Practice Management

PHM20 Virtual: Impact of racism in medicine


 

Presenters

Michael Bryant, MD – Children’s Hospital of Los Angeles

Kimberly Manning, MD – Emory University, Atlanta

Kimberly Reynolds, MD – University of Miami

Samir Shah, MD, MSCE, MHM – Cincinnati Children’s Hospital

Ndidi Unaka, MD, MEd – Cincinnati Children’s Hospital

Moderator

Erin Shaughnessy, MD – Phoenix Children’s Hospital

Session summary

This session was devoted to a discussion about how pediatric hospital medicine (PHM) as a field can address racism in medicine. The structural inequity rooted in poverty, housing problems, and differential education represents the essential social determinant of health. No longer can pediatric hospitalists neglect or be in denial of the crucial role that race plays in propagating further inequalities in our society and at our workplace. Historically Black people were exploited in research and still are disproportionately affected when it comes to infant prematurity and mortality, asthma, pain treatments, and so on. The pediatric hospitalist must explore and understand the reasons behind nonadherence and noncompliance among Black patients and always seek to understand before criticizing.

Dr. Mirna Giordano, a pediatric neurosurgery hospitalist at Columbia University Medical Center in New York

Dr. Mirna Giordano

Within learning environments, we must improve how to “autocorrect” and proactively work on our own biases. Dr. Bryant pointed out that each institution has the responsibility to build on the civil rights movement and seize the moment to create a robust response to the inequities manifested during the COVID-19 epidemic, as well as the events following the deaths of George Floyd, Breonna Taylor, Ahmoud Arbery, and many others. Dr. Shah called on the PHM community to take on that obligation by “stepping into the tension,” as Mark Shapiro, MD, has suggested in a conversation/podcast with Dr. Unaka.

As pediatric hospitalists, we will have to show up both individually and as constituents of institutions to address racism by specific projects looking at all data relevant for racism rather than race in quality and safety – thereby amplifying the voices of our Black patients and families, remarked Dr. Unaka. There was a brief reflection on the use of the word “allies” by Dr. Manning and Dr. Reynolds to remind the more than 200 session participants that a bidirectional framework of this process is crucial and that there is a clear need for a partnership to a common goal that should start by “a laydown of privilege of those who have it” to establish equal playing fields once and for all.

Dr. Bryant encouraged a deliberate and early thoughtful process to identify those with opportunities and help young Black people explore journeys in medicine and increase diversity among PHM faculty. Dr. Manning reminded the audience of the power that relationships have and hold in our lives, and not only those of mentors and mentees, but also relationships among all of us as humans. As with those simple situations in which we mess up and have to be able to admit it, apologize for it, and learn to move on, this requires also showing up as a mentee, articulating one’s needs, and learning to break the habits rooted in biases. Dr. Unaka warned against stereotypes and reminded us to look deeper and understand better all of our learners and their blind spots, as well as our own.

Key takeaways

  • The field of PHM must recognize the role that race plays in propagating inequalities.
  • Learning and mentorship environments have to be assessed for the safety of all learners and adjusted to correct (and autocorrect) as many biases as possible.
  • Institutions must assume responsibilities to establish a conscious, robust response to injustice and racism in a timely and specific manner.
  • Further research efforts must be made to address racism, rather than race.
  • The PHM community must show up to create a new, healthy, and deliberate bidirectional framework to endorse and support diversity.

Dr. Giordano is assistant professor of pediatrics at Columbia University and a pediatric hospitalist at NewYork–Presbyterian Morgan Stanley Children’s Hospital, both in New York, with an interest in surgical comanagement. She serves on the Society of Hospital Medicine’s Pediatric Special Interest Group Executive Committee and is the chair of the Education Subcommittee. She is also an advisory board member for the New York/Westchester SHM Chapter.

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