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Disclosures: Frank reports no relevant financial disclosures.
June 11, 2020
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Guest Commentary: Physicians can help fight racism — here’s how

Disclosures: Frank reports no relevant financial disclosures.
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Malcolm X said, “If you stick a knife in my back nine inches and pull it out six inches, that’s not progress. ... Progress is healing the wound that the blow made.” We are physicians, experts on attending to wounds. Yet we have not pulled the knife out the wound of racism. Many among us have not admitted the knife is there. Among those who see it there, many say, “It’s not my job.”

Fellow physicians, we are well beyond the point of, “First, do no harm.” It is time to acknowledge this deep, chronic, brutally-inflicted unhealing wound. This wound was first inflicted 400 years ago through slavery and driven deeper with every cruel and traumatic twist of the knife. This wound has been fatal to countless African Americans. Most recently we have been confronted with visual evidence of the public torture and death of George Floyd. If a picture is worth a thousand words, a video is worth at least a million. Fellow physicians, it is time for us to pull out the knife and lead the healing process.

It will not be easy. As physicians, we now face four inter-related public health crises, all of which threaten the health of our patients and the future of the world. One: COVID-19, a highly potent novel virus. Two: Economic despair and inequity, long present but amplified by the virus. Three: The ugly consequences of systemic racism too often expressed as police brutality. Four: Science denial that makes effective, rational intervention even more difficult.

In the face of such complex and overwhelming suffering, what can we do as physicians to heal?

Perhaps we need to recognize that who we are is how we have healed. Both individually and as a nation, we are all the sum of our scars — historical, physical, spiritual and emotional. The healing we have not done haunts every crisis we face today. Woundedness is a universal, necessary state of the human condition. Some are more profoundly injured than others. Biologically, we are designed to heal. But whether healing a person or a nation, the process must be actively facilitated. We know how to do it. Explore the wound, thoroughly and despite pain. Cleanse the laceration and debride it of infected, devitalized tissue. Stop picking at the wound, it only makes it worse. Most importantly, do not attempt premature wound closure, as we have so often. This results in the infection festering and bursting forth as an abscess. This wound must heal by secondary intent, from the bottom up.

I would not presume to tell anyone how to be anti-racist or an ally. But I can tell you how not to. Entering that space does not occur as a single epiphany that happens in a flash when you see George Floyd tortured for 8 minutes and 46 seconds resulting in his murder. It may start with an epiphany, but it cannot be momentary, it must be sustained.

To be anti-racist is a daily and constant process that requires committing ourselves to become uncomfortable, to open our eyes to the injustice we have preferred to ignore. Get uncomfortable. Do the work. Do not weaponize your words. Do not preach. Do not escalate. De-escalate, but do so assertively and often. Rise up against racism. These tables are not going to turn themselves.

Do not seek to empower the African-American community but seek to be empowered by them. Empowerment is not hierarchical in the way we with privilege think of it, granted generously by the “haves” to the “have nots.” True empowerment requires mutuality. Mutual empowerment is reciprocal and iterative, growing in strength as each party in a partnership grants power to the other. Conferring this power requires trust, earned through consistent action. I have only as much power as you assign to me. This power is only sustained as I offer it in return. Lilla Watson, an Australian aboriginal advocate stated powerfully, “If you have come to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.”

Health professionals can only break down the structural racism and redesign the system with equity and justice one intentional and generous action at time. So, what can we do to make a difference? I humbly offer these suggestions.

Recognize the interdependence of well-being

Everyone does better when everyone does better. Racism illuminates this essential principle of health. COVID-19 illuminates this principle. The profound injustice of the health and social inequities in the United States are sufficient to motivate caring people to act with outrage and effectiveness to support change. Full stop. That is motivation enough. We have long been caught up in the consequences of our failure to act on this recognition, illustrated by poor health outcomes despite high cost of health care in the United States. But now it is impossible to ignore. Human health —indeed all health —is connected, interdependent.

Practice with empathy

To heal, we must acknowledge the wound. By all means, read, take equity awareness courses, watch films, advocate, write letters, protest and donate. But above all, feel. Every day, feel pain. Acknowledge pain. Feel joy. Acknowledge joy. Are you a compassionate clinician? The root meaning of compassion is “to suffer with.” Use empathic curiosity to seek out the feelings that lie beneath the symptoms your patients describe and to understand why the patient has not accepted your diagnosis or “adhered” to your treatment. Seek to affirm your perception of these feelings by practicing accurate empathy, checking out whether you really understand those emotions. Everyone is the expert on their own experience.

Do best what people need most

Do your part. We all have different skills and resources. We all perceive different needs. Consider this call to service and action and fulfillment. How and who we serve depends on who and where we are. Where and whenever we work, we can apply the same process. See the need. Grasp the need. Meet the need. Eyes wide open.

The internet is ripe with resources to both better understand racism and to act on this understanding. They have been there in one form or another for decades.