I am a black male who lives in two worlds. I am a physician in a busy inner-city emergency department who works closely and respectfully with the law enforcement professionals who bring in patients. I am also someone who has been pulled over for driving while black, has been followed in stores for shopping while black, and is aware that we live in a country where black people can be killed for minor offenses like selling cigarettes, having broken tail lights, and holding sandwiches.

The busyness of the emergency department can act as a barrier to conversations and actions that would ideally lead to systemic change. Worse yet, the racism in the academic medical environment is covert as it is often systemic. Therefore, as a person of color and often the only black physician present in the room, I am compelled to share my perspective in order to create awareness and encourage change.

Here are four ways to help avoid racism in your emergency department.

1 Understand the difference between “systemic racism” and “personal racism.”

As with any issue, the first step is acceptance that there is a problem.  Systemic racism is as real as sepsis, myocardial infarction, and ringworm. It is often conflated with the more overt racism that we experience on a personal level. Systemic racism is defined by a set of policies that are put into place in order to maintain the disenfranchisement of a group based on race.¹ The personal racism we traditionally think of belongs to an individual who wields their own position of power to disenfranchise a people.

Emergency physicians should be very familiar with systemic racism to provide insight into their own practice. Knox Todd, MD, MPH, who has published extensively in the pain and disparity space, noted these disparities in several studies. We know that black people with long-bone fractures get fewer pain medications, but we also know that there are not sufficient data to support provider/patient concordance in these disparities.² A true understanding of why this occurs (and keeps occurring) cannot be obtained without accepting that all races and ethnicities of providers are complicit in the creation of this systemic racism.

2 Continue to educate about health care disparities.

In addition to oligoanalgesia, we know that blacks are less likely to get invasive cardiology procedures.³ We know that blacks are less likely to survive cardiac arrest even when it happens in the hospital.⁴ We know that blacks are less likely to receive thrombolytics for stroke.⁵ We know that blacks do worse in many aspects of the care we deliver to patients. We may never be able to adequately control for all variables and confounders, and perhaps, black patients are somehow predisposed to worse outcomes.