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visit ritual.com/podcast. Hello,

1:12

everyone, and welcome to

1:14

Talk Nerdy. Today is

1:16

Monday, January 29th, 2024,

1:18

and I'm the host of the show, Cara Santa Maria.

1:21

And as always, before we dive into

1:23

this week's episode, I do want to

1:25

thank those of you who have made

1:27

Talk Nerdy possible. Remember Talk Nerdy

1:29

is and will always be 100% free to download. And

1:33

in order to keep this boat afloat,

1:35

I rely on support from different sources.

1:40

So obviously, I sell ads in the

1:42

show. Ad sales have been

1:44

abysmal lately, as you've probably noticed, for

1:46

most podcasts. So really, the biggest contributor

1:49

to the show is Patreon

1:51

support. It's episodic support

1:53

from listeners just like you.

1:56

If you're interested in pledging your support, all you've got

1:58

to do is visit Patreon. patreon.com/talk nerdy.

2:01

This week's top patrons

2:03

include Daniel Lang, David

2:06

J. Smith, Mary Niva,

2:08

Brian Holden, David Compton,

2:11

Gabrielle F. Jaramillo, Joe

2:14

Wilkinson, Pascuali Gelati, and

2:16

Ulrika Hagman. Thank you all

2:18

so, so much. So

2:20

okay, let's just dive right into the

2:22

show this week. I was

2:25

lucky enough to speak

2:27

with Dr. Uche Blackstock.

2:30

Now she is an emergency

2:32

room physician and she's also

2:35

the founder of an organization

2:37

called Advancing Health Equity and

2:39

their goal is to partner

2:42

with healthcare organizations to

2:44

dismantle racism in healthcare and to close

2:46

the gap in racial health inequities. So

2:49

today we're going to be focusing

2:51

on a new book that she

2:53

wrote. It's called Legacy, a black

2:55

physician reckons with racism in medicine.

2:57

So without any

3:00

further ado, here she is, Dr.

3:02

Uche Blackstock. Well,

3:07

Uche, thank you so much for

3:09

joining me today. Thanks so much

3:11

for having me, Kara. I am

3:13

excited to talk about your

3:15

new book. I'm

3:17

also excited to learn

3:20

a lot more about you, which we'll be

3:22

doing through kind of talking about your new

3:24

book because it is sort of so legacy,

3:26

a black physician reckons with racism in medicine.

3:28

Would you say it's sort of half

3:32

memoir, half advocacy

3:35

or like social justice or really more

3:37

than that, just like the science of

3:39

kind of race inequity? Yeah,

3:42

I mean, I think it's a

3:44

little bit of everything. So, you

3:46

know, I always say like, it's a

3:48

generational memoir. There's also a lot of

3:51

history in it. So, you know, for

3:53

history books, people would love that part.

3:55

And then also there is that social

3:57

commentary, advocacy component.

4:00

too. So I

4:02

always say it's like a memoir with benefits. You

4:05

get that extra bit that you don't

4:08

typically have in a memoir, you know, I want

4:10

people to read legacy and

4:13

to feel like one, oh my goodness, I

4:15

learned something, even those folks who think they

4:17

know everything. And then

4:19

two, I want them to leave reading

4:21

it feeling like galvanized

4:24

and electrified to actually do

4:26

something about racial health inequities. Yeah,

4:29

you know, I'd love to start

4:31

off, I'd love to know a

4:33

little bit more about, you

4:35

know, your journey before you got

4:37

into, I'd say like

4:39

before you went to medical school, because obviously,

4:42

as the title implies legacy, this is something

4:44

that you kind of always, or at least

4:46

for most of your life, knew you were just

4:49

going to do, right? Yeah,

4:51

yeah. So legacy has that double meaning.

4:53

And one meaning of it is the

4:55

fact that, you know, I am a

4:57

second generation physician, my mother was a

4:59

doctor. And so I feel like there

5:02

was always this implicit understanding

5:04

that my twin sister and I would

5:06

become doctors. And I think part of

5:08

it was just also because our

5:11

mom was just this amazing woman who

5:13

had, you know, not the easiest childhood,

5:15

was the first person in her

5:17

family to go to college and then medical school, and

5:20

was, you know, our role model,

5:22

we wanted to be just like her. So I

5:24

feel like from a really young age, I

5:27

kind of like thought, okay, I think it's just good, I'm

5:29

going to be a doctor. And, you

5:31

know, I really didn't think about anything

5:34

else, because being a doctor for me

5:36

felt like, you know, something

5:38

very intellectually simulating, I would always be

5:40

learning something new, but also I would

5:42

be able to work in service to

5:44

my community. So it was just like

5:46

the cherry on the top. And

5:49

also, it sounds like, and of course, this

5:51

is kind of one of the points of

5:53

all of this, it sounds like it was

5:55

just normal, like it's what you knew, right?

5:58

And I think when talk

6:00

about representation or we talk about mentoring or

6:02

we talk about visibility,

6:06

part of the reason

6:08

that it's not normal for black women

6:10

to be doctors, it is still deeply

6:13

underrepresented, is because that

6:15

representation isn't there. Like when you

6:18

said legacy has a double meaning,

6:20

of course you were

6:22

going to come up to become a doctor with

6:24

your twin sister because your parent was

6:27

a doctor, went to Harvard. Exactly. Most

6:29

people are like, oh, you're her dad. Most

6:32

people would know your mother.

6:34

No, it's not what people

6:36

first think of. Yeah, and

6:38

honestly, it was the only thing. It was the

6:40

only thing that I knew. That was normal to me.

6:43

It was normal, obviously, to have a mother

6:45

who was a doctor, but not only that, my mother

6:48

was the

6:50

head of a local group of black

6:52

women physicians. So my mom would always take

6:54

us to those meetings when we were little

6:57

girls. And so we would sit in back

6:59

of the room and listen in on this

7:02

group of black women physicians doing amazing

7:04

work. And so I would joke

7:07

that growing up, I thought that

7:09

most physicians were black and were

7:11

black women. I didn't realize

7:13

until I got older that we actually

7:15

are only 2.8% of all physicians. But

7:20

in a way, I feel really grateful that

7:22

that was the norm for me because it

7:24

made me realize that that was a possibility.

7:27

I remember, if I'm being 100%

7:30

honest, and my friend Emily just

7:32

posted this online, I remember being

7:34

completely stumped when I was a

7:36

little girl by that riddle. And

7:39

you probably know this riddle, and probably everybody

7:41

is now primed to actually see the answer.

7:43

But when I was a kid and somebody

7:45

would tell me, okay, so a man and

7:48

his son get in a car wreck and

7:50

the man dies and the son is rushed

7:52

to the hospital. And the doctor comes in

7:54

and says, or the surgeon comes in and

7:56

says, I can't operate. It's my son who's

7:58

the surgeon. Everybody's like, I don't know.

8:01

I don't know, who could it be? This is so

8:03

confusing. The father died. And it's

8:06

like, obviously it's the kid's mother. But

8:09

nobody like, when we were kids, we were

8:11

so stumped by that. That's so gross. You

8:14

know, it really is. And I

8:17

realized like that is probably what is

8:19

normal for like the majority of

8:21

people. Like that, you know, they don't have a

8:23

mom. I always say that like, I'm, my

8:26

sister and I are unicorns. And it's not

8:29

something that I'm proud of, but I also

8:31

feel like shouldn't be the

8:33

case, right? Like to say that I'm

8:35

a physician and my mother was a

8:37

physician too. And we're

8:39

black women. Like

8:42

I said, it's super, super rare, but like

8:44

there's a reason for it. And I get

8:46

into it, you know, in the

8:49

book, like it's not because

8:51

there's something inherently wrong with women

8:53

or black women. It's because there

8:55

are and have been systemic barriers

8:58

and policies and practices that have

9:00

kept those numbers low. And

9:03

like, that's what I wanted to like help readers

9:06

like connect the dots with. Like, you know, I think

9:08

that there are a lot of things that we take

9:10

for granted. Like we see these percentages and we're like,

9:13

oh, that's really bad. And we don't really think about

9:15

why. Like, why is that the case?

9:18

And so that's what I hope this book does. And

9:21

so tell me a little bit more about

9:24

your kind of path going in. Were you

9:26

a biology student? You kind

9:28

of always knew you wanted to go to medical school. So

9:31

did you go through pre-med? Like what did you

9:33

do to sort of set your trajectory?

9:36

Yeah, I mean, I just feel like even when I was

9:38

12 years old, I

9:40

was doing summer science programs. You

9:42

know, like I knew that I was

9:44

super interested in science. I knew that I

9:46

either wanted to be an MD or MD,

9:49

PhD. Like, so it's either or. And

9:51

then I realized that, you know, the

9:54

more that I kind of observed

9:56

patient care, I realized I kind of wanted to lean

9:58

more towards doing. clinical

10:00

work, working with patients. And

10:02

so I went to a math and science high

10:04

school, Cybuson High School in New York City, which

10:08

has been around for a very, very long

10:10

time and is known as one of the

10:12

premier science high schools in the country in

10:14

New York City. And so I

10:17

think after going there, I was like, for sure,

10:19

I want to apply to medical school

10:21

eventually. And so I was

10:23

pre-med at Harvard, I

10:25

majored in biology and then did

10:27

my pre-med courses, although in retrospect,

10:30

I kind of wish I had kind

10:32

of majored in anthropology or sociology and

10:35

then also done pre-med, you know, fulfilled

10:37

my pre-med requirements because I realized like

10:39

that was the last time for me

10:41

to learn other disciplines.

10:45

And I realized also so much of what I do

10:47

now around, you know, health

10:49

equity and racial health and equities, it

10:52

involves like understanding how societies work and

10:54

how systems work. But anyway, so yeah,

10:57

I went to Harvard undergrad

10:59

with biology pre-med there. I

11:02

really enjoyed it, but you know, if

11:04

I talk about it in the book,

11:07

during that time, my mother was diagnosed

11:09

with acute myelogenous leukemia. So unfortunately, college

11:12

was not like the exciting experience

11:14

it should have been because I

11:16

was also balancing my

11:19

pre-med courses with coming

11:21

back down from Boston to New York

11:23

City to visit my mom while she

11:26

was getting her chemotherapy for leukemia.

11:29

Yeah, and so kind

11:31

of shuttling

11:33

or, I

11:35

don't know what the right word is, but

11:37

sort of finding yourself in a position where

11:39

you were having to grow up pretty quickly,

11:41

having to kind of balance

11:44

the really demanding

11:47

academic load along with this like

11:49

kind of deep personal thing that a

11:52

lot of kids, I mean, let's be honest, a

11:54

lot of kids at that age don't have

11:56

those kinds of pressures, but a lot of kids

11:58

at that age do. a

12:00

lot of kids at that age

12:02

are their family's provider. A lot

12:04

of kids at that age are

12:06

dealing with deaths in

12:09

the family or dealing with conflicts within

12:11

the family. But that's a lot.

12:16

Did you have to take any time off or did you kind

12:18

of push straight through? That's

12:20

such a great question because my mother,

12:23

being my mother, said to us, said,

12:26

I know that this is

12:28

a really difficult time, but I

12:30

want you to try to finish school

12:32

on time, finish college on time, and

12:35

if you need to afterwards, you can take time off.

12:37

And I think she was worried that

12:39

if we took time off during college

12:41

that maybe we wouldn't go back or

12:44

we'd be so devastated we wouldn't go

12:46

back. So, only my

12:48

twin sister, we actually stayed in

12:50

school. We would come down to

12:52

New York City on the weekends and sleep

12:54

in the hospital room with her and

12:57

then go back up on Sunday evenings to

13:01

Cambridge and resume our

13:03

college life. And so, I think at the

13:05

time we were just in survival mode because

13:08

our mom was like this very, she

13:10

was just full of life, vibrant woman

13:13

that she ran every day. She

13:16

ate well. She

13:18

lived life to the fullest.

13:20

And so, this idea that now she

13:22

was debilitated only the

13:25

age of 46, like she was so,

13:27

so young. We

13:29

definitely wanted to be there as much as

13:32

we could and we would be doing homework,

13:34

we'd do our coursework in the hospital room

13:36

while her team, her oncology team was making

13:39

rounds on her and talking to her. And

13:41

I think for her, being a physician and

13:44

then being a patient was very

13:47

difficult. It's very, very difficult.

13:49

Oh, I can imagine, yeah. She understood. Yeah,

13:51

being on both sides of

13:53

that is incredibly challenging. When

13:57

you were in school with Oni, were

13:59

you guys taking care of it? making all the same classes?

14:02

Were you able to be there for each other step

14:04

by step? Well,

14:06

we actually was a computer science

14:09

major. Oh, okay. So computer

14:11

science and pre-med. So she really,

14:13

really wanted to challenge herself. But

14:17

we were roommates all during college

14:19

except our freshman year because Harvard

14:21

doesn't allow twins to room together.

14:26

Even though our mother requested it, she said, please, I don't

14:28

really want to have to buy them to double everything. It

14:31

would be much more convenient if they could live together.

14:35

But we were roommates from sophomore

14:37

year to senior year. And so

14:40

we were really able to support

14:42

each other. It's

14:45

amazing having a twin because

14:47

you have someone who absolutely

14:49

guessed it, especially when you're

14:51

going through a difficult time. We both

14:54

were, we madly loved with our mom. We

14:56

just loved her so much. And so

14:59

it was difficult for both of us, but we were

15:01

there to support each other. Yeah.

15:04

And so ultimately, you finished

15:07

your undergrad, you went to

15:09

medical school. What

15:11

did you, what was your

15:13

residency in? Like, what did you choose to specialize in?

15:17

Yeah. So it was actually

15:19

during my first year of medical school that

15:21

I realized I was

15:23

interested in emergency medicine because

15:26

one of my anatomy instructors

15:28

was also the emergency

15:30

medicine physician at Mass

15:32

General Hospital, which is one of

15:34

the Harvard teaching hospitals. And

15:37

so he basically said,

15:39

if anyone wants to shadow me, come along. And

15:41

so one night I spent a shift with

15:44

him in the Mass General

15:46

ER and I got to see just

15:48

how exciting emergency medicine was that

15:51

you actually, like on one shift,

15:53

you could see someone coming in

15:55

with something as benign as a

15:57

cold. So someone coming in with

16:00

cardiac arrest or a trauma patient.

16:03

And I really appreciate the unpredictability

16:05

of it, but I also really

16:07

love the idea of, in

16:09

the ER you help everybody. It doesn't matter

16:11

what their insurance status is, doesn't

16:13

matter why they're there. I

16:16

think the idealistic part of me was you just you're there to

16:18

help them. And so I

16:20

ended up applying in emergency

16:22

medicine for residency. And

16:25

it's interesting because at Harvard,

16:28

most of the students go either

16:30

into internal medicine or surgery, more

16:33

of the traditional subspecialties. Emergency

16:35

medicine is considered a newer

16:37

specialty. And I remember my

16:40

attending, my supervising physician's asking me, are

16:42

you sure you want to waste your

16:45

Harvard education on going into

16:47

emergency medicine? No. Yeah.

16:51

And I was like, no, I was like,

16:53

yeah, I'm pretty sure I do. I

16:55

don't think it's a waste. Jeez.

16:59

What was it like for you when you actually spent

17:02

that time face-to-face in the ER

17:04

and you really started to realize what you had

17:06

signed up for? Yeah, I

17:09

mean, I think when you're

17:11

in medical school, you're young and idealistic.

17:14

And I definitely, when I started my residency,

17:16

so for residency I came back to Brooklyn,

17:18

New York to neighborhood

17:20

where I grew up in

17:22

to do my training. And

17:25

so I was at a

17:27

public hospital, so one of

17:29

Brooklyn city hospitals, and then

17:32

SUNY downstate, which is one of the state

17:35

University of New York hospitals, is the

17:37

University Hospital. But both of them are

17:39

pretty underserved. And it was

17:41

really challenging because, I

17:44

went from the Harvard teaching hospitals that

17:46

have tremendous

17:48

amount of resources that are well-staffed, that

17:50

are modern new, and

17:53

at King's County, the city hospital

17:55

in Brooklyn, where I was doing my

17:57

residency, we were always under- Never

18:02

enough nurses, never enough doctors, never enough

18:05

medical technicians, never enough radiologists.

18:08

And it was really hard.

18:11

It was really, really hard. And

18:13

you felt like you just wanted to do what was best

18:16

for your patients, but you felt really

18:18

constricted by the lack of

18:20

resources. How

18:22

did you cope with that? I mean, was this sort of one

18:26

of the important inflection points for

18:28

you to start to see the

18:30

inequities and start to see some of the

18:33

systemic failures in medicine? Or were you not

18:35

quite in social justice mode? Or

18:37

had you always sort of been thinking about

18:39

those things? Yeah, I

18:41

think I was always in social justice mode.

18:44

I just never, I didn't, like,

18:46

so for example, like, you know, growing

18:48

up in my neighborhood in

18:50

Brooklyn and Crown Heights, I

18:52

always like recognize that, you know, there

18:54

were a lot of abandoned buildings. We

18:57

always had to go to an adjacent

19:00

neighborhood, Park Slope, to

19:03

find a decent grocery store. My

19:07

parents never felt comfortable sending us to

19:09

the public schools in our neighborhood. And

19:12

so I never really understood why. And

19:15

then I started connecting

19:17

the dots that a lot

19:19

of like my neighborhood was

19:21

a formerly redlined neighborhood. So

19:23

it was a neighborhood that

19:25

in the 1930s had received

19:27

a very low rating by

19:30

the federal housing agency FHA.

19:33

And because of that, people living

19:36

in that area were not able to qualify

19:38

for mortgages or mortgage insurance. And

19:41

so my neighborhood essentially was

19:43

chronically disinvested in. And

19:47

I started making the connections, like

19:49

working at King County that there

19:51

were these connections between what we

19:53

call the social determinants of health,

19:55

education, housing, employment,

19:58

and how healthy people are. So

20:02

I would see my patients coming in

20:04

and many of them were having food

20:07

insecurity, unable to find

20:09

or purchase healthy foods. They

20:12

were having housing insecurity, couldn't afford

20:15

their rent, difficulty

20:17

finding employment. And

20:21

that was all actually impacting their health because

20:23

many of them were uninsured. We

20:25

know in our

20:27

country, most people have health insurance

20:30

that's tied to their jobs. And

20:35

a lot of people had jobs where even

20:37

if they did have jobs, those jobs didn't offer benefits.

20:40

So I was like connecting all the

20:43

dots during my

20:45

residency. It still wasn't

20:47

all clear to me, but that was definitely

20:49

the beginning of the journey to

20:51

focus on racial health and equities for

20:53

me. Like I talk about in the

20:55

book, a patient named

20:58

Jordan with a history of sickle cell

21:00

disease who really through

21:02

my experiences with him, I recognized

21:05

how larger systemic issues like

21:08

racism end up impacting health.

21:11

So like Jordan, Jordan was

21:13

in his 30s, had sickle cell disease, like he

21:15

was always in the ER. Like

21:18

he's what people would call a frequent flyer.

21:20

Like we would see him all

21:22

the time. He would come to the ER in

21:24

a pain crisis. So pain in

21:26

either his arm or legs or his

21:28

chest, which is very typical people with

21:30

sickle cell disease. And

21:33

I always wondered why do we see so many

21:35

patients with sickle cell disease in

21:37

this ER here in the middle

21:39

of central Brooklyn, mostly black patients.

21:43

And what it came to find out is because a lot

21:45

of funding has not gone into researching

21:48

sickle cell disease. So even

21:50

though sickle cell disease was first described over

21:52

a hundred years ago, because it

21:55

had been racialized as a

21:57

black disease, and that's only because in the

21:59

end. U.S. most people who have sickle cell

22:02

disease are black, even though people from all

22:04

over the world have it. But

22:06

because of that, you know, there

22:08

hasn't been a lot of research, there hasn't been

22:10

a lot of funding given to sickle cell

22:12

disease, unlike other

22:15

hereditary diseases like hemophilia

22:17

or cystic fibrosis, which

22:21

afflict mostly people

22:23

who are racially white. And

22:25

so it kind of, I was like, the

22:27

reason why Jordan is always in the ER

22:29

is because we have a system

22:31

that doesn't take care of him or take care of

22:34

the disease that he has. And

22:36

so what we're seeing is the manifestation of

22:38

that in these frequent visits to the ER.

22:42

And that actually turned into this issue of patients

22:45

with sickle cell disease becoming stigmatized

22:47

as, you know, seeking drugs or

22:49

seeking pain medication in a way

22:52

that is like suspicious.

22:56

You know, the fact that people are coming

22:58

in in pain and you're wondering, are they

23:01

really in pain or do they want pain medication? But

23:03

that's how I was trained. Like I

23:05

was trained to be suspicious and

23:08

recognizing that they were coming there

23:11

because their disease was

23:13

not being well managed. I

23:17

feel like this is a story that I've heard

23:20

specifically about sickle cell so

23:22

many times. It's

23:25

like that kind of extra layer

23:28

of you're already struggling with

23:30

this incredibly painful and debilitating

23:32

disease. And now on top of

23:34

it, you have the whole kind

23:36

of psychosocial layer of what

23:39

are they going to say? Are they going to

23:41

turn me away? Are, you know, are they going to be cruel

23:43

to me? How do I go

23:46

in and be as authentic and genuine

23:48

as possible so they believe me? And

23:51

I'm super curious, you know, I've

23:53

been seeing documentaries recently and talking

23:55

to individuals in like, let's say

23:57

OBGYN about cesarean rates among black

23:59

people. women or pain

24:01

being dismissed among black women or

24:03

infant mortality being higher. And

24:06

of course, different specialties kind of

24:08

have their specific examples.

24:12

And obviously, your sickle cell patient

24:14

is such a telling example.

24:16

Are there any other things that

24:19

you regularly saw sort of in

24:21

the ER that are very ER

24:23

specific that were just massive reminders

24:25

for you of health

24:28

inequity? You

24:30

know, I think so. I

24:32

think like the issue that you bring up about

24:34

pain and that's an extension of like the

24:36

sickle cell disease conversation is one

24:39

that, you know, has been

24:41

around for a while but hasn't received

24:43

enough attention. And I

24:45

think because it's often

24:47

difficult to maybe quantify, you know,

24:50

people want to say, like, OK, wait, what do you

24:52

mean people pain aren't being isn't being

24:54

treated properly? Like the

24:56

whole idea of not knowing

24:58

how in pain someone is

25:01

almost it causes health professionals to

25:03

doubt them because they need to look at it.

25:07

Yeah, exactly. Exactly. So pain is

25:09

one of those those

25:11

tricky areas and it shouldn't be

25:13

tricky. But, you know, I

25:16

was actually been doing some work

25:18

over the last year around what

25:20

we call like pain inequity because

25:22

we do have studies that have

25:24

shown that often black patients in

25:26

particular, their pain often goes

25:29

untreated or undertreated. And

25:32

so people say, well, you know, what

25:34

does that matter? Right. Like,

25:36

OK, well, you know, when you're

25:38

in pain that causes both emotional

25:40

and psychological distress. But often there

25:42

is a reason why someone's in

25:44

pain. There's some underlying diagnosis. But

25:47

if you don't dig deep enough that you're going

25:49

to miss. So that could

25:51

result in a delayed diagnosis, a

25:53

missed diagnosis, harm or

25:55

even death. Like, you know, I've spoken

25:58

to patients who were. turned

26:00

away multiple times from the ER

26:03

or their complaints about chest pain

26:05

or pain somewhere minimized and

26:08

then it turned out that they actually

26:10

had something very very serious that was

26:12

almost even life-threatening and so

26:15

yes so we see that

26:17

often around maternal maternal health

26:19

but we also just see it more

26:22

broadly and so one thing that you

26:24

know I often talk about is that

26:28

a lot of people say well

26:30

why does this happen right why

26:32

are black patients pain being why

26:34

is it being undertreated and

26:36

I will say that I think

26:38

it's because of these they're deeply rooted false

26:41

beliefs and myths about black

26:43

people that actually started you

26:46

know during during slavery so

26:49

you know this I did and I talk

26:51

about this in my book like so there

26:53

were for example like J. Marion Sims he's

26:55

known as the father of modern gynecology and

26:58

he experimented on enslaved

27:01

women he made these very very

27:04

useful discoveries like he discovered the

27:06

vaginal speculum and he

27:08

also discovered ways to fix

27:11

what's called the vestico vaginal fistulas

27:13

which are connections between the bladder

27:17

the bladder and the bladder

27:21

and vagina that happened after

27:23

childbirth as a result of

27:25

injury and so he made

27:27

these really important discoveries but he did so

27:29

and by using and

27:32

experimenting on enslaved

27:35

black women without even using any anesthesia.

27:37

Yeah who clearly could be consented and

27:40

clearly yeah. Right yeah again who couldn't

27:42

consent but then I think that it

27:44

unfolds into this idea this this idea

27:46

like biological essentialism and that's how that's

27:49

how slavery was justified that's that there

27:51

are just I mean you have to

27:53

find a way to justify it to

27:55

say the reason why one human

27:58

being can order an order but

28:00

own another human being is because

28:02

that other human being is not really fully human.

28:05

And so we see that in

28:08

terms of even people

28:10

who were physicians like Dr. Sims,

28:12

like he also, you know,

28:14

what wasn't in flavor. He had, he owned

28:17

human beings. But

28:19

in order to do that, you have to make them less

28:21

human. And so I think

28:23

that unfortunately, a lot of

28:25

those beliefs and those

28:27

myths, honestly, to get passed down

28:29

from generation to generation, whether people

28:32

realize it or not. And

28:35

there was a study actually in 2016 at the

28:37

University of Virginia, where they did a

28:42

study with medical students and residents, and

28:45

they gave them two cases. The cases

28:47

were exactly the same. One patient was

28:49

white, one patient was black. And

28:51

they asked the students and residents to rate

28:53

the patient's pain and to

28:56

come up with treatment recommendations. And

28:59

the majority of the students and residents,

29:02

they under rated, they gave the

29:04

black patient less pain

29:06

medication, and they rated their pain lower. And...

29:11

Because of this deep belief that somehow

29:14

either they're lying or they can handle it.

29:17

Exactly. Exactly. Right. And

29:20

the other thing was these authors also

29:22

came up with these false

29:25

beliefs. They made up

29:27

these beliefs, like black people's skin is

29:29

thicker, black people's skin is less sensitive.

29:32

And they asked the residents and medical students,

29:34

are these true? And they found

29:36

that the students and residents who believed

29:38

were more likely to believe these false

29:40

beliefs were also more likely to under

29:42

treat the pain in black patients

29:45

and the mock patient. And

29:48

they were also more likely to not

29:50

think the patient was in as much pain.

29:53

And that's 2016. Right?

29:56

And these are doctors in training. So,

29:58

you know, it's... It's

30:01

hard to talk about this because I think

30:04

that every person who takes

30:06

care of patients wants to say, I

30:08

am doing my best. I

30:10

am treating all of my patients the

30:12

same, but that's not

30:14

always what happens. And

30:18

it doesn't always happen, let's say,

30:20

cognitively or like overtly. Like a

30:22

lot of this stuff is sort

30:25

of unconscious bias. We

30:27

can say that, of course, there

30:30

were overt and verbalized

30:36

stigmatization lies in

30:40

historically. And it

30:42

still does occur, but I doubt you're

30:44

going to find a passage in a

30:46

medical book that says black individual's skin

30:48

is thicker. But you're going

30:50

to hear some little comment by an attending

30:52

or some little thing by a nurse or

30:54

some little. And those things

30:56

become ingrained. They're these little hints

30:59

and these little nods.

31:01

And all of those things

31:03

collectively become this implicit bias.

31:06

Exactly. And then the other thing is

31:08

that one thing I also write about

31:11

in the book about is this idea

31:13

of what's called a race correction factor.

31:16

So what I learned in

31:18

medical school was that in terms

31:21

of kidney function, there are different

31:23

kidney functions for black patients and

31:25

non-black patients. And that

31:27

was based on this different normal values. And

31:31

that was based on this idea

31:33

that or this myth that black

31:35

people had a higher muscle mass

31:37

and that muscle mass, you know,

31:40

the creatinine that's broken down from muscle

31:43

is related to kidney function. So

31:46

this is what I was taught. Not only

31:48

was taught that, but when I use

31:50

the electronic medical records, I

31:52

see that there's

31:54

actually a note in the

31:57

lab values that this is the normal range

31:59

for black patients. patients, and this

32:01

is the normal range for non-Black patients. And

32:05

that's something actually that has

32:08

changed in the last few years, because

32:11

there have been nephrologists, kidney doctors, advocating

32:13

for a change in that, saying that

32:15

this is based on a myth, because

32:18

what happened as a result of those

32:20

differences in normal values is

32:23

that Black patients were less likely

32:25

to be referred for specialty

32:27

care for kidney disease. And

32:30

they were less likely to end up on the

32:32

kidney transplant list. So we

32:35

have to really think about, what

32:37

are the consequences of these ideas

32:40

that Black patients or Black

32:42

people are somehow biologically different?

32:44

But even just seeing that

32:46

in the medical record, these

32:49

differences in normal values, that

32:52

has to have an impact on

32:54

health professionals, saying there's

32:56

something biologically different. There's even

32:59

in pulmonary function tests, so that's the

33:01

lung function test. There's also a race

33:04

correction factor in that as well, because

33:06

that was based on the physician

33:09

who originally developed the lung

33:11

function test said

33:13

that Black people have different

33:16

lung capacity than

33:18

non-Black people. So again, these

33:22

are ideas that

33:24

have actually crossed

33:26

generations of physicians

33:29

and medicine and still

33:31

current day exists, and

33:34

that what we're grappling with and dealing with.

33:37

And I think that probably a lot of

33:39

people who struggle confronting the

33:41

harsh reality, and who kind of,

33:43

there's a psychological protective mechanism that

33:46

says, I don't want it to

33:48

be true, that this is such

33:50

an entrenched problem, is I think

33:52

they try to sanitize in their

33:55

minds that it's a natural psychological

33:57

kind of approach to say, OK, yeah.

34:00

yes, there are historical wrongs

34:02

that say different, or

34:04

like, you know, it really like rings

34:06

like separate but equal to me. But

34:09

what we often don't realize or

34:11

don't want to admit is

34:14

that a lot of these documents,

34:17

a lot of these statistical

34:20

descriptions, they

34:23

come from a place of eugenics.

34:25

They come from a place of

34:27

white supremacy. It's not just, oh,

34:29

black people have this value and

34:31

it's different, it's black people are

34:33

inferior and this is why. And

34:35

like early, early, you know, I

34:38

come from psychology and so that's a huge part of

34:40

our field is grappling with the fact that most

34:43

of the celebrated early psychologists who

34:45

did brilliant things

34:47

statistically, you know, that statistical

34:49

contrasts are named after did

34:52

these things, they developed these IQ tests,

34:54

they did all this really sophisticated stuff

34:57

to prove the superiority of white people.

34:59

Like that was their goal. Yeah,

35:03

yeah, I mean, you know,

35:05

and I think that it's so important that

35:08

we have these conversations no matter how uncomfortable

35:10

they are. And

35:12

I think, you know, you mentioned unconscious bias

35:14

and you know, I always

35:16

like to use unconscious bias in

35:19

tandem with, you know,

35:21

systemic racism together because I

35:24

think there's this belief that because it's

35:26

like unconscious that it's less harmful, you

35:29

know what I mean? Like, but

35:31

the problem is is that it

35:33

is harmful and

35:35

it can, you know, when health professionals say like

35:38

I didn't realize it, I didn't realize I was

35:40

thinking this way, but the fact is is that

35:42

that it was happening, it was impacting the way you're

35:44

treating your patient. And what that

35:47

does is that actually perpetuates the

35:49

systemic inequities, you know? So what

35:51

happens between a health professional and

35:53

a patient, right? Like

35:56

it's super important, although we know

35:58

systemic factors have the biggest impact,

36:01

but still what happens in that

36:03

exam room, what happens in that

36:05

clinic, it's so incredibly

36:07

important, right? Because we know that

36:09

a decision, clinical decision making is

36:11

key in how well a patient does, right?

36:14

And so you want to make sure that

36:16

patient is truly being listened to. And

36:20

you know, just because it's unconscious,

36:22

or there may be bias that's

36:24

unconscious, it doesn't mean that it

36:26

is any more benign or less

36:29

harmful to patients. Okay,

36:32

round two. Name something that's

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36:38

a book club. Computer solitaire,

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and conditions. I

37:33

actually think in some ways it's more harmful because

37:35

it's harder to uncover and it's harder to

37:38

change. Like I can't help but be

37:40

reminded of the quote. I've

37:42

talked about this on the show before in

37:44

other contexts, but I feel like there's a

37:46

connection here. The quote from Martin Luther King

37:48

in Letter from a Birmingham Jail where he

37:50

talks about basically

37:52

that it's not the planner. It's

37:55

not the white citizen's counselor that he's

37:58

so much more afraid of. the

38:00

white moderate. It's the person who's sort

38:02

of like, shruggy who says like, I

38:04

just want a passive approach to justice

38:06

and it should happen on the timeline

38:08

that nature takes its course. No, like

38:11

that's why this stuff continues

38:13

because people go, Oh, they don't

38:15

mean it. It's not intentional. And

38:18

that's the overt like neo Nazi is

38:20

easy to point out and say, okay,

38:22

let's not be that guy. You know,

38:25

it's more subversive. I think that's I'm

38:27

much more concerned about that. I'm so

38:29

glad you said that because I think

38:31

that's absolutely correct. Because I think often

38:34

sometimes like some people when you say

38:36

it's unconscious, people are unconscious, what am

38:38

I supposed to do? You know, it

38:40

kind of absolves them of accountability,

38:43

it is all of them of

38:45

responsibility. But what I

38:47

think because I do

38:50

this work a lot with my, my

38:52

consulting firm that I have advancing health

38:54

equity, we work with healthcare organizations around

38:56

bias and racism in healthcare. But part

38:59

of the work we do is definitely

39:01

trainings are important. So to really

39:03

start having these conversations, it's what

39:06

I call courageous conversations. And but

39:08

also we talk about what are

39:10

strategies that you can use in

39:14

your interactions with patients to

39:16

mitigate those biases. One, but also two, we

39:18

also know there needs to be like, there

39:21

needs to be practices and

39:23

procedures and protocols in place

39:25

systemically, like with maybe within

39:27

the electronic medical record system,

39:29

that keeps track of keeps

39:31

track of how, for example,

39:33

you know, how opioids

39:36

or pain medications are prescribed.

39:39

And the hospitals doing, you know,

39:42

looking at metrics and seeing are

39:44

there differences in how, you know,

39:46

patients of color are

39:48

being prescribed medications versus white patients,

39:51

like there really needs to be

39:53

processes in place. Like, for example, I

39:56

was working with one of my clients,

39:58

a well known academic medical center. And

40:00

they found that black patients were

40:02

waiting 80 minutes longer to be

40:05

admitted to the hospital than other patients in

40:07

the ER. I know. Yeah.

40:10

I mean, so how do you... Yeah. There's

40:13

no justification for that. And there's no

40:15

like, there's no reasonable explanation except for

40:17

systemic racism. Exactly. And

40:19

so we talked about like, what are things

40:21

that we can do? So one thing was,

40:25

we can develop a dashboard

40:27

for each health professional so

40:30

that every quarter they can

40:33

see how they're doing compared to

40:35

their peers. One, or compared to the

40:37

standard. Two, maybe we

40:39

can put reminders in the electronic

40:41

medical record system. Like for example, the patient's been waiting

40:43

30 minutes. It

40:46

blinks on the screen. So

40:48

just like thinking about different processes that we

40:50

can put in place to mitigate these biases,

40:53

because it's one thing for someone to go

40:55

through a training and we know... And as

40:57

you know, like people probably

40:59

need long-term

41:01

multiple trainings to undo these

41:03

unconscious biases, right? So that's why

41:06

we need like systemic processes

41:08

in place to help them. Yeah.

41:11

I mean, I say all the time, like sometimes

41:14

I feel like a broken record when

41:16

I'm talking about anything. I mean, it

41:18

doesn't even have to be about these

41:20

social justice topics, but about critical thinking

41:23

or just like any like

41:25

neuropsychological humility, all these different approaches that

41:27

I often focus on in my work and

41:29

on my show. And I'm

41:31

like, oh, I've said this like a hundred times

41:33

now, like it's getting old. Like no, sometimes you

41:36

have to say something a hundred times before it's

41:38

heard. And I think we sometimes forget that.

41:40

Like it can't just be one and done. It

41:43

doesn't work that way. You know,

41:45

there's something that comes up for

41:47

me that I'm super curious about.

41:49

Obviously, your book is called Legacy,

41:51

a Black Physician Reckons with Racism

41:53

in Medicine. You are a Black

41:55

physician, but you're also a woman. And

41:59

the intersectionality... personality kind of component

42:01

of this, I think is really

42:03

fascinating. So I'm, you know, racially

42:06

I'm white. I'm a white woman. I

42:08

present white. I, you

42:10

know, everything about me has white privilege.

42:13

I'm, I'm Latina, but that's my ethnicity.

42:15

You wouldn't know it by looking at me.

42:17

It's my mom's Puerto Rican. And

42:19

I, you know, I think about intersectionality a lot. I

42:21

think about the fact that I am a woman. I

42:23

think about the fact that I, you know, sometimes identify

42:26

as queer. I think about the fact that I, I

42:29

don't know, I had a hysterectomy. I am a cancer

42:31

survivor. I have, you know, all these different aspects of

42:33

who I am and how that

42:35

makes me me. And when

42:37

we think about massive systemic

42:39

inequities, especially in medicine, I

42:42

can't help but think

42:45

about not just race, but

42:47

gender as a massive issue.

42:51

And so I'm curious about that

42:53

component of your reality and your

42:55

experience and how that plays in,

42:58

you know, being a black

43:00

woman, it's not additive sometimes. I think

43:02

that that kind of intersectionality, not

43:04

that we're talking about like oppression Olympics

43:06

or anything, but that that kind of,

43:08

that kind of intersectionality is, is

43:13

multiplicative. That's not even a word, but

43:15

you know, it's that much, you've had

43:18

that many more barriers and you

43:20

see that much more difficulty with

43:22

black women, but especially like, let's say black

43:24

queer women or black poor women or, you

43:26

know, whatever that may be. Yeah.

43:30

You know, it's interesting because there's

43:33

this, actually I write about it

43:35

in my book, this, this theory called like pet

43:37

to threat. Have you, I don't

43:40

know if you've heard about it, but this idea

43:42

that when a black woman or woman

43:44

of color enters an organization,

43:47

like initially, you know, the people are

43:49

like, Oh, you're so amazing. We're so

43:51

happy to have you here. And then

43:53

once that, that woman starts speaking up

43:56

and pointing out things that need to

43:58

be changed within the organization. they

44:00

actually become a threat. And then

44:02

they become isolated and people tell them

44:05

that they're problematic. So it's almost like,

44:07

it's like they want you there. I

44:09

talk about this in the book, like

44:11

I was appointed to this, I was

44:13

handpicked for this diversity, equity and inclusion

44:15

role at the medical school at

44:17

the academic center I was at. I

44:19

was super excited to be in

44:22

this role because actually the reason

44:24

why the role was even created

44:26

was because a survey had shown

44:28

that there were huge gender disparities

44:30

in terms of perceptions about being

44:33

mentored, being sponsored and being promoted. Like

44:36

when junior women faculty just felt like

44:38

they were not getting the support they

44:40

needed. So they created this role and

44:42

I was super excited about this role.

44:45

And it turns out like I was actually

44:47

just, it was like a figurehead role. Yeah.

44:49

Like the institution. Like the open kind of,

44:52

yeah. Yes. They just kind

44:54

of wanted to say, okay, in response to

44:56

the survey, we created this position. But

44:58

what happened was I was super excited about

45:00

getting the role that I actually like

45:03

came up with all these ideas and initiatives

45:05

that I wanted to do. And

45:07

initially I just got shut down. And

45:10

it just made me realize that like a lot of

45:12

times, a lot of

45:14

these efforts, whether they're around gender

45:17

equity or racial equity, oftentimes

45:19

they can be very performative. And

45:24

it was so incredibly demoralizing for

45:26

me. But

45:28

once I started speaking up, I

45:31

was doing work around gender equity

45:33

and again, sexual harassment, I

45:35

actually became oppressed. Like

45:37

I was told like you're becoming too

45:39

political. Your- Like

45:42

your life is politic. Like, that's the

45:44

thing. That's a privileged thing to say

45:47

like, I'm not political. It's like, well,

45:49

that's because you're in the majority and

45:51

all the laws favor you right now. Exactly,

45:54

exactly. And so I was,

45:57

and my social media was being monitored. Like.

46:00

I literally feel like I was under

46:02

a microscope. And I think that's often,

46:05

and at the time I felt incredibly

46:07

isolated. Like I felt like I was

46:09

the only one going through this. But

46:11

I think it's something that's actually really,

46:13

really common in corporate America or in

46:15

academic medical centers. I think that there

46:18

are these environments where we

46:20

go into and we're super excited to be

46:22

there, but people are not necessarily

46:24

excited to have us speak up. They kind

46:26

of just want us there, just be representation,

46:29

but don't say anything. And

46:32

also just to say like, I approve of

46:34

what the administration is doing. I'm proud

46:36

of their effort. It's like

46:38

a way for them to get off

46:40

the hook about things. Exactly, exactly. Exactly,

46:43

I know. How incredibly frustrating. And then I

46:45

think the sad thing is what ends up

46:47

happening is that women, individuals of

46:50

color, these intersectional people who have a point

46:52

of view, and that point of view is

46:54

not a political point of view, it's a

46:56

personal point of view. This has been my

46:59

life experience. They end up being

47:01

shut down in places where there

47:05

is no space for that kind of honest

47:10

and critical discourse.

47:12

And so they end up

47:14

finding places where they feel

47:16

safe. So you have these

47:18

little silos of like really

47:20

progressive and inclusive spaces, but

47:22

they're all, quote, alternative. Well,

47:25

that's what's happening with me. I eventually

47:27

decided I'm going to leave. I'm

47:29

leaving this career that I built

47:32

for 10 years in academic medicine.

47:34

I thought I would stay in academics for

47:37

my entire life. I

47:39

never thought that I would leave. And

47:41

actually, I actually went through a

47:44

grieving period when I realized that it was

47:46

untenable for me to stay because I couldn't

47:49

show up authentically. I

47:52

couldn't talk about the issues that I cared deeply

47:54

about. And so then I decided

47:57

to leave this position that

47:59

people... people looked at me like, like,

48:01

like, what's wrong with you? I had multiple

48:03

titles, but I felt, I felt

48:06

misaligned. I felt like I was in an

48:08

environment, like I said, where I couldn't be

48:10

myself. And so I left and I started

48:12

my own consulting firm. And

48:14

I had like a five year plan that

48:16

I would, I was also working part-time in urgent

48:19

care. So which was considered like

48:21

a huge demotion from being an academic, but

48:23

I knew that like, that's what I needed to

48:25

do. But then, you know, but then summer 2020

48:27

happens, BLM,

48:30

the pandemic happened, and

48:32

it just reinforced the need

48:34

for the work that I wanted to do. And

48:37

I've been busy and working

48:39

ever since. So I

48:42

left this environment where I couldn't

48:44

show up as myself and I created one

48:46

for myself. Which is incredible.

48:48

And I think what a brilliant

48:50

approach to kind of doing this

48:53

on, you know, with advancing health

48:55

equity, which is your organization. And

48:57

also like, you know, speaking across

48:59

multiple platforms, consulting with individuals who

49:01

are open to learn because

49:03

there is that sort of, that

49:07

sort of, I guess, position

49:10

of representation. My concern is

49:12

when people find themselves going,

49:15

and not that this is a bad thing, but going

49:17

and working in like more community medicine or going and

49:19

working in more community

49:22

organizing. And basically

49:24

only finding themselves making a

49:26

difference in places where the

49:28

people are already open. You

49:32

know, the people are already realizing that

49:34

there's a problem. And then you have

49:36

these institutional places. It just

49:38

becomes more and more siloed. The problem gets

49:40

more and more entrenched because they're pushing out anybody

49:43

who has an alternative point of view. I

49:45

know. And I feel so conflicted about it because

49:47

people are like, people are like, are you saying

49:49

that everyone should leave? Like you left? And

49:52

I, and of course not. I

49:56

mean, I feel like ultimately you have to do what's

49:58

right for you and for your. world being

50:00

like, you know, of course

50:02

not. I mean, I think that if

50:05

you're someone who can work within those

50:07

environments and not be incredibly

50:09

harmful to you, then do it, you

50:11

know, because I feel like we need to be in

50:13

those spaces also. But I don't feel

50:15

yourself doing it. Yeah, exactly. But yeah, but I

50:17

knew I had gotten to a point where I

50:19

was like, Okay, like,

50:22

I'm losing weight, I have the

50:24

ads underneath my eyes, I can't

50:26

sleep. Like, this is not

50:28

a healthy environment for me. I'm going

50:30

to have to find an alternative. Yeah,

50:33

I mean, it's the same thing I often say when

50:35

I'm working with like LGBTQ youth, like

50:37

I did my internship for

50:39

my psychology degree in Florida.

50:42

I mean, this is a place where kids

50:44

couldn't be themselves legally. And so

50:46

it's like, when we're talking about,

50:48

you know, be loud, be proud, it's like only

50:50

if it's safe to do so, you know, like,

50:53

don't put yourself in the in

50:55

the line of fire. Because

50:58

that's, you know, what you see

51:00

is the right thing to do.

51:02

It's such a difficult and very

51:04

personal decision. Like safety first. Like

51:07

if you're not safe, you know,

51:09

how are you ever going to

51:11

actually be effective? But what

51:13

a sad thing that so many people

51:15

are grappling with, with such a fundamental,

51:17

what I believe is a human right,

51:19

the right to, yeah, safely speak. Yeah,

51:22

yeah, absolutely. And

51:25

so, you know, I'm curious now, obviously,

51:27

we've, we're running low on

51:29

time, we've sort of followed the

51:31

arc of your training of your

51:33

of your, the conflicts that

51:35

you've, that you've not just seen,

51:37

you know, the inequities that you've not just

51:40

seen, but felt personally yourself, and how they've

51:42

actually affected your career. So I'm curious about

51:44

the future, you know, what is like,

51:47

what is the ultimate goal, let's say for the

51:49

book, obviously, it was probably a

51:51

cathartic experience for you, but also you wrote it

51:53

for other people to read it. So what are

51:56

you hoping people take from it? And also, what are

51:58

you hoping that your work now where

52:00

your work takes you. Yeah,

52:02

I mean, you know, I always say I

52:05

wrote this book for a broad audience that

52:07

this is not just for people interested in

52:09

medicine or healthcare or science. This is a

52:11

book that anyone who is

52:13

committed to equity and justice

52:16

should read because I think it's going

52:18

to help them connect the dots on

52:21

how we arrive to where we are

52:23

today where, for example, you know, Black

52:25

Lives Matter people are three to four

52:27

times more licensed divided pregnancy related complications

52:29

and where the United States

52:31

has the highest maternal mortality rate of

52:33

any high income country, you know, we spend

52:35

the most on healthcare. Like I want people

52:38

to understand why this is

52:40

happening. And at the end of

52:42

the book, I have a call to action. I

52:44

have a call that the last chapter is a

52:46

call to action for different groups of people. It's

52:49

for for white folks,

52:51

for institutions, for hospitals.

52:53

Like I want people to understand, like

52:56

you can play a role in changing

52:58

things. You can play a role in

53:00

making sure that we have a more

53:02

equitable society. So that's my my goal

53:05

is that people read this and are

53:07

galvanized to take action.

53:10

And then for me, in terms of

53:12

next step, I don't even

53:14

know. I mean, literally, this book, I've

53:16

been working on it since for

53:19

about two years. Yeah,

53:21

you're like, why do you do something else? And I

53:23

just I know, I know. I'm

53:26

so I'm really excited about the

53:28

reception that is going to receive the

53:31

conversations that it's going to make. And what

53:33

I would really love is actually

53:35

to start working around policy,

53:37

whether that's on a local state or

53:40

federal level, because I talk a lot

53:42

about how we can improve health by

53:44

thinking about health more holistically. And that

53:47

looks like changes in housing policies, education

53:49

policies, employment policies, like how can we

53:51

just make our communities healthier? And it's

53:54

not just about what happens inside of

53:56

like I said, inside the exam room

53:58

or the So we have to

54:01

write there's a lot that happens. Yeah leading up

54:03

to that point and you've got to make those

54:05

connections Yeah, yeah, I would love to do more

54:07

work on the policy front. Oh, I love

54:10

that. I love that Well gosh, everybody

54:12

the book is legacy a

54:14

black physician reckons with racism

54:16

in medicine by dr. Uche

54:18

black stock I cannot thank

54:21

you enough for being here with us for

54:23

sharing your insights your time your story. It's

54:25

been It's been educational.

54:27

It's been informative. It's been I think in

54:29

some ways really kind of motivating and I've

54:32

just really I've just really enjoyed talking to you. So thank

54:34

you so much for being here Thank

54:37

you, Tara. I really enjoyed their conversation also

54:39

and Everybody listening.

54:41

Thank you for coming back week after week.

54:43

I'm really looking forward to the next time

54:45

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