Northam’s Photo: How Physicians Respond Will Have Consequences

You have probably seen it—Virginia Governor Ralph Northam’s yearbook page featuring a photograph of a person in blackface and another in Ku Klux Klan garb. There has been much political debate about of whether Northam should resign. As a physician, I have been concerned about a different issue: how my profession’s response to Northam’s photo will set the tone for combatting broader, everyday issues of bias in medicine.

This ethical concern has become more acute amid revelations that Northam’s photo is only one of many ill-considered, distasteful, and racist images to appear in his school’s yearbook. In this pattern, a narrative of tacitly accepted racism seems to emerge. This narrative further damages the already strained relationships between medicine and some minority communities.

As physicians, we enter the practice of medicine in awe of the unique trust our patients afford us, often in times of great need and vulnerability. Most of us are also aware of our profession’s past transgressions when it comes to race, which cultivated disparities that stubbornly persist. To earn our patients’ trust, we must remember this history and work to ensure that similar biases and discrimination do not continue.

The American College of Physicians (ACP) takes this role of self-regulation seriously, recently publishing its seventh edition of the Ethics Manual (1). The Manual reminds us that making our health care system more just is a core responsibility of physicians and states that we must “use [our] position for the benefit of patients.” Further, it explains that “disparities in care as a result of personal characteristics such as race and gender must be addressed.” If action is a responsibility, silence is not an option. This call to action is based on an already 9-year-old policy statement from the ACP on racial and ethnic disparities in health care that cautions that “preconceived perceptions of minority patients may play a role in their treatment and contribute to disparities in health care” (2).  The policy also affirmed the importance of delivering high-quality care to “all patients, regardless of race, ethnic origin, gender, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion.”

While our profession is making strides toward this goal—with an increasingly diverse workforce and requirements for medical schools to address cultural competency—there are still many injustices to address. Unfortunately, Northam’s yearbook photo is just the tip of the iceberg.

In decades past, racism in medicine was dishearteningly overt. The U.S. Public Health Service’s study of untreated syphilis, in which antibiotic treatment was withheld from 400 black men without consent, is a striking example of such (3).  These actions—now universally repudiated—understandably bred distrust among some Americans. While such blatant racism has thankfully become less prevalent, our profession has only just begun to understand and confront a subtler form of discrimination known as implicit bias: the harboring of negative attitudes toward certain groups of people (4).These feelings, while potentially subconscious, beget real actions that exact a daily toll on some patients and clinicians.

Tackling decades-old patterns of racism and inequity in medicine can seem daunting. Sometimes, it’s hard to know where to begin. Today, however, the way forward seems clear. I suggest that we start by being ashamed. Let’s rally together as a profession to make it clear that physicians are responsible for the content they share and the harms it may cause. Let’s be clear that there’s no place in medicine for Klan hoods and blackface. And let’s do this now—before yesterday’s yearbook page becomes tomorrow’s Facebook page. If we do not, our promises to address more quotidian forms of racism will seem empty.

References

1. Sulmasy LS, Bledsoe TA; ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians ethics manual. Seventh edition. Ann Intern Med. 2019;170:S1-S32. [PMID: 30641552] doi:10.7326/M18-2160
2. Groman R, Ginsburg J; American College of Physicians. Racial and ethnic disparities in health care: a position paper of the American College of Physicians. Ann Intern Med. 2004;141:226-32. [PMID: 15289223]
3. Centers for Disease Control and Prevention. U.S. Public Health Service Syphilis Study at Tuskegee. Accessed at www.cdc.gov/tuskegee/index.html on 5 February 2019.
4. Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105:e60-76. [PMID: 26469668] doi:10.2105/AJPH.2015.302903