As an African-American physician who has experienced the effects of racism, I should be comfortable talking about it. I’m not — but I need to be.

That feeling was reinforced by a horrifying news story from the New Hampshire community where I work as a pediatrician. The mother of an 8-year-old biracial boy said he had nearly been lynched by some white teenagers. The image his mother posted on social media before driving him to the hospital where I work showed rope burns on his neck consistent with being hung.

I can’t help but think about how I would have responded to the boy and his family had I been his pediatrician.

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Racism, racist, and related “R” words have become a trigger for many in our society — one that can quickly end conversations. I vividly recall a visit with an adorable 3-year-old, during which her mother mentioned that her ex-husband (the patient’s father) was “extremely racist.” The instant she said that, I wanted to move the conversation in a different direction.

But I didn’t. The mother had begun a healthy relationship with a partner from the Dominican Republic and was expecting her second child. After her ex-husband had learned about the new partner, he started making racist comments about him to their daughter. The mother was visibly upset as she spoke about her daughter’s changes in behavior and attitude towards her partner and she worried about introducing a biracial sibling in this setting. The mother ended with a tinge of hopefulness, saying, “I’m glad you’re her doctor. Hopefully she’ll realize that the things her dad says aren’t true.”

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Physicians are charged with understanding their patients’ lives while providing medical care. With the increased presence of racial violence and discourse in the news and social media, this includes understanding how race and racism affect their patients.

Specialists have long studied the development of categorization during childhood for decades. Categorization is a thought process that helps people make sense of complex environments by putting things in groups. The visibility and social importance of race makes it a key factor for categorization and can lead to stereotyping and bias. While we don’t know the exact point in infancy that biases begin, categorizations and judgments based on facial characteristics and skin tones are robust by age 3 and reach full adult level by age 5 or 6. Although the skill of categorization is a necessary milestone for learning how to interact with the world, it can lead to negative stereotypes if children aren’t exposed to varied and diverse experiences.

Last summer, Dr. Benard P. Dreyer, now the immediate past president of the American Academy of Pediatrics, charged the pediatrics community to take an active role in confronting the epidemic of “intolerance in the lives of children, adolescents, young adults, and their families,” which continues to spread across the country. The academy’s Bright Futures Guidelines recommend that pediatricians address discrimination, prejudice, and lack of cultural opportunities at various stages throughout childhood. It will take much more than the concerted effort of dedicated pediatricians to tackle this problem — but that’s a good start.

Talking about racism and bias isn’t easy. Additional research, training, faculty development, and patient education materials are needed to help prepare all of us to talk about these issues. As I reflect upon the many things that I never learned in medical school and residency, race and racism now join the list.

In daily practice, it might work like this: My colleagues and I often give our patients (and their parents) guidance on the normalcy of genital exploration. In a similar way, we could — and should — take advantage of the teachable moments that arise when our patients mention differences in skin color, heritage, or abilities.

The pediatrician of the 8-year-old New Hampshire boy and his family have an opportunity to build up his cultural awareness and talk about racism. His pediatrician might say, “Tell me about your cultural identity. What opportunities have you had to explore this community?” This story also affords the opportunity to discuss bullying and, more specifically, racial bullying. Likewise, the pediatricians for the teenagers who allegedly injured him have an opportunity to encourage the families to engage in more diverse experiences. This will require some empathy and validation. In a state like New Hampshire, which is not diverse, it takes more effort to engage in cultural opportunities. But there are always options. Just as we work with families as they deal with defiant behaviors or academic concerns, pediatricians should be willing to help parents work through issues of diversity and racism.

In the words of Ruby Bridges, the first African-American child to attend an all-white public elementary school in the South, “Racism is a grown-up disease and we must stop using our children to spread it.”

Pediatricians can — and must — initiate, engage, and continue conversations about racism. To be sure, there will never be enough time to discuss all that we could or should address. But since our profession believes strongly in prevention and early intervention, we must talk about racism just as we do about vaccination, exercise, and healthy eating.

Stephanie White, M.D., is an assistant professor of pediatrics at Childrens Hospital at Dartmouth-Hitchcock, the diversity liaison for student/resident advising at the Geisel School of Medicine, and a Public Voices Fellow with the OpEd Project. The views expressed here are hers and do not necessarily reflect those of affiliated institutions.

  • Sorry, still not convinced. BTW, I also refuse to ask anyone if they have a gun in the house. Although a major health hazard in Chicago, I’m told. However, I do see the health effects of single parents; great grandmothers in their early 50s. The effects of wannabe “ganstas” and glorified “hos”. Unfortunately, in both black and white families.

  • I just wasted my time on an opinion piece from a Harvard educated Marxist that speaks in parables to get her “theoretic framework for understanding racism”, to the uneducated “oppressed” masses. Validating victimhood, in my opinion. Redistribution of fertilizer and the fundamental destruction of the, again, ignorant gardener. “Top to bottom. Bottom up and inside out”. Saul Alinsky must be proud. Don’t be useful idiot, please.

    • I think the article is taking blame from racism and pointing at the government. We know that the policies were meant to help but rather created a system dependence. So now you want people with little to pick themselves up by the bootstrap when they have none.r The affairs during slavery purposely created an uneven playing field to start with and black families had to stick together. Now we have structural instutional and personally mediated racism driving the issue. Article in AJPH: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.8.1212

  • “Racism impacts health….”, comma, semicolon and question mark. Countless of individuals of all races have been confronted by racism but have lived long healthy lives. ( Ms burnside might know them as uncle toms) I say it’s the “victimhood” attitude thats taught by irresponsible parents, by word and example, as an excuse for their failing their kids, that is the culprit. A form of child abuse, in my opinion. You still want me to bring up racism

    • Nope. Dont consider them uncle toms? In fact even when controlled for and matched based on SES, etc “healthy” outcomes are different which is consistent with racial disparities. In your example are you speaking to a 10 year old or 18 year old. Conversation would be different. Do you ask your patients if they have ever been in trouble with the police or followed in a store ? Cause it comes up when I am speaking with my patients.So when its appropriate those conversatioms occur. And yes many black ppl live healthy lives and what are the markers for that. Lets talk evidence basedmedicine. Are you familiar with this study? http://www.nejm.org/doi/full/10.1056/NEJM200105103441906. Either way outcomes are different and in general the research shows we still have a shorter life span across various health outcomes. Theres a reason medical schools are incorporating cultural humility/competency aspects in training. Racism is at the root of some of these courses.

    • No I don’t. He has facts to back it up. Just because someone comes up with a different and very plausible theory you and others may disagree with doesn’t mean someone is an Uncle Tom or the theory is wrong or partially right/wrong. I also suggest you learn about Josiah Henson, the “Uncle Tom”. He was an extremely honorable man. ” I regard Josiah Henson in many respects as a remarkable man. When I contemplate his unselfish efforts (at great risk to himself) to rescue his brethren in slavery, after he had obtained his own liberty, and his labours as a free man to educate and enlighten them, I consider that there are few men now living who have done so much for the negro race. When it is remembered, too, that he was a slave for forty-two years, his life affords an encouraging example of what may be done, even by one who has laboured under the greatest disadvantages, who is earnestly desirous to benefit his race. His Christian simplicity, and the absence of all bitter feeling towards those who have oppressed him, will have commended him to all who have made his acquaintance.”

      No I don’t ask people that. Again, move it to social workers or that like, not MD’s. Maybe we’re trained to fix broken bones, not social ills. Its no wonder no one wants to be a doctor when everyones’ social justice problem is they take to fix.

      Maybe you can explain where you were when on my own time, for the past couple of years, I’ve tried to get state senators/delegates to actually do something for healthcare racial inequality. Amazing how people just want to complain on all the ills, but when it comes to spending legitimate time with elected reps, no one is around. That includes includes reps of color and without.

      By the way, for years, the African American community in the 1865’s and up to civil rights time, did an outstanding job of trying to cope with a lot less opportunities that people have now.

    • You do not need to be convinced. I’m just expressing a viewpoint. We disagree and have different mindset . That’s okay. Just like when I speak 2 cardiologists (night vs day on call physician) when consulting on inpatient and Im presented with different next steps. You seem disgruntled and can keep the name calling to a minimum . It’s just debate.

    • Thanks for speaking to your senators. CBOs Myself and colleagues have been doing the same across our NIMHD Centers of Excellence for several years. Organizing and participating with many community boards and organizations. #BlackLivesMatter

  • Thanks so much for this excellent article. Racism impacts health. PERIOD. You cannot fix every medical problem without addressing the social context of the illness and disease often rooted in racism and many other “-isms.You would just be placing a band aid on a non-healing ulcer. Its okay to at least START the conversation. You can refer based on your level of comfort but at least acknowledge the issue at hand.

  • What kind of brain damage is this? Seriously, doctors have no time already, pushed to limits, and trying to solve medical problems, and now we’re dragging this into it? Are they getting paid for it (CPT codes)? No!

    There is way way too much “stuff” going into doctors’ time. When they have 10 min a patient, putting this waste in there doesn’t help. Doctors need to shuttle this off to social workers. Fix the physical/medical problems only. Don’t throw another time waster on top of that. Doctors fix *medical problems*, that’s what they’ve been trained to do, not social problems.

    Its no wonder docs have problems like burnout.

    • I’d like to respectfully disagree. Racism, and it’s detrimental effects on health, is a medical issue. There is a clear biological link between repeated exposure to racism and increased long term cortisol levels that can lead to negative health outcomes. From this perspective, racism CAN physically hurt a child over their lifetime, and should therefore be discussed to mitigate its ill effects.

    • and I respectfully disagree it is a problem peds has to deal with. In 10 min or 15 at the absolute rare most, when we’re having to argue over getting a child vaccinations, bone breaks, food problems, etc. something has to absolutely give. Unless we’re a psychologist or psychiatrist, peds has to stick to some items and social/home issues aren’t one of them. This means social workers or psychs to deal with them. They are trained to deal with that, regular peds can’t spend time doing that. We need to look at teeth issues, obesity issues, vaccines, etc. and parents bring us bone toe issues, etc. That is what peds are trained to do. Racism is not a part of that. It would be sending them off to those who can deal with it.

      I highly suggest you peruse the items that are required for *medical* and strictly medical purposes that peds needs to cover. Any physical problems caused by that, needing medication, goes to child psych’s. That is what they are trained to do. The reason why people complain about general medicine and no one wants to go into it is because no other specialty gets handed off with so much that is not in our “list”. That is why I said, go over medically what peds has to deal with in medicine. Vaccines and that argument is one thing. Teeth issues and going to dentists. Racism needs to be put upon those who are trained to do it and have the time and reimbursement to do so.

  • Cultural Marxism, like a virus will attempt to spread itself by any means. To me racism is a fact of human nature. I grew up in NYC during the 50s and 60s. Racism is far, far better, I would venture to say almost extinct. Until Comrade Barry. I’m not a pediatrician but if anyone attempted to talk to my under age child about it I would be very upset. Physicians need to be objective in every aspect of care and no care should be tainted by our prejudices. To recognize a problem when it exists as It did anecdotally in those cases is probably good. But to search and validateThe vast majority of today’s youth is color blind. Until comrade Barry came along and needed some useful idiots.

  • I appreciate the effort to open the conversation, but how does one say it in a way a young child will understand? I’m not sure these are the words (“Tell me about your cultural identity. What opportunities have you had to explore this community?”) that open up a conversation with an 8-year old.

  • Well said!
    “If we cannot end now our differences, at least we can help make the world safe for diversity …”
    — John F. Kennedy, 35th US President

    • “Sticks and stones may break my bones but words will never hurt me…,”
      My mother and father, 1951

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