Two physician leaders at Brigham and Women’s Hospital in Boston have authored an op-ed that was published on July 16 online in The New England Journal of Medicine, calling for the leaders of academic medical centers nationwide to address racial justice in the current moment in United States history.
Michelle Morse, M.D., M.P.H. and Joseph Loscalzo, M.D., Ph.D., M.A., have authored the Perspective article, entitled “Creating Real Change at Academic Medical Centers—How Social Movements Can Be Timely Catalysts.” Dr. Morse is an associate physician in the Division of Global Health Equity, and is assistant program director for the Internal Medicine Residency Program at Brigham and Women’s Hospital. Dr. Loscalzo is Hersey professor of the theory and practice of medicine at Harvard Medical School, chairman f the Department of Medicine, and physician-in-chief, at Brigham and Women’s Hospital.
Drs. Morse and Loscalzo being their op-ed by stating that, “The deaths of Alton Sterling and Philando Castile in July 2016 reverberated throughout the Brigham and Women’s Hospital (BWH) Department of Medicine, destabilizing daily routines in the new academic year. Momentum for change had been building since the Black Lives Matter movement burst onto national headlines in 2013. Our internal medicine residents enjoined us as a department and an institution to reinvigorate the long but essential process of recognizing racism within our environment and acting to address it,” the doctors note. “They declared that the issues that the Black Lives Matter movement was making visible weren’t external to or separate from our experiences at an academic medical center. Structural racism, discriminatory policing, and criminalization of black people affect health care. These long-standing issues reflect the living legacy of our country’s history of racial discrimination and its many tragic consequences, including genocide of Native American people, slavery, Jim Crow laws, and eugenics. The question posed was simple: ‘What are we going to do?’”
To put this into context, Morse and Loscalzo note that “Leading with action on issues of health justice has been a long-standing challenge for health professionals, who are often more comfortable with descriptive research as the main focus of intervention. In our department, the Black Lives Matter movement created a window of opportunity for open critique of current inequities in health care practices and direct conversations about structural racism. Residents and faculty called for hospital-wide communications clearly stating our values, mandatory training on implicit bias for all hospital staff and faculty, visible solidarity with immigrant patients and staff, a more welcoming environment for all patients and employees, and commitments to racial, ethnic, gender, and other forms of diversity. Calls for platforms to convene and coordinate efforts throughout the institution were met with action by hospital and department leaders who recognized the need for change,” they add. “Health equity and social justice committees at several institutional levels were reborn with the support of key hospital leaders. Some of these groups had been previously convened during times of social change but disbanded when fervor faded.”
Describing the journey that they and their colleagues have been on together at Brigham and Women’s, the doctors state that, “The learning and knowledge generation that take place at academic medical centers have generally not been extended to include issues of racism and racial inequity. To address this shortcoming, the SJPHC created a program called Adaptive Leaders for Racial Justice, which seeks to prepare clinicians to challenge the dominant beliefs about causes of and solutions to racial inequities in health. Several faculty members and residents on our health equity committee participated in this program and became leading voices for racial justice as well as formal and informal teachers on these issues.”
And, though pushing ahead to identify and address systemic racism, Morse and Loscalzo share their perspective that “Physicians must engage with social movements if we expect to contribute meaningfully to improving health by addressing its social and structural determinants. We should proceed with caution, however, since our profession hasn’t always been supportive of social movements, as illustrated by the history of the American Medical Association and the civil rights movement.”
What’s more, they state, “In fact, our clinical training has the potential to create a mindset that directly conflicts with the visions espoused by social movements. Clinical training creates a mindset of urgency; a focus on short-term goals and on fixing and curing; an expert identity, sometimes with distaste for being challenged; and risk aversion. These attributes are, for the most part, necessary and desirable in clinicians, but they can be counterproductive in the context of social movements. The social transformation that movements seek requires long-term vision, building power for enacting change over time rather than implementing rapid solutions, humility, a willingness to take chances despite uncertainty, and a learning mindset.”
And, despite the challenges, they assert that “Our experience shows that institutional change in health care is possible. We are moving toward becoming an antiracist institution; however, it’s easy to lose momentum as attention and headlines shift to other urgent issues. Such loss of momentum most likely led to the withering of prior institutional efforts related to racial equity. Capitalizing on the urgency generated by the Black Lives Matter movement was a powerful strategy through which to align interests and focus attention at a large, often slow-to-change institution. Sadly, the recent murder of George Floyd has demonstrated the persistence of structural racism.”
