COMMENTARY

Medicine Must Dismantle Racism With
Academic Rigor

Patricia Poitevien, MD, as told to Usha Lee McFarling

Disclosures

July 13, 2020

Being told the operating room has already been cleaned. Being questioned by patients about where you went to medical school. Being asked for ID every time you enter your own hospital. Being told you don't look like a doctor. In a series of conversations with Medscape, Black physicians talk about racism they've faced in their training and their clinical work, the change they'd like to see, and how they're coping during this period of both pandemic and racial upheaval.

Patricia Poitevien, MD

When I was six or seven, I told my mom I wanted to be a babysitter because I really liked kids, and my mother said, "Why don't you be a children's doctor?" So, I've practiced saying I want to be a pediatrician since I was six or seven, and the rest is history. My parents were extraordinarily supportive, so I don't think I paid attention to the conscious and unconscious bias that was probably coming my way. My family created a wonderful bubble of resilience around me. It was just so clear to me I was going to be a physician.

Race and gender discrimination played a part in my training and later in my career. When I was in training, I said I wanted to give back to my community, and that was the end of the conversation. There was no probing, no additional questions, no one asked me if I had an interest in academic medicine or wanted to subspecialize or do research or do anything outside of going back to my community to see patients one on one. I really see that as a failing. When I spoke to other trainees, it was clear they were having different conversations than I was. The same advisors were asking them more questions and offering them more opportunities. I was chief resident at NYU Medical Center, which is a huge honor and a recognition that you have good clinical judgment and leadership skills. You would think if there was anyone who would get advice about staying in academic medicine or doing research, it would have been me, but I never received it.

I find this useful now as someone who does a lot of advising. My job as the pediatrics residency director at Brown is to show students there is a lot more on the buffet table than they thought. I tell them they shouldn't choose a path until they see everything that's laid out on that table. And I tell them not to let anyone tell them there's something on that table that's not available to them because of the way they look.

I now wonder, if I had been mentored differently, would I have had to stumble my way into academic medicine and become a residency director, or could I have known that was a choice all along? On my path here, could I have done more research or academic work? More recently, I've been asked why I would want to publish and told I shouldn't bother because it's not like I'm going to be chair or anything.

My oldest son is 13. When he was in preschool, Trayvon Martin was killed. We have been having conversations about race, painful and somber conversations, pretty much since then. The conversations we are having now in our home are not new, they have just taken on a new level of intensity. Those conversations are very hard to have and don't get any easier. The hardest part for me is the cognitive dissonance. I spend my entire life telling my children they are talented and kind and smart and going to be wildly successful. I believe these things. Then, in the same exact moment, I have to tell them there are groups of people who hate them because of the way they look. My younger son is 10 and believes that everyone is good. He's really struggling with this. He doesn't want to believe people are racist. I think, ugh, now I have to teach him that some people are bad, which is such a terrible thing to have to teach your kid.

"Tired" is the word I used most commonly to describe how I'm feeling, but it's not enough. It's five letters that don't do justice to how I'm feeling. When everything first happened, I was so emotionally overwhelmed. My first instinct was to set up a Zoom for the residents of color. We all sat on this Zoom and cried and shared stories and really consoled each other. There was no agenda, this was just a way to ask, are you OK? Some were crushed, some tearful, some angry, there were so many different emotions. And all of these people were working residents, coming to the hospital every day and trying to give patients the best care they could while the entire world was imploding around them. We told them we feel exactly how you guys feel, we get it. More recently, I've noticed how spent I am. At random points in the day, I will just burst into tears. As a clinician, I know that's not OK.

My fellow faculty are all well intentioned, and some have emailed me to ask what they could do. I said, listen guys, you're all really smart people. If you want to know about racism, Google it. You'll figure it out. I told them something I heard from a colleague: Do you ask the guy dying of COVID how to treat COVID? No, that makes no sense. So please don't ask the people suffering from racism how to fix it. It's not right. When COVID emerged, what did you all do? You went to the literature, you researched, you joined list-serves, you published case reports on it, and within a month, everyone was an expert on COVID. And COVID just showed up. Racism has been around for 400 years.

We physicians can no longer live in a bubble where we use words like "bias" and "inequity" to describe what is happening to our patients. This is racism. If we call ourselves physicians and we think our calling is to care for the health of others, failing to recognize the impact racism has on our patients is a failure of our entire profession. We need to face dismantling racism with the same rigor we use to face any health challenge, with that same academic focus, that same desire to find answers, that same desire to look at outcomes and innovate solutions. If we don't answer the call in this moment to treat racism as the disease that it is, we've really failed.

Patricia Poitevien, MD, 46, is a pediatric hospitalist at the Warren Alpert School of Medicine at Brown University, where she also serves as the residency program director for the Department of Pediatrics and assistant professor and assistant dean for the Office of Diversity and Multicultural Affairs. Poitevien was raised in Brooklyn, New York, the oldest daughter of Haitian immigrants. Her mother was a seamstress. Her father, who trained as an engineer in Germany, worked in the United States as a taxi dispatcher. She received both her bachelor's (1994) and medical degree (1998) from Brown University.

Usha Lee McFarling is an American science reporter who has written for the Los Angeles Times, Boston Globe, STAT News, and the Knight Ridder Washington Bureau. In 2007 she won a Pulitzer Prize for Explanatory Reporting. Follow her on Twitter @ushamcfarling.

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