After seeing multiple medical professionals down-play the role racism played in the death of #DrSusanMoore, I have been thinking of how to describe the logistics of how racism manifests in medicine. One way is what I will, in this thread, call "cumulative de-prioritization." 1/

2/ Lay people may think medicine is a panacea of limitless resources, but (especially in a pandemic), that's not true. Medical providers are CONSTANTLY triaging and prioritizing which patient gets which test / drug / family meeting at all times. Prioritizing must be done quickly.

3/ Imagine there are three critically ill patients in the ER and one current ICU bed. Which patient gets the ICU bed?

Imagine there are three patients all with symptoms of PE (blood clot in lungs), but there is only one scanner available to make the diagnosis. Who gets the scan?

4/ Imagine you urgently need open beds and there are three patients who are almost ready for discharge. Which patient gets discharged when marginally ready?

Imagine you have three families who need extensive communication about their loved ones' illness. Who gets the most time?

5/ Imagine you are the charge nurse. Which patients get assigned the most experiences nurses and who gets the nurses right out of orientation?

Imagine three patients need to be intubated and there is only one team available. Who gets intubated last?

6/ Imagine you are a nurse. One family is quiet, reserved, and (rightfully) distrustful. They ask questions because they want to make sure optimal care is being provided. And one family is smiley and easy and they also happen to look like you. Which room do you visit more?

7/ When docs and RNs are forced to make multiple, quick prioritizations in a day, FOR SURE implicit bias and deep subconscious beliefs about who matters and who is more valuable / dispensable creep in. This is a hard thing to know (as a patient) and admit (as a doctor or nurse).

8/ Racism in medicine manifests as cumulative de-prioritization over many small decisions. No one person is overtly racist. No one says "we provide less care to Black patients."

But this is one (common) way Black patients receive different care: cumulative de-prioritization.

Even I, a Black MD, know I have internalized anti-Black bias from growing up in USA. I unlearn it & actively fight against it in life and every patient encounter. But first I had to admit it and look for it. If all in medicine followed suit, #DrSusanMoore would not be a hashtag.