Pushing to Move From Reactionary to Preventive Medicine

Isaiah Cochran, MD, as told to Usha Lee McFarling


August 25, 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.

Isaiah Cochran, MD

I love clinical medicine, but it is not my final goal and it never really was. It may sound strange for a first-year resident to say this, but my reason for going to med school was to gain a platform to enter the field of policy and make a difference, because I think more LGBTQIA people and people of color should have a voice. My mom was a single mother who adopted me. She was a huge activist in the 60s, and that definitely influenced me. Activism is my calling.

My mom dealt with a lot of things as a Black woman when things were bad. I know things are still really difficult now and we have a lot of work to do, but we've also made so much progress. My mother was second in her class in her high school, but she wasn't allowed to be a part of the National Honor Society simply because she was Black. I never had that kind of experience. I'm a physician now, and I feel hard-pressed to say that the color of my skin has held me back. Have I run into people who had other thoughts about what an African American who also happens to be gay should be doing? Sure. But I am hard-pressed to say that because of the color of my skin, I was not able to make it. I know I have to thank those who came before me who made this possible, but I never heard the words, "You can't become a physician." All I heard was, "You put your mind to something, and you can do it." A lot of that was what I heard at home, but some of my greatest mentors have been White people who are older and wanted to support me.

I think that we have made a lot of progress on racial issues as a nation in the past few decades, but I worry that we have taken a lot of steps backward in the last 4 years. I really love President Barack Obama, but I have to be honest. I think these last 4 years we've seen a guttural reaction to having had a Black president. I think we've been seeing the response of people saying, "I can't believe we had to deal with that."

I really hate to say this, but at times, I have struggled more with being a member of the LGBTQIA community than with being Black. As a gay man, I have faced discrimination from people of every race, including my own.

Medical schools are trying to do better with equipping students to work with the LGBTQIA population, but there are so many misconceptions. One thing that really bothers me is how people make generalizations, like all gay men are promiscuous or effeminate. No one person is like any another. That goes for White people, Black people, and the LGBTQIA community. That is a major issue when dealing with patients. You have to be able to deal with any individual patient. For example, you need to use the right pronouns when you deal with a transgender person and be comfortable speaking to them. Medicine for so long was homogenized with predominately White men who did not have experience outside of what they knew. If you didn't meet that norm, you might not get the best care. Not because physicians didn't want to give the best care but simply because they might not have known how to handle what you were presenting.

In med school, we had an LGBTQIA patient, and one of the residents asked me if I could go in and talk to the patient. In my head, I was like, "Wow, listen, I might be gay, but it doesn't mean I can do everything." Medical-knowledge wise, I was still quite naive. When people are uncomfortable, they tend to go into a shell, and you can't do that when you are a provider. It can lead to poor care and distrust. I have so many friends who tell me they don't really like going to straight doctors because they feel they don't really help them. I think that's the problem with our medical education system. It's not outright discrimination — it's having a medical system that does not equip us to help patients who are not the norm. I also find it annoying to have to keep saying "the norm," because I think very soon the minorities are going to outnumber the majorities.

I don't think people are consciously racist, but the system has been set up to be racist. Think about medical images. Most are of White patients. Even me. As an African American provider, when I see a Black patient, I might think, "Black Americans don't get this, this disease is only seen in White people." I see the problem as not individual people who are racist but as a system that is broken. That's why I'm interested in going into policy. I'm not someone that can keep working in a system that's broken.

I'm excited to be starting my residency, even though we're in a pandemic. Here in Daytona, our numbers are going up. Our hospital is getting closer to capacity, but it's not all due to COVID. I am fearful that central Florida will be the next hard-hit hot spot. I think snowbirds are still going to come down, so in wintertime, we could get hit hard. I don't want to get infected because when folks are sick in residency, other people have to pick up the slack. If I get sick and I don't know and I spread it to one or two other residents, that is a big issue, because we work so many hours. We do have adequate levels of PPE right now. I'm optimistic it won't be as bad here as it's been in Miami. Contrary to what the news is reporting, here in Daytona, people are wearing their masks. Every store has a sign stating that you need to wear a mask.

I was just on a call with some state senators, religious leaders, mayors, and other physicians to talk about COVID. We need to increase funding for Medicaid. Some 27 million people have lost their health insurance since this pandemic started, and Medicaid doesn't have enough funding, so what's going to happen? And some in the federal government want to take away parts of the ACA. I was like, "Really? During a pandemic, you're going to take away people's healthcare?"

So much about our medical system and human nature is reactionary. As a family medicine resident, I'm learning to think more about preventing problems before they even start. The pandemic, the murder of George Floyd, I hope that all of these things have us thinking about not just reacting and marching but being more preventive and trying to stop things before they happen.

I do like to see physicians using their voices. We don't need any more brilliant doctors who just focus only on what's right in front of them. As a physician, you have so much respect in the community, not only from your patients but also from representatives, so I personally think it's great that medical students are writing op-eds and speaking out. I'm so glad we're not in the old days, when doctors were told to stay in their lane. I wouldn't have been able to do it.

Isaiah Cochran, MD, 27, is a first-year family medicine resident at Halifax Medical Center in Daytona Beach, Florida, and the immediate past president of the American Medical Student Association. He obtained his undergraduate degree in biochemistry from Waynesburg University in Pennsylvania in 2015 and his MD in 2019 from the Boonschoft School of Medicine at Wright State University in Dayton, Ohio. He recently joined the editorial board of Medscape.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.