1) I feel like I have been relatively (for a white person) aware of racial disparities for a while thanks to my education and some incredible mentors of all backgrounds, but this last week was the first time I realized how much #RepresentationMatters

2) I had a patient who needed a procedure done as a last step to get home, we had tried previously with sedation but the anesthesia team had felt she was too high risk at the time and sent her back to the floor

3) While she was in the procedural room, she had overheard some comments about the risk and complications they thought were more likely for her, and she was now terrified of having the procedure. We had replanned for this week, but she stopped me as I discussed our plan.

4) She said, “Dr. D’Amico, don’t take this the wrong way, but I want a doctor who sees me like I could be their daughter or sister. Especially now, you never know how people feel, and I don’t want someone to see me as a statistic, just another black girl with heart problems.”

5) I clarified that she meant she wanted a black physician for the procedure, and she said yes. I was horrified to think that she was afraid for her life because somebody may not try hard enough or do enough because of her race, as that never crossed my mind if something to fear.

6) I will point out her fear is not unfounded, as many atrocities have been committed against African Americans in medicine, and that implicit bias can affect small but important parts of our behavior. I told her I would do my best to find someone she felt she could trust.

7) While I had sat & talked to her and validated her feelings, I knew that I wouldn’t be able to truly understand, so I looked for one of our black staff members to discuss with her. While our physician team is all white, I thought maybe one of the staff could empathize with her

8) As I was wandering around the floor, I realized NO ONE working that day (RN, RT, PCA) on the floor was black. I called IR and they also did not have any black physicians or staff that day.

9) I was appalled. I had never clearly seen the disparity before. But I knew those around me who are minorities had seen it all along. As a woman in medicine I notice when I’m surrounded by all men; not because I fear for my life like my pt, but because I don’t feel understood

10) This meant that not only did our patients who are minorities not have someone they felt they could relate to and count on to not judge them by their race, but our white patients weren’t seeing people in positions of power and care who were black, worsening their own biases

11) We settled on the IR attending who did the procedure was aware of my patient’s concerns & took personal responsibility that nothing was said in the room that would make her feel separate or lesser than. They would also do it under local anesthesia so she felt less vulnerable

12) My patient was very happy with her experience during her procedure and said the whole staff made her feel welcome and comfortable. While I’m glad we were able to improve this moment for her, we can’t rely on people sharing concerns & individual providers being supportive

13) There will be (and are) patients who are terrified and say nothing. There will be (and are, whether we admit it or not) providers who ignore, brush off, or don’t support their patients’ concerns about how their race affects their care

15) We need systematic improvement- more recruitment efforts for people of color and then supporting them after, work on increasing interest in healthcare among children who are minorities, and implicit bias training for existing providers.

16) Healthcare is great about QI, patient safety, & we also value patient experience. Diversity in healthcare is integral to all of those. So why should we avoid talking about it? Of course it’s uncomfortable, but it’s important and we deal in the uncomfortable on a regular basis

17) I’m glad my institutions have started to work on this in their own ways, but I’m not sure that’s the norm. To my friends and patients who are black, I’m sorry I didn’t see what was right in front of me. I know you already know this- but to everyone else- We must do more.