Black Man in a White Coat: Implicit Bias in Healthcare

On July 9th, I joined a group of about 600 people, from medical professionals to interested South Carolinians, and attended a discussion of Dr. Damon Tweedy’s Black Man in a White Coat.  The discussion, sponsored by SC AHEC, focused on the first part of the book; another discussion will follow on Tuesday, July 21st, and the event culminates with Tweedy’s virtual visit on July 29th.

As our nation awakens to the realities of systemic racism, the humanities hold an especially important role in highlighting narratives that illustrate individual lived experiences. As racial disparities become more and more evident in health care, it behooves us to listen to Tweedy’s experiences as someone on both sides of the stethoscope.

When polled about what surprised us the most about Tweedy’s book, the answer wasn’t systemic racism or inequalities in medicine.  It was his openness in talking about these things: in admitting that, even as a person of color, Tweedy experienced inherent bias against patients of color. One African-American physician spoke eloquently about how similar Tweedy’s thoughts, feelings, and biases were to his own, and to those of other healthcare providers of color.

Exacerbating the systemic racism at play here is the hierarchical culture of medicine itself. As with many high-pressure careers, this comes with the notion of “imposter syndrome,” especially for someone already considered different. In medical school, many medical students said, one is supposed to be “untouchable,” always “on.” As a person of color, though, one cannot be too aggressive, overconfident, or arrogant, or one earns the dreaded epithet of “angry” or overly “emotional.” This reminded me of Austin Channing Brown’s I’m Still Here: Black Dignity in a White World.  On her first day in a job, Brown’s boss tells her that he is there for her if she has any “concerns,” but, when she shares a concern about a racist incident, she is told that she is too “sensitive.”  It is a catch-22 that characterizes the lives of many professionals, especially in hierarchical settings like that of a medical hospital.

And bias is baked into medical training, too. One medical student perceptively reported that, when he was taught about sexual transmitted infections, most of the genitalia on the slides were dark. When it came to less stigmatized diseases, people of color were not represented. Curious, I did a “Google Search” for images of STD’s. They are too gruesome to post, but they were all, with the exception of one, images of people of color.

We all need to be aware of our implicit biases, of our racism, but health care professionals also have to make quick decisions regarding their patients. How, asked one doctor, do we “combine experience (good, thoughtful, meaningful experience) with an understanding of our own biases?”

The last question was, perhaps, the hardest: do we feel comfortable educating our colleagues, or our friends, about discrimination? It is hard—damn hard—to allow oneself to be “educated,” which reminded me of Robin DiAngelo’s White Fragility.  As one participant said, “we educate (people) about speaking up, but not about listening.” How do we listen, really listen, to our colleagues and friends?  To the people we will serve? How do we do this when we have been accused of bias?

These are really important questions, both in and outside of a healthcare setting. We need to interrogate bias because, as one elderly doctor said, the medical evidence is incontrovertible: bias makes people sick. Bias kills. And it is preventable.

Masks in Class

The Post and Courier ran the following article “SC educators say absence of masks, social distancing threatens in-person classes this fall” to highlight the challenges many schools are facing. Senior and Medical Humanities minor Maddie Gies is quoted in the article and shares her concerns:

Gies, who lives in downtown Charleston, said she’s felt discouraged and frustrated by the lack of masks she sees being worn on King Street and other public spaces near the heart of the college’s campus. Based off what she’s seen on social media, many of her friends are continuing to socialize as normal.

“I would love nothing more than to go out right now, but I can’t,” Gies said. “It’s just kind of hurtful because it makes me feel like I’m wasting my time or like you’re not taking it seriously or I’m having to sacrifice and you’re not. It’s just like a slow build of just seeing those things.”

Gies, who is studying special education, also worries that the spread of the virus will impact her ability to get in-person student teaching experience in the classroom this year.

At least two of the five classes she’s registered for in the fall have already been switched to take place solely online, she said, causing her to consider putting her studies on hold for a semester.

“It’s not just my senior year. It’s your kid going to school. It really affects everyone. And I don’t think people are realizing that,” she said.

Pick-up for College of Charleston face mask, hand sanitizer and sanitizer wipes for college offices at the Stern Center on Tuesday, May 26, 2020.

Since the article ran, the College released the Back on the Bricks plan for fall.

Commentary: Epidemics past and present provide context for coronavirus

Jacob Steere-Williams, CofC History professor, wrote about the history of epidemics in an editorial for the Post and Courier. His class, History 291: Disease, Medicine, and History, counts toward the Medical Humanities minor.

I often kick off the semester in my undergraduate classes at the College of Charleston with a simple question: What disease are you most afraid of?

The replies are predictable; Ebola, bubonic plague and HIV/AIDS usually top the list, though sometimes a wry public health student will mention cholera or dengue fever. I use this exercise to open up a conversation with students about an uncomfortable truth: We rarely fear the diseases most likely to make us sick or kill us. The leading causes of death in the United States today are heart disease, cancer and accidents. Students never mention accidents. Read More.

Special Topics Classes for Fall 2020

Hi all! We don’t have a lot, but I do want to let you know that
EDFS 410, 420, and 430 as courses that fit the medical humanities minor (see criteria down below). These are “Characteristics of Students with Mental Disabilities,” “Characteristics of Students with Emotional Disabilities,” and “Characteristics of Students with Learning Disabilities.”

Also, the Women’s and Gender Studies class, WGST 120, “The Sexuality of Childbirth,” will count toward the minor. Just please let me know ( if you’re definitely taking it, as I have to fill out a special topics petition.

Also, Allison Foley will be teaching MEDH 200 over the summer- stay tuned for a flier and more information.

Music Therapy at MUSC!

Welcome to 2020, and I look forward to our inaugural visiting scholar this spring (more information to follow). For now, read here about music therapy being offered at MUSC.