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Remove Race as an Initial Identifier From Clinical Presentations

In December 2021, one of our most controversial pieces was published in a well-read journal, the American Family Physician (AFP). It was an editorial entitled “Dismantling Anti-Black Racism in Medicine.” I admit that I do not understand what the controversy was about, but there was a robust response. This article, whose main points are re-published here are not controversial in my mind at all, nor in the mind of the editors of AFP. (See Table 1.)

Table 1. Individual Actions That Physicians Can Take to Eliminate Systemic Anti-Black Racism

Problem Individual action
Anti-Black racism contributes to the disproportionate prevalence of Black patients who are uninsured and enrolled in Medicaid. Choose to work in practices that serve patients enrolled in Medicaid and patients who are uninsured, and make changes to private practices to ensure that Black patients in these categories are served well. Advocate for higher reimbursement for physicians., more generous Medicaid income cutoffs, and Affordable Care Act Medicaid expansion.
Anti-lack racism and White privilege silence the voices of Black members of our society. Apply an antiracist equity lens and advocate for systematic changes in our society to address systemic anti-Black racism, which is a significant cause of inequities in social determinants of health and health disparities. Recognize that White privilege advantages some and disadvantages others, and speak out to include Black colleagues in decision-making.
Medical students who are Black experience a lack of opportunities and more mistreatment. Use physician offices as pathways to opportunity and to level the playing field for students who are Black. Many of these students are our patients, and family physicians should encourage them in their professional growth.
The lack of physicians who are Black and in leadership is evidence of systemic anti-Black racism in medicine and its profound impact on decision-making. Influence local hospital medical staff and professional societies to actively recruit Black physicians, and encourage Black physicians to become active members and move into leadership positions. Seek opportunities to collaborate with student organizations such as the Student National Medical Association and add Black voices to efforts to serve the Black community.
Systemic anti-Black racism and White privilege get their power from the denial of their existence. Seek education on the roots of systemic and institutionalized racism in the United States, learn from others who have experienced the effects of racism, and then actively share this knowledge with others. The medical literature has multiple articles on what practicing physicians can do and where they can learn about systemic anti-Black racism. Professional organizations can provide CME on eliminating the systemic anti-Black racism that is pervasive in the recruitment and hiring of physicians and its foundational role in health inequities.

Source: Rodríguez JE, Campbell KM, Washington JC. Dismantling Anti-Black Racism in Medicine. Am Fam Physician. 2021 Dec 1;104(6):555-556. PMID: 34913649.

AFP is sent to over one-hundred twenty-seven thousand members of the American Academy of Family Physicians, (AAFP) who are among the best, hardest working physicians I will ever meet. And even so, the journal allowed people to comment, and we received 55 comments. These are special comments, as they were only allowed to be posted by active members of the AAFP, with their names and credentials. The initial comments were benign, and then there were multiple comments that said the authors were, and I quote, “the problem with America” and other more insulting comments about our intelligence. These comments were on the site for a short time before other members of the AAFP came to the defense of the authors and the science in the editorial. I will say that I am delighted with the attention that this editorial has received, in that no other editorial from 2021 has one fifth of the comments.

Dr. Alan Blum, a family physician and accomplished artist, responded to the editorial, and his response was published in the August 2022 edition of AFP. In that reply, he reminds all physicians that race does not belong in the first sentence of the documentation or presentation of the medical encounter, which was first mentioned in the journal Family Medicine by Dr. Matthew Anderson (one of my mentors).

My co-authors and I responded to his letter, reiterating Dr. Blum’s point, and reminding all of us that while race, per se, is not a risk factor for adverse health outcomes, exposure to and being the target of racism is. In addition, we share that how we speak about patients ultimately affects how we speak to them and treat them. It was both reassuring and fascinating to observe community members are actively seeking solutions. We join with them and invite you to read the editorial, the letter to the editor, and our response.

José E. Rodríguez, MD, FAAFP

Oct 19, 2022 8:39 AM