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  • Writer's pictureDr. Bow Tie

On Racism In Medicine

I have discussed in a couple of posts here about how prevalent racism still is in the United States. Usually if I bring up that or Black Lives Matter, the main objection from those around me is that "Well, I'm not racist, and making everything about race just divides us more." To which I have to respond that I am not talking about the overt "n-word-shouting" racism (although apparently we still need to talk about that because Morgan Wallen feels he can represent country music by saying the N-word and he gets rewarded by ascending the sales charts; so very quickly: if you are not Black, do not say the N-word. No exceptions. It is a word that was used to degrade and torture Black people for so long. It has been and is being reclaimed by Black people for themselves. Non-Black people (including me, in case that wasn't clear) are not allowed to use it in any context).

Instead, what I am talking about is institutional racism. It's the ingrained racism that has been a part of all of our lives since we were born. It's the "War on Drugs" which was actually just an excuse to target Black people, the for-profit prison system which is terrible for all of its prisoners but in which Black people are often disproportionate in their suffering (they certainly aren't offered organic meals after participating in a White supremacy terrorism attack on the capital). It's the dramatic underrepresentation of Black people in media (film, TV, video games) and then so many of us questioning why that needs to change instead of seeing how much it matters when Black people are cast.

I am hurt (a pain which pales in comparison to that of Black people) the most this month by some examples of institutional racism in medicine. My beloved profession is, unfortunately, rampant with racism, not just in its past (Tuskegee experiments, Henrietta Lacks), but right up to today. I'm going to highlight a couple of stories that recently rocked medical academia (but not as much as they should have).

The first is that of Dr. Aysha Khoury. On August 28, 2020, she led one of the small group discussions in which every 1st- and 2nd-year medical student participates throughout those two years. Jacob Blake had recently been shot by police in Kenosha, Anthony McClain had been shot by police in Pasadena, and Kyle Rittenhouse had murdered multiple people at the Kenosha protests, so understandably there was much to discuss, break down, and process. Kaiser Permanente School of Medicine asked its small group facilitators to discuss these topics, so that's just what Dr. Khoury did - she had a frank discussion with her students about Black Lives. Dr. Khoury had been wholeheartedly praised by KPSOM leadership only a month or two prior; she was up for a promotion. The evening of the small group, she was suspended because of an alleged "complaint." She was suspended and investigated for what turned out to be 18 weeks before she was eventually fired last month. At no point was it made clear what policy she had violated or why she was being suspended; instead they assassinated her character. They supposedly asked her to come in to talk about what the school could do to improve, without acknowledging that she had been fired and that they were asking her to basically do so without compensation (which, I have recently become aware, happens to Black people, especially women, in faculty positions FAR more often than it should).

The second story is that of Dr. Princess Dennar. She is the former (as of just a couple of days ago) program director of the Tulane University Medicine-Pediatrics program in New Orleans (Medicine-Pediatrics, or Med-Peds, combines training for both adults and kids. It's a specialty that usually requires two separate board exams, meaning it requires that much more commitment and training). Dr. Dennar excelled in her position enough that she was able to interview for Directorship as far back as 2008, but she was told by faculty leadership that they did not want to "change the face of Tulane" and that "White students wouldn't follow or rank favorably a program with a Black program director." This is taken directly from the court case. It bears mentioning that if a student ranks a program lower because they have a Black director, that student probably should not be in medicine - so that is pretty flawed logic. They forced her to settle for a "co-director" position alongside the previous director. Before this time the program faced issues and the Accreditation Council for Graduate Medical Education (ACGME) had already had to investigate them. Dr. Dennar eventually ascended to directorship after a year, and got the program on track (she did 100% of the work even though she only had 50% of the title). The program (and their Associate Dean of Graduate Medical Education Dr. Jeffrey Wiese) still did not publicly announce her sole directorship until they could get a White assistant director (again, to help recruite White students), an entire year later. Dr. Dennar was then undermined at multiple turns - they removed her access to vital medical resources, didn't support her accreditation at institutions where she should have been able to practice, left her out of meetings. I know it's tempting to ask if this is for real. So then we have to look at the fact that Wiese has eight (count them, 8) cases of discrimination filed against him from trainees (students and residents) (that's what the ACGME had been aware of prior to all of this). In addition, Wiese implemented use of a tool called ATLAS to "help" in their ranking of interview applicants which was specifically designed to rank residency applicants from majority-Black medical schools lower. Read that again. There is no logical reason for such an algorithm - Black students are no different than White students in terms of intelligence or brain power - if anything, they often face more obstacles and still achieve. So the ATLAS program is rooted in racism. After all of this, Dr. Dennar has been inexplicably terminated in what appears to be retaliation for calling out the racism in her colleagues and her institution, one that routinely expresses a "commitment" to fighting racial discrimination and which is in a city where many of the patients are Black, Brown, and other People of Color.

Nearly ten years ago (oof, I feel old), a student in the medical school class behind me often brought up topics of racism in healthcare. At the time, many of us ignored him or dismissed his efforts. I regret every moment of that because it is only in recent years that I have realized that he was ahead of his time (and yet long overdue).

I might not write this post if students were being made uncomfortable or had complaints about these two individuals. But in both cases, and in so many other cases of discrimination against Black/PoC women in medicine, the students and residents have shown up in droves expressing support for the women facing discrimination and horror at their institutions' administrations. If medical institutions are failing at anti-racism, how can we provide anti-racist healthcare to our patients?

Below I've include articles on Dr. Khoury, Dr. Dennar (and her court case), and a link to a GoFundMe for Dr. Dennar's legal fees, as well as an article written by Dr. Uché Blackstock (who co-wrote the piece I shared yesterday on vaccine distribution). We are encouraging pre-med and medical students and residency applicants to avoid Kaiser Permanente School of Medicine and Tulane Med-Peds (#DNRTulane) (though the racial discrimination is apparently not just limited to the Med-Peds department). These institutions need to make profound changes and take real steps to erase their toxic environments before they can be trusted with trainees.

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