The woman lay in the emergency department, in terrible pain from a tear in her stomach.
She needed surgery to save her life.
But when the trauma surgeon introduced himself and explained the operation, she looked up and said, “I don’t really want a Black doctor. Is there anyone else?”
He calmly replied: “Ma’am, I am the only surgeon on call. There is no such thing as a second opinion tonight,” he said. “I am happy to save your life, but it’s your choice.”
A half-hour later, the woman sent word that she wanted Dr. Gibson to perform the surgery.
Racism in health care doesn’t always rear its head in such an obvious way. Sometimes, it comes in the form of dismissive attitudes and skeptical questions directed at Black physicians, nurses and other members of the care team.
A Black doctor discusses a medical concern with a patient, only to be asked when the “real doctor” will get there.
A Black nurse arrives in a patient’s room and is expected to empty the waste basket or deliver food.
Often, racism comes from colleagues in inappropriate or disrespectful comments and actions—such as skeptical questions about their medical judgment or an insult about a natural hairstyle.
“I think the biggest thing for me is the microagressions—when there’s a clear sense that people don’t think you belong or you got to your position because of favoritism or that you are underqualified for your position,” said Lisa Lowery, MD. A pediatrician who specializes in adolescent medicine, she also serves as assistant dean for diversity at the Michigan State University College of Human Medicine.
Racism reverberates throughout the community, dogging the footsteps of Black medical professionals as they shop, drive, play and simply go about their daily lives.
“There’s this stress that we carry with us as we navigate our lives,” Dr. Lowery said. “When people subtly or not-so-subtly make you feel ‘less than,’ that’s an extra burden that we deal with.”
They learn to compartmentalize their feelings at work, so they can focus on their mission—caring for patients.
When Dr. Gibson performed surgery on the woman who didn’t want a Black doctor, he gave her the best care possible.
“I don’t judge people based on their beliefs,” he said. “If you come in to the hospital, I will give you the same care that I would give to my own mother, because that’s the oath I took—to take care of all my patients the same way.”
“We’re always going to do what’s right for our patients,” Dr. Lowery agreed. “That’s why we do what we do.”
But encounters with racism—the overt and the subtle—take a physical and emotional toll on Black health care professionals. After devoting years to education and developing their skills, dedicating their lives to saving lives, they can be dismissed at a glance because of the color of their skin.
The impact is felt especially keenly these days. As they battle on the front lines against the COVID-19 pandemic, the video of George Floyd dying beneath the knee of a police officer provides a painful reminder of racial inequality and injustice in America.
You do feel you have to work a little bit harder.
Kandace Ward, a physician assistant, feels a painful disconnect from her white colleagues each time she returns to work emotionally devastated by the release of a video showing the violent and unjust death of a Black person, like Floyd.
“Everyone else is in the hallway, merrily asking me, ‘Hey, Kandace, how are you doing?’ And I am hurting on the inside because I just saw another reflection of the systemic oppression of people who look like me.”
But she recalled lessons learned from her grandparents—talk of racism makes others uncomfortable.
In the past, she said, “I put on my big-girl pants and smiled. I was not being honest about how truly and repetitively heartbroken I was.”
The disease of systemic racism has festered for a long time, and no one is suggesting a quick cure. But a treatment plan must come from all quarters of society, including those who are white.
“We can’t solve inequity if we only call to the table the people who are experiencing inequity,” Kenyatta Curry said. “If we want to get this done, we need all hands on deck.”
In her 23 years as a registered nurse, Curry often is the only person of color on a medical team.
“You do feel you have to work a little bit harder,” she said. “Because you often feel like a sore thumb.”
Curry’s sense of mission helps her cope with racism on the job. Along with dispensing compassion and medical care, she hopes to bridge the racial divide and defeat harmful stereotypes.
“When you see nurses who look a little bit different than you, it’s OK,” Curry said. “Because we care. That’s why we are here. We want to try and save the day for everyone.”
Supportive co-workers can make a world of difference, she said.
That’s the case in her current position, in the Spectrum Health Limb Care and Wound Healing Clinic.
“I work with a phenomenal team. When those issues come up, whether it’s racism or sexism, we are not going to sweep it under the rug,” she said. “We are going to talk about the big elephant in the room, and we are going to deal with it before it grows out of control.”
Erica Michiels, MD, a white physician, compares issues with racism to violence against women. Women can’t change cultural standards for men’s behavior on their own.
“It takes men and women together to solve the problem,” she said.
Likewise, to right the wrongs of racism, “white people have to be part of the solution,” said Dr. Michiels, an emergency medicine specialist at Spectrum Health Helen DeVos Children’s Hospital.
“How can we say to people who have been treated inequitably for hundreds of years, ‘OK, now this is your problem. You have to solve it’? We have to get everyone to the table to solve this problem.”
Nastaciea Robert, Spectrum Health’s director of contact center services, recalls an uncomfortable encounter with a white co-worker.
When Robert wore a new dress one day, the other woman complimented her enthusiastically. But she quickly added an insult—making it clear that while she liked the dress, she did not approve of Robert’s natural hairstyle.
Robert responded with education, explaining to the woman the cultural importance of hair in the Black and brown community.
But she added, “It was pretty traumatic at first. It really felt like she was trying to suppress my identity.”
When situations like that occur, allies can help by speaking out, she said, so a person of color does not have to take a stand alone.
“What would be extremely helpful is really being courageous. Speak the unpopular truth. Stand against it,” she said. “If it’s in your gut and you know it doesn’t feel right, it doesn’t sound right, even if it doesn’t look right, it’s likely not right.”
But such open discussions about race and racism make many white people uncomfortable.
An awkward conversation
Kendall Hamilton, MD, waited for his 2 p.m. appointment, a man with a bad knee injury. From his notes, he knew the man would need surgery and pain medication.
When 20 minutes passed and the patient still hadn’t arrived, he asked the athletic trainers in the office if the appointment had been canceled.
They just said, “Don’t worry about it,” Dr. Hamilton recalled.
But he did worry. He felt a responsibility to make sure his patient received help in a timely manner.
After some back-and-forth questions and vague answers, Dr. Hamilton learned what happened. When the patient arrived at the office, he looked at an informational card about Dr. Hamilton, which included his background and a photo.
He told the athletic trainer: “I’m sorry. I’m a racist. I will not see a Black doctor.”
The trainer explained that Dr. Hamilton is a highly qualified surgeon trained in orthopedic sports medicine. His resume includes work as a team physician for the Houston Astros and NASA. He performs about 600 surgeries a year.
Still, the man refused to see him, wanting to instead wait to see one of his white colleagues.
Dr. Hamilton believes his team tried to shield him from the patient’s racist attitude because they didn’t want to hurt his feelings. And they felt uncomfortable talking about it.
“They had never seen racism happen like that,” he said.
But brushing the issue aside only allows racism to go unchallenged.
He told the team members: “We are not going to accept discrimination. We are not going to accept prejudice in any of its forms.”
Will we ever get rid of racism? No, we are human. But we can make this a more welcoming society.
Dr. Hamilton contacted Spectrum Health leadership and legal experts to clarify Spectrum Health’s policy protecting employees from discrimination.
Team members then informed the patient he could not choose his doctor by race. And the man left the office.
Dr. Hamilton also arranged for the staff to receive training on how to handle similar situations in the future.
Three years later, Dr. Hamilton said, “I know if I would encounter a situation like that, I would not have to initiate the support I need. I know our organization would step up and step in.
“We have a long way to go, don’t get me wrong. But now we have made a stand.”
Followed in a store
When Candace Smith-King, MD, puts on her white coat and walks through the halls of Helen DeVos Children’s Hospital, she feels respected—as a pediatrician and as Spectrum Health’s vice president of academic affairs.
“But the minute I leave the hospital, the respect is gone,” she said.
Dr. Smith-King, who has four children, recently shopped at a local store for treats for her child’s birthday party. As she went through the aisles with a basket of trinkets, she realized she was being followed. Clearly, security suspected her of shoplifting.
“It kind of broke my heart,” she said. “But I didn’t want to let (my kids) know that I was being followed around.”
Encounters like that make her wonder how the community views her and other Black women.
“Do they just assume I am a single Black woman with multiple kids who can’t afford to take care of them?” she asked. “Because I feel that’s the lens (with which) the media portrays Black women.”
She tries to keep calm, not just for her kids, but to avoid playing into the stereotype of “an angry Black woman.” But keeping a lid on emotions only exacerbates the stress caused by stereotypes and negative assumptions.
“The stress of always having to feel like I am representing me and my race is heavy,” she said. “You have good and bad people in all shapes and colors. But negative things are connected to Black people in a way that they are not with other races.”
Chronic stress affects health. A long-term increase in stress hormones, such as cortisol, is linked to high blood pressure, insulin resistance, cardiovascular disease, as well as mental health issues such as anxiety and depression.
And Dr. Smith-King believes the stress caused by racism contributes to health conditions that disproportionately affect the Black community.
“There is no (medical) code for racism, but you can’t tell me that high blood pressure and stressful chronic conditions don’t have something to do with the pressure I feel being Black every day, that is boiling in my blood all the time,” she said.
That only intensifies when traumatic incidents occur, such as the killings of Ahmaud Arbery in Georgia, Breonna Taylor in Kentucky and George Floyd in Minneapolis.
“Every Black person is wondering, when is this going to be me?” Dr. Smith-King said. “When is this going to be my son? When will this be my daughter? My husband?”
In the outcry over Floyd’s death, in the diversity seen in the marches held around the country, Dr. Smith-King sees a growing awareness in the general population about racial injustice and a willingness to work toward solutions.
In conversations with white friends, she sees them connecting the dots—from the legacy of slavery, Jim Crow and segregation to the war on drugs and racial disparity in the criminal justice system—and how it all adds up to the disease of systemic racism.
“It’s almost like an awakening to the history of our country,” she said.
Why did Floyd’s death, rather than the others that came before, become that catalyst for change? Dr. Smith-King believes timing may have played a role. With the COVID-19 pandemic, society slowed down, people stayed home and pulled closer together, protecting loved ones from an unknown and highly contagious virus.
“I think the pandemic allowed us to feel the pain,” she said. “It allowed people to be vulnerable and to be open.”
Dr. Smith-King grew up in Grand Rapids and has a wide network of support, including her parents, friends and her church community. But she understands how difficult it can be for medical professionals new to the West Michigan area.
As a community, she said, “We need to be more welcoming and diverse.”
Diversity in health care
Nationwide, Black doctors are underrepresented in medicine. They account for 13% of the population, but only 5% of physicians, according to the Association of American Medical Colleges.
The number of Black doctors has increased in recent years, with most of the gains made by Black women, Dr. Smith-King said.
In 1978, there were 542 black male students enrolled in MD-granting medical schools. That number dropped to 515 in 2014, the Association of American Medical Colleges reports.
“In 2020, we are only up to 550,” said Dr. Smith-King.
And yet diversifying the health care workforce is crucial to creating trust with patients, solving racial and ethnic disparities in health and a healthier population in general, Dr. Michiels shared.
“There is great evidence that a diverse workforce produces better health care results than a non-diverse workforce,” she said. “Not only do you deliver a better product, but you deliver it at a lower cost.”
There is a history of racism in medicine, of Black people not being treated fairly.
Hankondo Sibalwa, a nurse who immigrated from Zambia, once worked as a licensed practical nurse in a pediatric clinic—and was the only Black male health care provider on staff.
One day, a mother asked him to speak to her son, an African-American teenager, about the importance of education. Sibalwa advised the young man to go to Grand Rapids Community College after high school.
“Check it out. See if it’s for you,” he said.
A few years later, Sibalwa attended GRCC himself, studying to become a registered nurse. As he walked across campus one day, a young man called out to him. It was the teenager Sibalwa had advised several years earlier.
“I’m here because of you,” the young man said.
Sibalwa’s words carried weight, in part because his teenage patient could see him as a role model. That one example underscores the need for diversity in a health care workforce that matches the diversity of the community, he said.
“There is a history of racism in medicine, of Black people not being treated fairly,” said Renee (Constance) Jordan, MD, a pediatrician who just completed a fellowship at Helen DeVos Children’s Hospital.
Numerous studies have documented racial bias in medicine that affects the medical treatments received by people of color, reports the National Academy of Medicine.
When Dr. Jordan walks into a hospital room to care for a Black child, she often sees surprise on the faces of the child and parents.
“Their eyes light up,” she said. “Sometimes there’s even tears or a huge sigh of relief.”
She can see them thinking, “Is this real? Is a doctor who looks like me taking care of me?”
She understands their reaction. At times, she has seen the concerns of Black patients dismissed by medical staff.
In the emergency department, she once saw a mother who pushed for answers about her daughter’s symptoms be dismissed by other staff as an “angry Black woman.”
And yet when Dr. Jordan met with the woman and listened to her concerns, the woman’s anger turned to tears.
As Dr. Jordan discussed the medical issue in detail with the mother, she uncovered concerns for a worsening diagnosis. She arranged for urgent specialty follow-up care that the girl needed.
Dr. Jordan made a connection with the woman when her white colleagues could not.
“To be fair, (the mom) was a little feisty,” Dr. Jordan said. “And one reason she let her guard down was because I looked like her.”
Still, she said, the incident left her shaken, because she could see cultural bias at work.
“For another mom, they might say, ‘She’s having the worst day of her life.’ There is more patience to work through that,” she said. “I think a lot of times, Black moms get written off.”
The incident did lead to positive change.
Dr. Jordan contacted Dr. Smith-King, who at the time was the program director for her residency. Together, they brought the issue to Dr. Michiels, co-director of the emergency department.
“She was amazing, wonderful,” Dr. Jordan said. “She was the perfect ally. She asked, ‘What can we do as an emergency department to be more culturally competent?'”
Recruit and support
Jeri Kessenich, MD, sees a growing recognition in health care of the need to diversify the medical team—and to support doctors and other medical professionals of color.
As director of the pediatric hospital medicine fellowship, she particularly worries about how racism and microagressions affect interns, residents and fellows. She hears their stories about minority physicians being dismissed and overlooked, as patients or families ask to see a “real doctor.”
It adds extra stress to what already is a stressful time for new doctors, as they learn vast amounts of academic material, how to relate to patients and how to navigate the hospital system.
As a white physician, she has learned she can play a role in setting them up for success. She makes clear to patients and families that the residents are physicians and respected members of their medical care team.
It’s important to send the message: “We have people of different genders, ages, races and cultural beliefs, and we put our faith in all of them as team members,” she said.
That will require a genuine openness, understanding and respect from the medical team—and not just surface-level politeness, Dr. Lowery said.
“There is this culture that is often called ‘West Michigan nice.’ I would call it ‘West Michigan passive-aggressive,'” she said.
In the broader community, Dr. Kessenich believes white people must speak out against racism.
“We need to be more vocal about being anti-racist,” she said. “We can have influence in our community and as leaders of our own families. Silence, I think, means we condone what is going on.”
In her leadership role, Dr. Smith-King often is the only person of color at the table for leadership meetings. But that is changing, she said.
“There are a lot of efforts being put in place at Spectrum Health—and I think at a lot of other institutions across the country—to support people of color and to diversify (leadership),” she said.
“There are people I can lean on who look like me, who can mentor me, which is one of the blessings of being at an institution that is trying to make a difference.”
Diversifying leadership can have an impact throughout the organization.
Erika Stevenson, a medical assistant, recalls an unsettling experience when she worked in a hospital clinic.
For years, she enjoyed a warm relationship with patients and their families, as well as a good rapport with colleagues at work. But after a physician cited her for being “stand-offish,” she felt she came under intense scrutiny.
She hesitated to say for certain that it was because of racism. But she could not understand why she was constantly criticized for minor issues—ones that were never raised with her white colleagues.
“I felt like I was on pins and needles every day,” she said. “I felt like nobody was on my side.”
It helped to share her concerns with two Black physicians, Dr. Smith-King and Dr. Lowery, and to have their support.
“It definitely made me more comfortable having Dr. Lowery or Dr. Smith-King present during any discussions with my (manager),” Stevenson said.
Stevenson, who has since taken a new position in Sleep Medicine, praised the way Spectrum Health addressed racism during a “Day of Understanding” on June 19. She found encouragement in the open discussions about race and equity.
“Our office announced the doors were open if any of us had a concern we wanted to talk about,” she said. “I think that was a great thing.”
For Dr. Lowery, the visible and vocal support that has emerged in recent weeks makes her “optimistically hopeful.”
“Will we ever get rid of racism? No, we are human,” she said. “But we can make this a more welcoming society.”
To make that happen requires commitment to change—and to keep values of diversity, equity and inclusion top of mind, said Alejandro Quiroga, MD, Spectrum Health’s senior vice president for population health.
“We need to be vigilant,” he said. “We have to hold each other accountable, that we deem this important and we keep working on this.”