Black Lives in the Emergency Room

Scholars have long studied outcomes driven by slavery, segregation, and racism on the social determinants of health and well being. We can easily talk at length about all the work being done in these fields. In short: The Black condition in America faces generations of systemic oppression that account for many of today’s severe economic, health, social, and educational disadvantages. Click here for historical reference. If you followed current events over the past year, you couldn’t have missed the socio-cultural impact of the Black Lives Matter movement. Black Lives Matter. Three words that, in the very least, represent for centuries of oppression, violence, and discrimination by the state towards a population based on skin color. For a year, we’ve watched the BLM movement spread across the country; educating us and demonstrating for justice. I’m captivated by how this movement demands recognition. Injustice paints a powerful, visual narrative. News coverage takes us to the front lines in Ferguson. We watched riots evolve in Baltimore. We connected with the characters involved, and names like Michael Brown and Eric Garner are now house hold names. The narrative took social media, television, and radio hostage. As a person of privilege, I can never truly appreciate the struggle, the history, of what Being Black in America means. But for this year, at least, I learned why Black Lives Matter.

Why I’m Interested:
I’m a family medicine resident physician. Still in training, idealistic, unjaded, and naive beyond measure. I want to learn about and contribute to serving populations facing severe disparity, like those suffering racial discrimination. As a medical student, I thought the clinic, the hospital, and the emergency room, were safe havens for all patients, peoples, colors, and creeds. Our clinic is a sanctuary where doctors check their racism, sexism, and xenophobia at the door, or so I thought. I was conditioned to believe the white coat was color blind. 

A study funded by the National Institutes of Health covering racial disparity was published last month. The study looked back at how doctors used pain meds to treat black children and white children with the same chief complaint - appendicitis. When adjusting for pain score, insurance status, age, and sex, this is what the researchers found:

-Black children were less likely than were white children to receive opioids for the treatment of appendicitis when they arrived in the emergency room.

-Only 25% of black children in severe pain received opioids for appendicitis pain compared to nearly 60% of white children.

I questioned the study. Was the data real ? What could explain such disparity? How could we allow children to suffer so needlessly in pain? We’ve long known about health disparity based on race/ethnicity in adults, but the idea of children being discriminated against so negligently gave me a nauseating turn. I’m curious to see how deep this runs. 

You can read the study, published in JAMA Pediatrics, here.

Quick Reflection:
-How are medical schools implementing unconscious bias into their curricula?

-How is physician prejudice checked at medical facilities?

-What is your experience with discrimination in the hospital/clinic?

-In your health/bioethics course, what is the conversation on race like? 

While these findings warrant further investigation, I anticipate strong pushes from medical-social justice groups like White Coats for Black Lives Matter. I hope to see the movement flood the emergency rooms across the nation, just as it did in Ferguson and Baltimore. However, making racial-health disparities palpable to the country won’t be as easy as say police brutality. I think back to Officer Michael Slager  and the shooting in South Carolina. The country watched in shock. Everything Black Lives Matter was demonstrating for was sadistically recorded for public viewing. BLM framed the conversation and demanded change. Can something like racial-inequities in medicine ever be presented to the public eye in the same way? We may not be gunning people down in the streets, but if the study stands, we are imposing cruel suffering onto black children by withholding pain-alleviating medication. Patient privacy and the physician-patient relationship is protected and held sacred. Methods like suiting doctors in body cameras obviously won’t happen.

Take Home Questions:
-How can movements like Black Lives Matter hold health care providers accountable?

-How do we take privileged encounters and perpetuate them to the masses as the fatal shootings of black men were?

-A robust, national discussion of racial health disparity is long over due. Will this study play a role in sparking change?