key: cord-0776658-y9v277c3
authors: Kung, Alina
title: As Physicians, We Must Assert That Black Lives Matter
date: 2021-02-02
journal: Acad Med
DOI: 10.1097/acm.0000000000003950
sha: 0f82d02e0e0d569fd60745ea4cbc411839565935
doc_id: 776658
cord_uid: y9v277c3

nan

To the Editor: I rarely spent my days thinking about my "race. " Greeting my patients, I was generally more preoccupied with their medical cases than with what they thought seeing my dark hair and almond eyes.

But that has changed. COVID-19, sometimes misleadingly referred to as the "Chinese virus, " has exacerbated anti-Asian sentiment. My friends and family trade stories about being coughed at, spit on, or told to "go back to China. " For some, contemplating how our physical appearance may mark us as unsafe is disorienting and new. For my Black friends, this happens every day. But COVID-19 has amplified their racial experience in a different way. Nationally, Black Americans are dying of American Pacific Islander (AAPI) medical trainees work as part of the pandemic response, we have needed to guard against more than respiratory droplets. AAPI trainees have also been subjected to waves of COVID-19-related harassment and violence across the country.

AAPIs comprise 1 in 5 physicians, 1 in 10 nurse practitioners, and 1 in 10 registered nurses. 2 We are here to help. We are here to treat everyone-including those who denigrate us. This racial hostility, however, evokes familiar feelings of being other. Some of the charged remarks that resident physicians have received on duty include, "I don't want to see that Asian doctor!" "Go back to your country!" and "You people eat bats!" 3 Harassment of AAPIs will be a source of distress and burnout unless it is addressed at all levels, from the individual to institutional.

Trainees can reduce uncertainty about handling bigotry by using Paul-Emile's clinician-patient relationship model. 4 Though uncomfortable, debriefing with mentors and peers can be therapeutic and help trainees identify how to respond effectively. 5 Supervisors can find resources for supporting AAPI trainees at places such as the Massachusetts General Hospital Center for Cross-Cultural Student Emotional Wellness. Bystanders can speak up by using bystander intervention models. 6 Institutions can lead through proactive responses and policymaking. For example, when an anesthesiology resident in Boston was followed home by a man shouting racial epithets, the institutional response included phone calls from her program director, department chair, campus security, and counseling services, as well as a webinar and email sent to all community members. 2 These are some of the ways that institutions can support AAPI trainees who are being targeted during this time. 

To the Editor: As the COVID-19 pandemic unfolded in 2020, 2 trainees at Tulane University were threatened by a gunman who said, "If you are Chinese or Japanese, I'm going to kill you. " 1 The debriefing organized by our community, students and alumni of the Asian Pacific American Medical Student Association (APAMSA), was "Zoom-bombed" with anonymous racist messages. While Asian radio silence. I would walk down Broad Street in Philadelphia neurotically wondering if strangers crossed the street to avoid me. While I raged against external acts, I was confronted by my own internalized racism, which I thought I had pulled out by the roots nearly a decade ago. I began avoiding my favorite grocery stores in Chinatown.

When I finally got COVID-19, it felt like both a blessing and a curse. In the throes of my nonsensical fever-scrambled thoughts, I felt like I had fallen into a stereotype. I felt some secret shame that strangers had been justified in giving me the side eye.

Even though our implicit biases operate subconsciously, we can fight them through our actions. I am still struggling with the role of wet markets as a vector for zoonotic transmissions versus my knowledge of the wet markets that my grandmother in Wuhan depends on for her groceries. I am still vacillating between confusion about and agreement with former presidential candidate Andrew Yang's remarks that Asian Americans need to "out-American" other Americans to show that we are part of the cure. More than ever, COVID-19 has been a wake-up call for me and other Asian Americans to critically examine society and ourselves. Combating racism-both external and internal-is a journey rather than a destination.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Fourth-year medical student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; email: daisy.yan@students.jefferson.edu.

Doing the Daily, Deliberate Work of Addressing Systemic Racial Injustice in Health Care To the Editor: As a medical student, I cannot disconnect the tragedy of the COVID-19 pandemic from the tragedy of the racially motivated injustices and violence in the headlines over the last year. Both call us in medicine to examine our health care system as one that allots winners and losers so often separated along racial lines.

In the case of COVID-19, I see a supply problem-a system failing to justly meet the needs of a diverse population. No doubt, the virus has a disproportionately negative impact on people of color. Where I live in Washington, DC, Black people comprise 45% of the total population yet account for 59% of COVID-19-related deaths. 1 This disparity is not rooted in genetics but rather in the persistent shortcomings of our health care system. These shortcomings leave people of color disproportionately affected by diseases like hypertension and diabetes, which are associated with worse COVID-19 outcomes.

In the recent tragic acts of violence and discrimination against Black people, I see reflections of a demand problempopulations that have historically experienced unjust treatment by the medical system understandably have developed some distrust of that system. Just as incidents like the killing of George Floyd have left people of color less able to trust the criminal justice system, a history of unethical exploitation, like the Tuskegee syphilis study, has left people of color less likely to seek medical care and participate in research studies, which has further contributed to health disparities. 2 Medical school today thankfully emphasizes these systemic problems. But this focus during preclinical education can give way to other concerns on the COVID-19 at 2.4 times the rate of their White counterparts. 1 This is unjust, and it is not by accident.

The cause of excess deaths from COVID-19 among Black Americans is anti-Blackness. Anti-Blackness in our laws, policies, and practices limits access to quality food, education, housing, and health care. These disparities accumulate and lead to chronic stress, lung disease, diabetes, and high blood pressure. In addition, Black Americans comprise an outsized portion of our essential service, homeless, and incarcerated populations. Together the odds are stacked against Black communities. If you are Black and you get COVID-19, you are more likely to die. 2 The structural racism that permits anti-Asian hate and disproportionate Black deaths from COVID-19 is the same. It treats Asian Americans as perpetually foreign and Black lives as less valuable. It gives individuals permission to hurt others to preserve their own comfort rather than acknowledge our interdependence. Structural racism promotes assaulting people who appear Asian rather than holding our institutions accountable to a coordinated COVID-19 response. It asks whether Black Americans are more genetically susceptible to COVID-19 to deflect from unjust social systems that increase Black mortality.

No Americans should fear for their safety due to their "race" or ethnicity or fear for increased odds of death from COVID-19. To address structural racism, we in medicine must first recognize that our Black brothers and sisters are dying. As stewards of health, only when we assert that Black lives matter can there be hope that all lives will matter. busy wards. I can forget, for example, that a patient may view me-a White medical provider in a white coat-as someone who has benefited from White privilege in ways that words cannot appropriately convey, as someone unable to consider the history of systemic oppression that inherently colors our clinical encounter, as someone unwilling to call out the racially charged macro-and microaggressions that a person of color interacting with the medical system will experience.

The enduring lesson, then, must be to do the daily, deliberate work of addressing systemic racial injustice. My fellow trainees and I must remember that each clinical encounter exists in a context of historical and present-day systemic racial injustice, and only through the deliberate work of recognizing our privilege and biases and calling out unjust words and actions can we begin to chip away at the racial divide of our nation's health care disparities.

Funding/Support: None reported.

The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the US

COVID-19 and African Americans

Communities of color at higher risk for health and economic challenges due to COVID-19

19/issue-brief/ communities-of-color-at-higher-risk-forhealth-and-economic-challenges-due-tocovid-19

More than Tuskegee: Understanding mistrust about research participation

Acknowledgments: The author would like to thank the UNtraining community and Dr. Keith Norris for comments and suggested revisions. 

"I Can't Breathe"-COVID-19 Perspectives as a Black Trainee To the Editor: From my Chicago apartment, I listen to a young Black woman tearily exclaim over the phone,