians have been on the forefront of health equity since the late 1800s, according to Khaalisha B. Ajala, MD, MBA, FHM, who will examine the evidence of structural racism in everyday clinical practice during the session, “Rounding While Black,” 2:40-3:30 p.m. on Monday. Dr. Ajala is an assistant professor of medicine at Emory University School of Medicine in Atlanta, Georgia.
From the beginning, Black students who set out to become doctors struggled to gain access to medical school. When U.S. medical schools finally opened their doors to them, the next roadblock was securing privileges in segregated hospitals.
“Black doctors also were barred from entering medical societies, which were, in many instances, a gateway to obtaining privileges to local hospitals,” Dr. Ajala said.
Even after the Civil Rights Act of 1964 made it illegal to deny hospital privileges to Black doctors and other doctors of color, and opportunities increased, it has not boosted the number of Black medical professionals. In fact, the number of Black male physicians has decreased despite the increase in the overall number of Black males enrolled in college. Only 5% of all U.S. physicians are Black despite being 13% of the U.S. population, Dr. Ajala said.
“We need more Black physicians in every field of medicine,” she said. “Although hospital medicine is well represented in hospitals and academic programs around the country, there are many medical students and even residents who don't know exactly what we do. The academic hospitalist is one key to addressing the disparity of Black physicians in hospital medicine.”
Medical professionals also must be intentional and move with urgency, she said. As a member of the SHM DEI Committee, Dr. Ajala has worked as part of a task force to engage underrepresented in medicine (URiM) learners in every city hosting SHM Converge.
“This year, we will welcome students and residents from Dell Medicine School UT Austin on March 28. They will represent Indigenous learners, Student National Medical Association, Latin Student Medical Association and Med Pride,” Dr. Ajala said. “Now that's moving with intention.”
Educating hospitalists on intentional systemic injustices is another important step toward understanding and reducing biases in work with colleagues and patients, she said.
One study on physicians and implicit bias revealed that some providers tend to dominate the conversation more with their Black patients. Some race-based calculations have been phased out across the U.S., but there has been no global approach to discontinuation.
“The use of clinical reasoning is not void of implicit or even anchoring bias, even when we feel our most objective,” Dr. Ajala said. “So, we must educate ourselves by taking an implicit association test periodically to [find out] where our blind spots are in our day-to-day interactions.”
She recommends creating a safe space for patients by empathizing with what brought them to the hospital. Seek a connection by listening to them and making sure that they feel heard, she said. Once you hear that chief complaint and you obtain the history of present illness, let that be your guide in treatment and not any preconceived notions about the patient.
“Rounding While Black is not a sad story,” Dr. Ajala said. “It is an eye-opening journey through the eyes of Black physicians and Black patients. It's a story of movement within more than a centuries-old marathon race toward equitable care. We must work together and move with intention and urgency. See you on rounds!”
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