White Coats for Black Lives: The Time Has Come for Action
Authors: Valerie E. Stone
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions20 October 2020White Coats for Black Lives: The Time Has Come for ActionFREEValerie E. Stone, MD, MPHValerie E. Stone, MD, MPHBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (V.E.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4280 Annals Author Insight Video - Valerie E. Stone, MD, MPH In this video, Valerie E. Stone, MD, MPH, speaks at the White Coats for Black Lives demonstration in Boston. (Courtesy of Brigham Health. Used with permission.) (Duration 3:17) SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For a record 21 days and counting, people across the nation have taken to the streets. From every walk of life, every race, many masked, none silent, they protest racism and police brutality in support of Black lives. The White Coats for Black Lives movement was born in 2015 out of the outrage that medical students felt following the senseless murders, at the hands of the police, of Michael Brown and Eric Garner (1, 2). This movement led to an increased commitment to health equity at many medical centers, including my own (3). Yet academic medical centers, while increasingly concerned about long-standing health inequities, showed little concern about racism and police brutality, and the impact that these 2 evils were having on Black individuals and the Black community (4, 5). Remarkably, however, today's protests include not only medical students and residents, but also faculty physicians, nurses, and even hospital leadership (6).When we as a nation witnessed the casual brutality of a Minneapolis police officer murdering George Floyd, his death became a breaking point. The coronavirus disease 2019 (COVID-19) pandemic had already inflicted untold pain and loss on the Black community. This senseless murder, piled on the pain from the murders of Ahmaud Arbery, Breonna Taylor, and a growing list of other victims, was simply too much to bear. At the tipping point, we the people began to protest. Now we are at a watershed moment in history.Led by a passionate group of resident physicians committed to bringing this movement to our doorstep, our hospital joined the protests. For months, we were providing compassionate care to hundreds of patients with COVID-19, an epidemic disproportionately affecting the Black community (7, 8). We turned, we intubated, and when all else failed, we held a dying hand, and we made the sad and painful calls. How could anyone entrusted to "protect" crush a knee into a neck? How could anyone entrusted to protect ignore the words "I can't breathe"? As hundreds gathered on the well-groomed lawn outside our hospital, I had the privilege of speaking in support of Black lives (6):We must be emboldened by our residents' courage and be courageous ourselves, as individuals and as a community. It is time to do something new, to change how we see our commitment to the Black community, to make our institutional commitment to stand against racism and racially motivated violence, one that goes beyond words to real action. We need to move from hollow words of support to specifically naming the focus of our anger and outrage. As stated recently by several Black resident leaders, at times like this, our colleagues make "generic remark[s], like 'We stand in solidarity [with you]….' But what good is solidarity that is powerless to name what we stand against? What is this vague solidarity that cannot use the words 'racism' or 'police brutality'? What [value] is this solidarity that fails to produce real change?" (5)The collective demonstration of support for Black lives at academic institutions is encouraging, but it is not enough. To move forward as a community, academic medicine needs to gain a much greater understanding of racism and how it plays out in our institutions and in the lives of the Black individuals who work in and seek care at our medical centers. For us, racism is not a theoretical construct; it does not happen to unknown and unfortunate people "out there" in the Black community. It happens to us. Our lives, despite relative privilege, have often been challenged by an appalling juxtaposition of either complete invisibility or, when seen, being seen as dangerous, a likely criminal, or at best simply unimportant. We are pulled over by police for no reason; we fear for our lives. We fear that at any moment, we or a family member may be confronted by someone who, motivated by racism, could say we are not good enough, don't belong, aren't ready for promotion, may derail our career, harm our family, take our life. As we move forward with decisive action, allies of all races need to understand these facts about racism and how it affects all Black lives.The epidemic of fear and violence rained down on the Black community by police departments across this country has led to one of the greatest manifestations of racism in this nation: the mass incarceration of Black men. Black people are more likely to be pulled over by the police; more likely to be searched; more likely to be charged with a criminal offense; and, when charged, more likely to be convicted (9). As a result, a Black man born in the United States in 2001 has a 1 in 3 likelihood of being incarcerated in his lifetime. This most disturbing manifestation of structural racism creates a far-reaching downward cascade, limiting Black lives, especially Black men's lives, in housing, education, employment, income, and health (10).So what actions should academic medical centers and their leaders take to ensure this unprecedented moment in history is one that truly becomes an inflection point? We should commit to recruiting more Black faculty. This is essential to the care of our Black patients and to transforming our academic culture. Building a critical mass of Black faculty will provide a robust community of support for Black medical students and trainees. We must endeavor to create an environment in which Black trainees thrive, succeed, and are retained as faculty. Yet we know that it takes more to transform a culture than this. Antiracism training should be required; a shared understanding of racism is essential to promoting racial justice. Most importantly, we must use the power of our institutions to demand accountability and reform of policing practices.Finally, we must ensure that Black leaders alone aren't tasked with "fixing" racism at academic medical centers. Black people did not create racism; thus, it is illogical to believe that we alone can devise and implement a plan to eliminate it. All of us, regardless of our race, must engage in and sustain this effort. Together, we can overcome.References1. Bassett MT. #BlackLivesMatter—a challenge to the medical and public health communities. N Engl J Med. 2015;372:1085-7. [PMID: 25692912] doi:10.1056/NEJMp1500529 CrossrefMedlineGoogle Scholar2. Charles D, Himmelstein K, Keenan W, et al; White Coats for Black Lives National Working Group. White coats for black lives: medical students responding to racism and police brutality [Editorial]. J Urban Health. 2015;92:1007-10. [PMID: 26382654] doi:10.1007/s11524-015-9993-9 CrossrefMedlineGoogle Scholar3. Morse M, Loscalzo J. Creating real change at academic medical centers—how social movements can be timely catalysts. N Engl J Med. 2020. [PMID: 32521157] doi:10.1056/NEJMp2002502 CrossrefMedlineGoogle Scholar4. Eberly LA, Richterman A, Beckett AG, et al. Identification of racial inequities in access to specialized inpatient heart failure care at an academic medical center. Circ Heart Fail. 2019;12:e006214. [PMID: 31658831] doi:10.1161/CIRCHEARTFAILURE.119.006214 CrossrefMedlineGoogle Scholar5. Nze C, Avakame EF, Ayankola OJ, et al. Police brutality is our lane too, doctors say. Stat. 5 June 2020. Accessed at www.statnews.com/2020/06/05/physician-advocacy-against-police-brutality-thisisourlanetoo on 5 June 2020. Google Scholar6. Griffin G, Adams D. Boston medical community steps up for racial justice. Boston Globe. 5 June 2020. Accessed at www.bostonglobe.com/2020/06/05/metro/boston-medical-community-steps-up-racial-justice on 6 June 2020. Google Scholar7. Azar KMJ, Shen Z, Romanelli RJ, et al. Disparities in outcomes among COVID-19 patients in a large health care system in California. Health Aff (Millwood). 2020:101377hlthaff202000598. [PMID: 32437224] doi:10.1377/hlthaff.2020.00598 CrossrefMedlineGoogle Scholar8. Price-Haywood EG, Burton J, Fort D, et al; Hospitalization and mortality among black patients and white patients with Covid-19. N Engl J Med. 2020. [PMID: 32459916] doi:10.1056/NEJMsa2011686 CrossrefMedlineGoogle Scholar9. Pierson E, Simoiu C, Overgoor J, et al. A large-scale analysis of racial disparities in police stops across the United States. Nat Hum Behav. 2020. [PMID: 32367028] doi:10.1038/s41562-020-0858-1 CrossrefMedlineGoogle Scholar10. Badger E, Miller CC, Pearce A, et al. Extensive data shows punishing reach of racism for black boys. The New York Times. 19 March 2018. Accessed at www.nytimes.com/interactive/2018/03/19/upshot/race-class-white-and-black-men.html on 12 June 2020. Google Scholar Comments0 CommentsSign In to Submit A Comment Fernando Lopez, MD, FACPPrivate Physician Services of San Antonio23 June 2020 The time is now What happens at the Brigham matters. Trainees from all 13 departments are disproportionately represented in leadership roles. In that sense, principles learned at the Brigham have the effect of shaping policy across the spectrum of academic hospitals in the United States. Blacks and Latinos remain underrepresented at the Brigham as well as in most urban academic medical centers. This fact is well known and has deleterious effects to the minority communities that many of those hospitals are supposed to advocate for. The time to act is now! Kathleen Brunts, M.D.none28 June 2020 racist language in medicine When I was a student, many years ago, we were taught to present our findings about a patient: This is a 40 year old, black female. I learned later that race has very little clinical relevance, but taps into one's racist preconceptions. If this has not changed, It is one small step to make medical care less racist. Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (V.E.S.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4280.Corresponding Author: Valerie E. Stone, MD, MPH, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3-026, Boston, MA 02120; e-mail, [email protected]harvard.edu.Author Contributions: Conception and design: V.E. Stone.Drafting of the article: V.E. Stone.Critical revision of the article for important intellectual content: V.E. Stone.Final approval of the article: V.E. Stone.Administrative, technical, or logistic support: V.E. Stone.This article was published at Annals.org on 18 June 2020. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Valerie E. Stone, MD, MPH In this video, Valerie E. Stone, MD, MPH, speaks at the White Coats for Black Lives demonstration in Boston. (Courtesy of Brigham Health. Used with permission.) (Duration 3:17) FiguresReferencesRelatedDetails Metrics Cited byScience class as clinic: Why histories of segregated instruction matter for health equity reforms todayFailure of leadership in U.S. academic medicine after George Floyd's killing by police and amidst subsequent unrestTransformative Learning in Graduate Medical Education: A Scoping ReviewSurgical research journals - Under review: An assessment of diversity among editorial boards and outcomes of peer reviewForks in the Road—As Faced by Women in GastroenterologyWomen and Academic Medicine, 2020 20 October 2020Volume 173, Issue 8Page: 656-657KeywordsAfrican American peopleCOVID-19FearHealth equityHomicideHospital medicineKneesPatientsRacial and ethnic issuesStructural racism ePublished: 18 June 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...