'This Is a Pandemic of Inequality'

Uché Blackstock, MD

July 15, 2020

As told to Usha Lee McFarling.

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 spread and racial upheaval.

Dr Uché Blackstock

Here in New York, people are taking COVID very seriously. We all still have PTSD. The first week of March, people were coming to get tested, but it was mostly flu. Then people started coming into one of the urgent-care clinics where I work as an emergency medicine physician, complaining of the same symptoms, saying they felt very fatigued and had chest tightness and shortness of breath, their oxygen numbers low. Urgent care is interesting because those are the walking wounded, the people who weren't sick enough to go to the emergency room. Within a week, I noticed a shift in my patient population to mainly Black and Latino patients. I said to my staff, "Do you notice most of the patients look like us?" This was before the racial and demographic COVID-19 data for New York City came out.

When we first started hearing about the virus and that people with underlying chronic diseases — diabetes and heart disease — did poorly, I thought, "Oh no, those are my Black patients." These disparities existed long before the pandemic. Black communities have carried these burdens for decades. The coronavirus exposed the inequities that were already here and is hitting those disadvantaged communities harder. This is a pandemic of inequality.

I had a patient, an older Black man who had the virus. I've seen so many patients with COVID-19, I can tell just by taking vitals who has COVID-19. I did an X-ray and he had bilateral pneumonia; his oxygen levels were low. He lived by himself and I said, "You have to go to the hospital." He said, "I'm not going. I'm not going to be treated well and I don't want to die there." I'm still so worried about him.

He's not the only patient I've had that conversation with. This pandemic reveals the distrust Black communities have with the health care system. There's the layer of preexisting conditions because of a lack of access to health care, a lack of insurance, and a lack of quality care and specialists. People who are Black are also at increased risk because so many are service workers and use public transportation. In every way, Black Americans are more exposed to and more at risk from coronavirus.

I was super excited to speak before Congress about this. When I started Advancing Health Equity a year ago it felt like a pipe dream, so the thought of having the opportunity to influence legislation was huge. But the experience left me emotionally and physically depleted. Those hearings really are very performative. You aren't given time to respond if someone says something inaccurate, and there was so much misinformation — one person even said maybe Blacks are genetically predisposed to COVID. But afterward, the staffers asked me to come up with recommendations for the committee, so I'm a little more hopeful.

Working in academic medicine was so traumatizing for me, I had to leave. Even when writing about why I left, I cried. I had just been promoted to associate professor. Colleagues said I was crazy to leave. But I was working in this culture of fear where I felt I couldn't speak up, and if I spoke up, I would be retaliated against. It was incredibly toxic. I literally had to fight for my promotion and earned it despite having hardly any mentorship. For a very long time, I was the only Black faculty member in my department, and no one batted an eye. I would sit in faculty meetings and look around at 100 other people. No one looked like me and no one thought that was a problem. When you combine that with lack of support, a lack of promotion sponsorship, and being told what you can and cannot say, it was just too much.

I felt so much pain because I always thought I would stay in academic medicine. I had just been promoted to associate professor. I had imagined my career would be in academic medicine. And it's not just one academic institution, it's many. After I wrote the piece, so many people reached out to me and said, "You said what I could not say." And that just reaffirmed my decision to leave. These last 6 months working to create Advancing Health Equity have left me feeling vindicated. I feel like I can still have an impact working outside of an institution, maybe even a larger one.

When the protests started and people began speaking out very frankly about their experiences in academia on Twitter, it was retraumatizing for me, but reaffirming as well. Everyone was waking up to the fact that racism was a problem and I thought, this is what I have been saying. This is why I left academic medicine. But it's also what I left to work on at the company I founded to promote diversity within health care.

The disparities we have are multifactorial, but one important factor is health care bias. Health care workers, especially physicians, like to think that we give everyone equal treatment, but the fact is we don't — and we have the data that shows that. I hope in this moment, physicians engage in some serious self-reflection about how they may be complicit in perpetuating the racism that results in the disparities that we see.

I do feel hopeful. I think this is an inflection point. This feels very different. I don't know if it's because you have people dying from a pandemic that's been mismanaged and you're also seeing in broad daylight a man murdered in the street. These things are so profound, you can't turn away from them. There are conversations happening now that we've never had in such an honest and frank way. If this is not a moment for change, then what is?

Uché Blackstock, MD, 42, is an emergency medicine physician in New York and the founder and CEO of Advancing Health Equity, an organization seeking to address racial health disparities. Last month, she testified before a Senate subcommittee on racial disparities and COVID-19. Blackstock and her twin sister, Oni Blackstock, MD, are Harvard Medical School's first Black female legacy students: their mother, Dale (Evans) Blackstock, MD, graduated from Harvard Medical School in 1976 — she died of leukemia at age 47.

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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