White Coats for Black Lives

By John H. Vassall II, MD

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I was gratified to join with thousands of masked colleagues in a recent march from Harborview Medical Center to Seattle City Hall in support of the struggle against racism. This felt different than when I participated in a march across the Edmund Pettis Bridge in Selma, Alabama, on the 50th anniversary of Bloody Sunday, or when I first tasted tear gas during the March on Washington in my college days.

The size and diversity of the crowds and the depth of the conversations were greater than in the past. Systemic racism and the oppression of people of color was acknowledged, not defensively denied.

Yet discussions of “social determinants of health” can deflect attention from racism in medicine and health care delivery. James Marion Sims, the “father of modern gynecology,” developed his surgical techniques after experimental surgery without anesthesia on enslaved women. The Tuskegee syphilis study, in which Black men were observed as a deadly, treatable disease ravaged their bodies, has left a legacy of mistrust of American medicine among many African Americans. To this day, biomedical corporations continue to reap billions of dollars from HeLa cells, cancerous cells used in research that were removed and cloned from the cervix of a Black woman named Henrietta Lacks taken without her knowledge or consent; Henrietta and her family were not compensated.

How might we address racism in medicine? We can learn from our efforts to address safety in medicine. In 1999, the Institute of Medicine issued its landmark report, “To Err Is Human: Building a Safer Health System,” documenting that 44,000 to 98,000 people each year died in American hospitals because of preventable medical errors.

Like many of my colleagues, my reaction was denial. I was a practicing primary care physician dedicating every day of my life to healing. I refused to believe that I could be responsible for the unnecessary death of my patients.

But when I studied the literature, I came to understand that unsafe policies and procedures, a hierarchical culture, and lack of error-prevention skills made hospitals dangerous environments. To prevent needless deaths from errors and to make substantive change, I came to the painful realization that I was putting my patients at risk with every hospital admission. Despite my best intentions and doing everything I was trained to do, I almost certainly must have had patients who died in my care from an error I did not recognize.

As with systemic safety issues, so it is with systemic racism. It may be difficult to see, but it still causes harm.

What should we do? Make it personal. We can do everything in our power to make health care safer or we remain complicit with unsafe conditions; there is nothing in between. We can either do everything in our power to recognize and deconstruct racism or remain complicit with racism. There is no other choice.

Become educated about systemic racism. Racist ideas, policies, and practices have been developed, entrenched, and refined over hundreds of years. They are inculcated in culture and are self-perpetuating. They will not change without intention and effort, just as hospitals became safer only after systemic changes and education of physicians, all hospital workers, and patients about recognizing and mitigating unsafe practices and behaviors.

Act. Have brave, respectful conversations that focus on the system and the problem, not the people. With faith in ourselves and in our collective humanity, we can and will prevail against racism if we continue the effort we’ve started.

John H. Vassall II, MD, is CEO of the Foundation for Health Care Quality and serves as a WSMA trustee.

This article was featured in the Sept/Oct. 2020 issue of WSMA Reports, WSMA’s print newsletter.