We Have to Do Something to Level the Playing Field

What your doctor reads on Medscape.com:

As told to Usha Lee McFarling

July 14, 2020 – I was told that the operating room had already been cleaned. Be asked by patients about where you went to medical school. You will be asked to show proof of identity each time you enter your own hospital. You are told that you don’t look like a doctor. In a series of conversations with Medscape, black doctors talk about the racism they have faced in their training and clinical work, the change they would like to see and how they are coping during this time of pandemic and racial upheaval.

When I went to school, I thought, “I’m leaving Mississippi. I know there’s racism here. But in Pennsylvania, it’s the north and it’s going to be fine.” But you see the same racism – maybe not the same degree, but you see it. I still remember very well an evening when I was in a summer research program and I was walking with my roommate, who was also African American. People in a van drove past us, shouted a racial epithet, and said, “Open your eyes so that we can see you.” My roommate was ready to chase them, but I said, “No. We are walking and we have nothing, and they are in a truck and we don’t know what they have. We have more to lose than to win, so give up. “You have to control your anger.

In residency, when I was training in cardiology, I went out to do a stress test or an echo and I introduced myself as Dr. Lewis, one of the fellows. I was asked repeatedly, “Where did you go to medical school?”, And I didn’t think about it much. I guess I was pretty naive. But when I asked my fellow students if they were bothered by the people who were still asking where they had gone to medical school, they said, “We are never asked.” It was then that I realized that people only asked me because I was black. I was thinking, here I am, of a cardiology fellow at one of the best programs in the country, at Harvard Medical School, and the patients are checking my references.

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There have been times when I have been paginated for a consultation for a patient who was not doing well, and I come in with my white coat, with my stethoscope, with my name tag, with everything, and the surgeons look and say, “We don’t need transportation, we’re waiting for cardiology.” And I will say, “You have it.” Their faces turn red and they apologize, and I usually say, “It’s okay, let’s focus on this patient.” Every part of the hospital, every job is really important, and we all work together, but it’s frustrating when you work so hard for so long – 4 years of college, 4 years of medical school and 7 years of training. – and you get confused for transportation.

What made me realize – and I told my colleagues – was that I could easily have been George Floyd. Because if I get arrested, they’ll treat me like all other black people. I always drive with my hospital card in the car. I always keep my hands in plain sight. I have this level of anxiety every time I get behind the wheel of my car.

Even though I was a promotion major in my high school, not a single advisor told me that I should apply to Harvard or Yale or Princeton or Cornell. They didn’t give me any advice. I had no idea. Don’t get me wrong, I’m excited to be a Penn State alumna, which has prepared me well for my career; however, I had no help with this decision either. For me, it is important to guide the students. We have to do something to level the playing field. If you look at the best cardiology programs, there are only three black heads of cardiovascular medicine. So I’m delighted to be the new chief of cardiovascular medicine at Stanford. I hope that by being here and doing a good job, others will say, “I can do that too.” I don’t compare myself to Barack Obama at all, but it’s like seeing how black children can now say that I can also be president. It doesn’t have to be a white man.

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One thing that is difficult for me, for many reasons, is the poor results we see in so many black cardiology patients. I lost a family member at an early age due to a heart attack. He lived in a small town in Mississippi. He had a heart attack at the typical time you have a heart attack, at 1 a.m. He then sat there in a small community hospital for 6 hours without receiving treatment and without being transferred to a larger hospital where he could get the treatment he needed. The rationale was that the ambulance drivers needed to sleep. By the time they called an ambulance, the heart had been damaged. A simple heart attack that could have been corrected led to his death, all because of lack of access to care. He was in his forties.

My question, all these years later, is to ask, if he had been mayor of the city, if he had been a man of choice, if he had owned a business, would they have waited until in the morning to transport it? I think we all know the answer. When they finally treated him, he had a lot of complications. Subsequently, we discovered that not only did they tear his artery without realizing it, but they didn’t even open his stent completely.

The Mississippi cardiologist had the same tests as us, he had the same training, so my question is: why are there more complications in black patients? Are our arteries different or is the quality received from the doctor different? What I’m wondering is if this doctor cared enough to save his life. There are many times when we have to look in the mirror as doctors and say: do we care enough? Are we ready to carpet to save this life? It can make all the difference. The decision we make can mean years of life for a patient, decades of life, chances of quitting smoking, chances of losing weight, and chances of seeing grandchildren grow up.

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Eldrin F. Lewis MD, MPH, was born in the Mississippi Delta and attended a high school that did not hold a prom until 1987. His history book had a Confederate flag on its cover. Lewis’ father, a plant pathologist, was a medical doctor and the first black director of research in the United States Department of Agriculture. Her mother was an elementary school teacher. Valedictorian from his high school, Lewis chose to go to Penn State University because his family had recently moved to Pennsylvania. He then attended the Perelman School of Medicine at the University of Pennsylvania, received an MPH from the Harvard School of Public Health, and trained at Brigham and Women’s Hospital, where he worked and taught for more than two decades. In March, Lewis was appointed chief of cardiovascular medicine at Stanford University.

Usha Lee McFarling is an American science journalist who has written for the Los Angeles Times, Boston Globe, STAT News, and the Knight ridder Washington office. In 2007, she won a Pulitzer Prize for the explanatory report. Follow her on Twitter @ushamcfarling.

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