Op-Ed: Clinic Consultant Note on Racism in America
How sick, toxic, and broken is America for African Americans? The medical community’s lack of response to urgently deal with racism is felt to be hypocritical with the name of caregiver. As a Black female orthopedic surgeon, less than 2% in the nation, I was trained to fix broken things. Racism in America is not just broken, it is being dismantled before our very eyes. How apropos to discuss racism as an illness, virus, or cancer, through a clinic consultant note via history and physical exam. We can do better and we are stronger together. America is at a historic tipping point. I believe medicine has to be on the side of justice, equality, and anti-racism. It’s time to evaluate, treat, and heal!
Chief Complaint: Racism
HPI:
Today I was called to the ER STAT for a broken patient. We have a multigenerational race of African Americans who recently have been illegally traumatized again and again and again, but this time with media proof. The patient describes “in your face racism” for 8 minutes and 46 seconds.
The patient states they have been brutalized, and systemically disenfranchised; resulting in loss of life, hope, and dreams of hundreds of thousands of Black men, women, and children. The patient stated their pain is due to the lack of basic human rights, abuse of their civil rights with poor access to the American dream primarily due to covert structural racism (aka inequality). It has been documented the patient has experienced numerous associated medical issues higher than any other race, such as CAD, HTN, stroke, cancer, diabetes, depression, HIV/AIDS, substance abuse. It should also be noted that many other comorbidities are associated with the diseases, such as harassment, bullying, fear, stress, and anxiety. The patient has tried everything within their power, but nothing seems to make it better.
They believe that the perpetuated status quo, with ignorance of history, implicit bias, and white privilege makes it worse. The full history of the present illness could not be obtained since the patient was told by others they had heard enough and the patient should just be happy with current circumstance as better than it used to be. Today the patient is in immense pain 10/10. I observed the patient to be very hurt, sad, depressed, anxious, disappointed, angry, disgusted, and fed up.
PMH:
Murdered/lynched (KKK)
Loss of children (highest perinatal mortality)
Red-lining (new-age segregation)
Loan denial for real estate and entrepreneurship
Affirmative action (poor implementation, now people think we were getting too far ahead)
Marginalized by society
Blatant police brutality with no recourse or reprimand
Social History:
+Tob
+EtOH
+Marijuana (imprisoned for use and sales but now legal for corporate America)https://tpc.googlesyndication.com/safeframe/1-0-37/html/container.html
Commercially mocked and exploited (Aunt Jemima, Uncle Ben’s, Blackface, etc.)
+Prison (industrialized corporate slavery)
Payday loan (high-interest loans and/or credit cards)
Education level:
Varies
1740-1830 illegal for “slaves” to be educated in fear of a revolt or escape
1830-1863 gravely discouraged from education (fear of their life)
1863-1950 “separate but equal” ($ for education per capita white vs black was 3-6 times more)
1954 integration with Brown vs Board of Education but not widely accepted for years
1960 Ruby Bridges, first African-American girl to integrate at a white school in the U.S.
1964 Title VI of the Civil Rights Act of 1964 provided a mechanism for ensuring equal opportunity in federally assisted programs and activities
1977 as part of the Adams case, a court ordered the federal government to establish new, uniform criteria for statewide desegregation
2008 AMA apologizes for systemic racism … and still no correction
Family History:
Kings and Queens of Africa
Brutally enslaved and placed on a ship with unimaginable Middle Passage (over 1/2 loss in route due to disease, dysentery, rape, murder, and suicide)
American slavery 200 years (killed, beaten, raped, treated, and traded as animals)
Broken families (economically disadvantaged)
Single mothers
Allergies:
Skittles
Nooses
Bullets
Knees on our necks
Inhumane treatment due to the color of our skin
Meds:
Acceptance
Complacencies
Silent protest
Legal marches
Non-violent sit-ins (Woolworth)
Riots (release of frustration and anger for years of oppression with disregard of our life AGAIN)
Prayer (why our faith is so strong and should not be ignored)
Review Of Systems:
+HA (beaten with billy clubs)
+Cough (more tobacco ads and sales in black neighborhoods)
+SOB (“I can’t breathe” #GeorgeFloyd)
+CP (shot in the back)
+nausea/vomiting (hit or kicked in the stomach)
+depression +anxiety (in fear for our lives) +PTSD
+musculoskeletal pain (college/pro athletes for entertainment)https://tpc.googlesyndication.com/safeframe/1-0-37/html/container.html
PE:
Vital signs critical
HEENT: +head trauma (beaten)
PERRLA EOMI: +ecchymosis and swelling and redness due to pepper spray
Neck: +shoe marks, nose broken, throat crushed-mute
Cardi: tachycardia +murmurs, +rubs, +gallops (heartbroken)
Resp: tachypnic +cough +rhonchi (high risk for COVID-19)
Abd: +BS NTND (BMI over 30+ highest among any other race, food deserts, or lack of access to healthier foods, lack of $ for healthy food)
Back: +tenderness to palpation (knee on back, thrown to ground) +bruising
Neuro: CN II-XII intact, sensation increased
Msk: 3+/4 reflexes globally, strength 5/5 systemically/collectively
Vasc: decreased pulse (slowly exsanguinate due to injustices in society)
Assessment:
- Black Lives Matter
- Systemic structural racism
- Implicit bias within healthcare
- Pain due to lack of justice
- Trauma secondary to lack of opportunities and fairness
Plan:
- Patient to the OR STAT for dismantling structural racism in America
- Consent for anti-racism engagement (risks and benefits discussed)
- Post-op implicit bias training (start early)
- Consult Anesthesia to cover the pain (not going to be easy)
- Consult social work to create and revise diversity and inclusion policies/programs
- Consult case manager for assistance with insurance (aka funding)
- Nursing check and measure deliverables and attainable goals for anti-racism
- Return to clinic for re-evaluation with ramifications for non-compliance
- Will need to establish transparency and accountability before discharge
- Consult the hospital chaplain to pray for us all!
Sonya M. Sloan, MD, is a CompHealth locum tenens orthopedic surgeon and author of The Rules of Medicine: A Medical Professional’s Guide for Success.