Minnesota, Baton Rouge, Dallas: Physicians Have a Part to Play, Too

Given the recent events in Minnesota, Baton Rouge and Dallas, the topics of institutional racism and police brutality are again in the public consciousness. President Obama called these tragic events “not just a black issue, not just a Hispanic issue. This is an American issue that we all should care about.” I want to draw some parallels between law enforcement and the medical community.

In Medicine

I once had a mentor tell me (jokingly) regarding the USMLE Step 1 exam:

1. If the question involves a black man, then the answer must be sickle cell disease, HIV, or multiple myeloma.

2. If it’s a black woman? Then it must be sarcoid.

It turned out he was more right than I wanted him to be. We racially stereotype in medicine every day — it’s a part of our diagnostic problem solving. But we don’t think of it as institutional racism or racism at all. Why? Perhaps it’s because we believe it’s simply pattern recognition. Maybe it’s because we believe we don’t attach any social judgement to the pattern. But in reality, we do. If you encounter a young patient with infective endocarditis, try convincing me that you attach ZERO social judgement to that patient. In practice, institutional racism is ubiquitous in medicine. In fact, it’s often why “classic” cases are deemed “classic.”

In Law Enforcement

I want to preface this by saying I’m not defending the bad apples in law enforcement. Given the video footage, I don’t think there is any excuse for what happened in Minnesota and Baton Rouge. But as I wrote in my previous post Why Some Docs Do It For the Money — “almost nobody starts a career in medicine only for the paycheck.” I also believe the overwhelming majority of law enforcement officers did not go into law enforcement because it allows them an outlet to harass minorities. Just as we are taught to recognize patterns, they are as well. Well, not every patient follows the pattern, neither does every suspected criminal. The difference? When we make a mistake, our weapons are much less deadly.

The Solution

The solution is straight forward, yet extremely difficult at the same time. Think of the respected physician who seems to be able to nail every diagnosis. What’s different between the astute diagnostician and the average physician? They astute physician has a much better understanding of the patient. They invest time and energy into learning more about the patient, picking up on details others would have missed, finding patterns in clues that are barely legible to the rest of us. What am I getting at? Law enforcement officers need to become the astute diagnostician, they need to spend more time, more energy, be more open with the communities they police. Admittedly, it’s easier for a physician than a police officer as we usually aren’t worried that our patient may harm us.

The Challenge

Do you work with any members of minority groups, or simply a colleague with a cultural upbringing different from yours? I challenge you to reach out to that colleague, spend some time to find out the triumphs, and more importantly, the challenges that person faced up to this point in his/her life. Trust me, it will make you a better person.