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I’m thrilled to be having an uneventful recovery a few months post c-section. 
I was inspired by the skilled & kind care I received from many wonderful people.
I’ve been reflecting on what made that good care actually good, especially in the context of medical racism.
I was inspired by the skilled & kind care I received from many wonderful people.
I’ve been reflecting on what made that good care actually good, especially in the context of medical racism.
Something the anesthesiologist said stuck with me: “Tell is how you’re feeling, because you’ll feel it before I can see it on the monitor.”
Sure enough, I had some vasovagal near syncope symptoms that he treated before I could pass out.
Sure enough, I had some vasovagal near syncope symptoms that he treated before I could pass out.
The anesthesia team did an amazing job of communicating with me about how my body was feeling and addressing any issues.
(Side note: spinal anesthesia is amazing! It was wild to experience major abdominal surgery while awake and not feel any pain.)
(Side note: spinal anesthesia is amazing! It was wild to experience major abdominal surgery while awake and not feel any pain.)
We divide data in medicine into the subjective (what the patient tells us) & objective (what we can observe & measure). We often prioritize obj data.
This distinction is often arbitrary.
Why is what the patient observes considered less important that what the clinician sees?
This distinction is often arbitrary.
Why is what the patient observes considered less important that what the clinician sees?
Good care for me was having people listen and affirm my experience.
“I feel like I’m in labor.”
“I feel like I’m going to pass out.”
“I’m in pain and would like more meds.”
Those “subjective” elements were objective for me. And the staff listened.
“I feel like I’m in labor.”
“I feel like I’m going to pass out.”
“I’m in pain and would like more meds.”
Those “subjective” elements were objective for me. And the staff listened.
We know that white pregnant people and babies are more likely to survive birth than black pregnant people and babies.
As I reflect on my good experience, what struck me as a white patient was the privilege of being listened to.
My observations and concerns were acted on.
As I reflect on my good experience, what struck me as a white patient was the privilege of being listened to.
My observations and concerns were acted on.
In contrast, I think about Serena Williams’ postpartum experience.
She had a history of PEs, got short of breath post-op and off anticoagulation, said “I think I have a PE” and was not listened to by the hospital staff. https://twitter.com/drchaeed/status/951117112323518465
She had a history of PEs, got short of breath post-op and off anticoagulation, said “I think I have a PE” and was not listened to by the hospital staff. https://twitter.com/drchaeed/status/951117112323518465
As an Emergency Physician, I often see racism manifest as patients’ concerns being questioned or met with skepticism because of “objective data.”
Patient: “I can’t breathe.”
Clinician: “The lungs are clear and the O2 sat is normal, it must be a panic attack.”
(Severe asthma)
Patient: “I can’t breathe.”
Clinician: “The lungs are clear and the O2 sat is normal, it must be a panic attack.”
(Severe asthma)
Patient: “I’m in pain.”
Physician: “They are playing on their phone and their vitals are normal. They must be exaggerating.”
(Note: playing on my phone was exactly how I coped with the surprise and discomfort of being in active labor.)
Physician: “They are playing on their phone and their vitals are normal. They must be exaggerating.”
(Note: playing on my phone was exactly how I coped with the surprise and discomfort of being in active labor.)
Patient: “I have a terrible migraine & have been vomiting all day.”
Clinician: “Their vitals are normal, they look comfortable, they aren’t vomiting now, let’s just give IM ketorolac. They don’t need an IV.”
Clinician: “Their vitals are normal, they look comfortable, they aren’t vomiting now, let’s just give IM ketorolac. They don’t need an IV.”
This clinician-override of what the patient reports can happen to anyone.
But it’s more likely to happen to Black patients.
But it’s more likely to happen to Black patients.
Ultimately, there is subjectivity inherent in every data point.
Our job as clinicians is to gather that data and acknowledge the range of possible realities.
Is that test a false positive? Did I miss something? Is that patient under-reporting their symptoms?
Our job as clinicians is to gather that data and acknowledge the range of possible realities.
Is that test a false positive? Did I miss something? Is that patient under-reporting their symptoms?
Good care for me was having my concerns validated, taken seriously, and acted upon when necessary.
My reality mattered.
My reality mattered.
As a clinician, I think we should strive for that in all our patients.
We need to acknowledge that our racist society programs us to be more likely to ignore Black patients and patients of color.
That racism may be unconscious, but it can still be deadly.
We need to acknowledge that our racist society programs us to be more likely to ignore Black patients and patients of color.
That racism may be unconscious, but it can still be deadly.
We need to be realistic about our own human limits and double check ourselves.
Am I taking this patient seriously?
What blindspots do I have?
Am I taking this patient seriously?
What blindspots do I have?
It’s up to institutions to take a long, hard look at what systems they are asking clinicians to work in.
We’re always working with limited resources. Racism is fundamentally about resource allocation.
How may white patients be benefiting & Black patients be harmed?
We’re always working with limited resources. Racism is fundamentally about resource allocation.
How may white patients be benefiting & Black patients be harmed?
American society is deeply racist. Medicine is not immune.
Listen to stories like #DrSusanMoore’s.
Ask yourself: what would happen if we believed Black patients as much as we did “objective data”?
What would it look like to take a patient’s concerns seriously and act on them?
Listen to stories like #DrSusanMoore’s.
Ask yourself: what would happen if we believed Black patients as much as we did “objective data”?
What would it look like to take a patient’s concerns seriously and act on them?
