Reprinted from the Winter 2020 Issue of The Ohio Family Physician
By: Paula Amin, MD, and Roma Amin, MD, Grant Family Medicine Residency Program
“The beauty of anti-racism is that you don’t have to pretend to be free of racism to be an anti-racist. Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And it’s the only way forward.” – Ijeoma Oluo
In her book, White Fragility, Robin DiAngelo discusses that every interracial relationship is affected by race and racism. As we reflected on this statement, we began to think back on relationships and memories from our childhood. Interactions with teachers. Conversations with friends. Appointments with doctors.
Throughout our childhood, we received our primary care at the same lovely office, tucked away in a familiar neighborhood. Our physicians were compassionate and dedicated. They answered all of our questions with kindness. They were also all white. We were the only people of color in the office at every appointment. Looking back at these interactions, we now realize the impact race played in that setting. We never talked about the race-based hate speech at school or the challenges of being first generation American-born. We hid the stress of this important part of our identity and the impact that it had on our health. We learned unhealthy coping strategies to deal with this trauma as a way to keep moving forward. Our physicians might have been open and helpful with these conversations, but they never asked.
As family physicians, we know the importance of screenings and preventive care during adolescent appointments. We discuss sensitive topics such as sexual activity, drug use, and mental health.1,2 Family physicians are often the only health advocate in our adolescent patients’ lives. We help them navigate difficult conversations with their parents. We encourage them to pursue their dreams, even when it feels impossible. We are experts in navigating these difficult situations, but if we don’t talk to them about race and racism, we’re missing out on life-changing conversations.
In response to this need to address race in pediatric care, the American Academy of Pediatrics released the policy statement, The Impact of Racism on Child and Adolescent Health.3 This policy statement calls on us to incorporate race as a social determinant of health in order to acknowledge and begin to understand the immense impact of race and racism on health outcomes.3 Such classification also allows us to more clearly identify and develop interventions that address systemic racism, and improve health and academic disparities for our adolescent patients.4
These reports also give us guidance on how to begin to address race with our adolescent patients. The first step for many of us is to actively acknowledge the impact that race and racism have in our patients’ lives and to create space for these discussions in our exam rooms. Additionally, we need to commit to diversity and inclusion, and address the systemic barriers that continue to exclude Black and brown students from accessing medical education. As we work to ensure increased representation, we also need to commit to funding the research that physicians and scientists of color are already doing in order to continue sharing clear and robust data on the effects of racism on health.
This is by no means an easy or clear journey, but these are our patients. We are by their side at every step through adolescence and their transition to adulthood. They trust us to help guide them and they need to know that their family physicians support their whole selves. Only by giving them the space to share vulnerable and important parts of their identity, can we begin to address this important determinant of health and unlock the incredible potential that we all have to be allies for our patients of color.
References available online.