Leveling the Field for All Patients

To combat bias, doctors need to understand where patients are coming from, physician and author John Rich told Tufts medical students.

John Rich speaking at Tufts

At a time when homicide is the leading cause of death for African American men between the ages of fifteen and thirty-four, doctors, social workers, and other health-care professionals are seeking ways to stem the violence, said John Rich, a physician and professor at Drexel University School of Public Health.

“If you follow those who have been shot or stabbed, five years later 45 percent of them will have been shot or stabbed again, and 20 percent will be dead. It’s unacceptable to do nothing, knowing those rates of morbidity and mortality,” Rich told Tufts School of Medicine students at an October 22 talk about his book Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men, which was the Common Reading Book Program selection for all incoming medical students this fall (the initiative is supported by Jonathan M. Tisch College of Civic Life).

But quick fixes can do more harm than good, said Rich’s friend and colleague, Roy Martin, who also addressed students. One of the subjects of Wrong Place, Wrong Time, Martin grew up in the Boston area immersed in violence, but meeting and working with Rich changed the course of his life. Today he mentors and supports troubled youth as a case management director at the Safe and Successful Youth Initiative in Massachusetts.

“We make mistakes when we decide the score of the game before we play it,” said Martin. “You may find that what you’re offering is not broad enough, and that predicting what works for everybody is almost as responsible for the failures as anything else.”

“We just need to let people find their place and accept that’s where they want to be and that’s good enough,” Roy Martin said. Photo: Alonso Nichols “We just need to let people find their place and accept that’s where they want to be and that’s good enough,” Roy Martin said. Photo: Alonso Nichols
What should practitioners do instead? In dialogue with each other and with students, Rich and Martin shared their personal and professional experience with racism, violence, trauma, and offered the audience some concrete ways to understand and support victims—both as future physicians, and as human beings.

Notice unconscious bias. “As you train, keep an eye out and watch carefully what happens to patients. See how differently patients get treated,” said Rich, who first decided to write Wrong Place, Wrong Time, which was published in 2008, after observing these discrepancies on the job.

Black patients often get denied pain medication or are treated as though they deserve what happened to them, Martin added—and there isn’t enough recognition that perpetrators of violence can be victims, too. “If you don’t feel you can be other things, that’s the one thing you can be: violent,” Martin said. “For some people, if they feel the rest has been taken from them, that option tends to feel a bit more available and palatable.”

Choose your battles when speaking up about disparities. “In medicine, we can be very polite about how we talk about stuff—there’s no right, no wrong, it’s very nuanced. It’s kind of a club we’re in where it’s very difficult to tell [other health care professionals], ‘What you’re doing is wrong,’” said Rich, who previously served as the medical director of the Boston Public Health Commission and created the Young Men’s Health Clinic as a primary-care doctor at Boston Medical Center, recalling some painful past conflicts. It’s especially tricky because calling attention to unfair treatment can impact your career, he said.

“It’s a challenge for med students early on, because they don’t feel empowered to speak about [disparity in treatment],” he said. “You have to be creative: What are your opportunities to identify bias in the system and to affirm what you know, because studies show disparities in the health system?”

See the whole person. Rich cited his early encounters with Martin, which were driven by mutual curiosity and recognition of each other’s humanity. “We have to engage people as human beings without judgment or prescription,” Rich said. “The people closest to the problem are the people who are closest to the solution.”

For his part, Martin reflected on a client at the Safe and Successful Initiative who wanted a job where he wouldn’t have to work with people—a job Martin didn’t think would be easy to find. But the client ultimately ended up working at the Franklin Park Zoo. “We just need to let people find their place and accept that’s where they want to be and that’s good enough,” Martin said.

Be or suggest good role models. Responding to a question about rap music, Martin said black youth are often drawn to violence because rappers and drug dealers are their best models of wealth, power, and success. Growing up, he didn’t have any role models who attained status through education—and then he met Rich.

“I’m like, well, damn,” Martin said. “You just threw another possibility in for consideration.” Rich was living proof that there was a way of making it where no one ended up shot, stabbed, addicted to substances, or in jail, Martin said—he didn’t hurt people, he helped them.  “What we must do is show folks with swagger who are not rappers,” he said.

Monica Jimenez can be reached at monica.jimenez@tufts.edu.

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