“Do you think you will able to take care of a Black baby?”
Before heading out into private practice, I did not realize that “Meet and Greets” with a prospective pediatrician were a thing. As time has gone on, I have done a decent amount of them and I pretty quickly came up with a little speech that I would give and some basics that I would cover to help introduce myself. However, the most effective thing I have found is to greet the family and then give them room to ask their questions.
Having been a pediatrician for about 13 years now, I feel like I am pretty much prepared for any question that would come my way. However when a set of soon-to-be parents asked me the question above, I had to mentally step back for a moment.
You may be thinking to yourself that the question opening this post was odd or off-putting or maybe even inappropriate. Of course a pediatrician, even though he is white, would be able to take care of a baby that is Black, white, brown or any shade in between. “Medicine is color blind”. Unfortunately, the medical literature would indicate otherwise.
Black newborns are three times more likely to die in childbirth than white newborns. This disparity is cut in half if the doctor taking care of the newborn is Black instead of white. Pick a disease… cancer, stroke, diabetes… while they are both in the top 10 of causes of death for both white and Black people in the US, the mortality rate for Black people is higher than that for whites. Even during our current COVID pandemic, Blacks were more likely to get COVID, be hospitalized for COVID and die from COVID.
The question then is, why does this occur? The one reason that is certainly not behind it is genetic. Race is an invention of the human mind. While each human is genetically unique, the areas of genetic diversity across all of humanity are minuscule compared to the areas that are in common.
Some percentage of this difference lies in medical education. In a sample of white medical students and residents as recently as four years ago, half of them believed the medical myth that Black people feel pain to a lesser degree than white people. I cannot speak to whether this was an official part of any school’s medical curriculum (I certainly don’t remember having heard that before), but whether it was learned in the official curriculum or the hidden curriculum, it was learned and reinforced somewhere as this leads to Black patient pain being significantly under-treated.
Even more insidious than this is the fact that medical education is mostly thought of with white patients in mind. Traditionally, the standard patient was a 70kg white male. And while that may not make much of a difference for studying how a disease works inside the body, for something like Dermatology, teaching how different rashes look for different skin tones is a big deal. Thankfully, there are smart people hard at work trying to rectify this problem.
A larger percentage of the problem most likely lies in Social Determinants of Health. Another term for this would be Systemic Racism. This is something I am well aware of both from some of my academic work as well as my previous clinical work.
Back when I worked at the Riley residency program, I did a lecture series called This Month In Pediatrics . I would discuss with the residents some of the latest treatments, discoveries and guidelines in pediatrics. There would be studies that looked at child health outcomes or disease prevalences and invariably outcomes would be worse for minorities and children of lower socioeconomic status.
I felt like a broken record every month, mentioning the same thing over and over again. But it was true then and it is true now. Like a perverse logic puzzle – If you are poor, you are more likely to have worse health and worse outcomes. If you are a minority, you are more likely to be poor. Therefore, if you are a minority, you are more likely to have worse health outcomes. I hope it is a lesson the residents took to heart. Looking back on it now, I wish I would have talked at least a little bit about what we should or could do about it.
Clinically, I spent 10 years in the resident clinic at the Pediatric Adolescent Care Center. It serves a patient base that is almost exclusively insured through Medicaid, the government program to help insure families that live at or near the poverty line. My time there was one of the highlights of my career. Families would travel from multiple counties away because there are so few pediatricians outside of Indianapolis that take Medicaid. Every day there I would see some of the barriers that these families would fight through for the health of their children: ever changing pharmacy formularies, Medicaid cabs that wouldn’t show up, randomly getting reassigned to a different provider. Not to mention building bridges to families that had an ingrained skepticism towards the white medical community after decades of mistrust.
I don’t remember exactly what my answer was to that family that day, but I remember discussing my experiences at the PACC and using that as a way to partner with Black families to ensure their children are well taken care of. I think I earned their trust that day and continue to do so whenever I see them.
Our world has a myriad of problems these days. It almost seems too overwhelming to handle. Conflict, anger and animosity are everywhere. Some days it feels like the fabric of society is being torn apart. However, despite the lingering gloom there are signs of hope. Public support and clamoring for racial justice has not been this prevalent in decades. People of all races are becoming more aware of how they have fallen short in our march towards progress but also the ways in which we can push forward.
I don’t know exactly what the right answers are, but I do know what the one wrong answer is: doing nothing and ignoring the issues at hand. Let us not let this moment pass us by. Expand your viewpoint. Challenge yourself to face uncomfortable truths. Learn about events in history that were glossed over or never taught at all. Support Black artists and authors and business owners. Do something.
Mamihlapinatapei 