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June 30, 2020

Academic Medicine and Black Lives Matter: Time for Deep Listening

Author Affiliations
  • 1Northwestern University, Feinberg School of Medicine, Division of Cardiology/Department of Medicine, Chicago, Illinois
JAMA. 2020;324(5):435-436. doi:10.1001/jama.2020.12532
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Echoes of “medicine as the noble profession” continue to resonate, now 35 years since my legendary Chair of Medicine imbued me with this guiding ethos. Nobility in medicine is not obsolete; the selflessness, courage, self-sacrifice, and altruism on gallant display in the response to COVID-19 reassures that at its core, this ethic of egalitarian service remains intact and deeply established in the DNA of physicians worldwide, including the ranks of academic medicine. But now, a new test of this nobility has emerged.

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    5 Comments for this article
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    Addressing Race-Based Score Differences
    James Thompson, MD ABIM ABEM | Retired physician
    With respect to differential race-based outcomes, the most insoluble issue for medicine and other STEM-based pursuits is that, even when adjusted for privilege of background, substantial standardized test score differences exist between self-identified group of "black" students and those self-identifying as "white" or "asian." At some level, STEM pursuits use these scores (SAT; MCAT; placement and certification exams) for ongoing advancement in the various fields.

    The gap is wide and has been highly resistant to efforts to close it. We need to fix it, and we need to find ways to address how we evaluate black students in
    the interim so that the testing score gaps do not prevent their advancement.
    CONFLICT OF INTEREST: None Reported
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    Radical Change
    Steven Blaser | None
    I concur with the author on almost all points.

    In his assertion that change occurs from the top down, he fails to acknowledge the situations where radical change occurs from the bottom. Such changes have included the rise of the Protestant sects of Christianity, Marxism, and the rise of popular music.

    History is full of cautionary lessons warning of the need to listen to and react to the forces of change or be left behind. If today's leaders are not responsive others will arise and take their places.
    CONFLICT OF INTEREST: None Reported
    Truth and Reconciliation
    Jacques Drolet, Ph.D. | Private Consultant
    Deep listening is something extremely difficult because it asks for getting out of the boundaries of our paradigm which for some is a betrayal of our reason-based values. However, there are techniques like "truth and reconciliation" that have been used to great effect in the most polarized context. The idea is if eye to eye is of value, there is much work from both sides (if polarized) and from many sides (if multidimensional, which it is...) to move toward a state where the contribution of all is optimized, which should be the goal, acknowledging that it is a dynamic process and that it will ask for re-assessments. Should you want to talk more, see www.idrg.eu.

    Kind regards,

    Jacques
    CONFLICT OF INTEREST: None Reported
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    Academic Medicine
    Nicholas Klokochar, M.D. | Retired
    If racism is present in Academic Medicine then fix the Academic Centers, ie, the faculty that apparently espouses it. Judging the present by the past solves nothing. Turning doctors into social justice warriors may salve Academia's conscience but actually teaches racism by forcing doctors to look at patients by factors other than their illness.
    The goal of Academia is to turn out the best doctors regardless of race, ethnicity, sex or other uncontrollable attributes. Filling quotas does just the opposite. It is reverse discrimination. Fairness and not social justice should be the goal.
    Categorically blaming
    disparate outcomes on racism while ignoring the effects of genetics and personal responsibility is a cop out.
    CONFLICT OF INTEREST: None Reported
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    The Pace of Change in Medicine
    Catalina Lopez, MD | Private Physician
    That academic medicine has been slow to integrate is an understatement. There are many causes and “truism 4” indirectly addresses what may be one of the biggest hurdles to achieving racial equity: unconscious bias in identifying the new leadership. That knot can only be unwound by strong leadership from the top to include the Board Chair of the hospital, the President/CEO, the Department Chair, the Division Chief, and the Program Director. Given that “truism 1” is so widely challenged (hence, not a truism) and that so many people would have to overcome their unconscious bias and system 1 thinking, I see it as a near impossibility that academic medical centers on their own will actually act. Perhaps if their funding were threatened or if financial incentives were rendered for the creation of a more diverse environment will we see change.

    And change we do need to see because there is evidence galore that diversity in medicine has many benefits to the community as well as to the Academy itself. But I am pessimistic. They say that it takes 15-20 years for research evidence to reach clinical practice. I have been following this debate for 30 years and the ending never changes.

    Fernando Lopez, MD, FACP, FACC
    CONFLICT OF INTEREST: None Reported
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