I’m Not Going to Treat That White Guy’
There’s clearly a generation gap between these doctors on Zoom, the youngest of whom has been practicing for at least 10 years, and doctors just beginning their career. The older clinicians are more likely to appear politically neutral, at least at work, while younger students and clinicians are more likely to prioritize activism. Those differences can be a major source of tension.
One prominent organization, White Coats for Black Lives, was formed by medical students in 2014 and now has at least 75 chapters all over the U.S. In addition to publishing a
Racial Justice Report Card that grades medical schools, the group encourages medical students to make specific
demands of their institutions, including that medical schools and hospitals end all relationships with local law enforcement.
When asked what severing ties with police would do in his urban emergency room, one ER doctor said it would be a “total disaster.” Police, he told me, are a vital part of emergency operations, from securing crime scenes so emergency responders can see victims to helping transport patients to keeping hospital staff and patients safe when private security is inadequate.
“I was in a situation once where an ambulance brought in a gunshot victim,” he said. “We brought the patient in, and about 15 minutes later, a group came looking for him. They came to finish him. They were going from room to room, looking for him, and when a couple of guys from hospital security tried to get them to leave, one shot a gun in the air. Luckily enough, we heard police sirens bringing someone else in, and when they heard the sirens, they ran. If not for the police, I don’t know what would have happened.”
As another example of the generation gap, an ER doctor on the West Coast said he sees providers, particularly younger ones, applying antiracist principles in choosing how they allocate their time and which patients they choose to work with. “I've heard examples of Covid-19 cases in the emergency department where providers go, ‘I’m not going to go treat that white guy, I'm going to treat the person of color instead because whatever happened to the white guy, he probably deserves it.’”
Some in medicine would like to see such race-conscious bias mandated on an institutional level, particularly in regards to Covid-19, which has killed black, Hispanic, and Native American people at three times the rate as whites. These discrepancies are likely due to an array of factors, including income, housing, work, language, pre-existing conditions, access to health care, and, yes, possibly some degree of racism.
But some politicians and public health officials decided the remedy was to distribute vaccines by race.
In April, Vermont’s Republican Governor Phill Scott announced that any resident over age 16 who identified as a black, indigenous, or a person of color would be eligible for the vaccine before white people, a decision that, according to some legal scholars, likely violated federal law. The CDC itself
considered recommending that states prioritize essential workers over the elderly despite the fact that the number one risk factor for dying from Covid is age. The idea had plenty of supporters. Harold Schmidt, a professor of medical ethics and health policy at the University of Pennsylvania,
told the New York Times, “Older populations are whiter. Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”
Ultimately, the CDC did recommend prioritizing vaccines by age, but race-conscious policies go beyond Covid. In May, the
Boston Review published an editorial by physicians Bram Wispelwey and Michelle Morse entitled “An Antiracist Agenda for Medicine.” In it, the doctors argue that in order to address discrepancies in health-care access and outcomes, hospitals should commit to “preferentially admitting patients historically denied access to certain forms of medical care.” That is, they should admit people to health services based on their skin color.
This idea is not coming from people with no power.
Michelle Morse is a physician at Harvard Medical School and Brigham and Women’s Hospital. She was
recently appointed to be the first Chief Medical Officer of the New York City Department of Health and Mental Hygiene. “Dr. Morse’s experience has combined the best of public health, social medicine, anti-racism education, and activism,” said Health Commissioner Dr. Dave A. Chokshi in a
press release. “Health equity requires leaders who propel change and I am grateful that she has joined the Department to help us create a healthier, more equitable, city.”
In the same article in the
Boston Review, Dr. Morse and her co-author write that because a
study they conducted found that white heart failure patients are more likely to be referred to cardiology specialists than some minority groups, in their own practice they have developed “a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service.” So when these patients seek care, they are now far more likely to be referred to specialists and admitted to an inpatient service, regardless of whether that’s the most appropriate strategy for their condition, or their primary care providers’ recommendations, or their own personal preferences.
What the authors don’t mention is that while their own study does show that white heart failure patients are more likely to be referred to specialists, this alone doesn’t demonstrate they’re more likely to have better outcomes: More whites in that very study died soon after discharge. This, according to one physician, is exactly what’s wrong with race-conscious policies.
“We have been working for almost a decade now to keep people from getting unnecessary care and unnecessary hospitalization because there are all these unintended consequences,” he said. “You can get infected with an antibiotic-resistant bug; you can get the wrong medication; errors happen. We’re trying to keep people out of the hospital if they don't need to be there. So when you enact a policy like the one proposed by Michelle Morse, you’re just opening that person up to all these potentially negative consequences.”
In other words, in an effort to address racial disparities, it’s possible the very patients they are attempting to help will suffer more, not less.
Whole areas of research are off-limits. Top physicians treat patients based on their race. An ideological 'purge' is underway in American medicine.
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