Monday, July 13, 2020

Prioritizing in Palliative Medicine: Why Quality of Life Suffers with Racism

by Michelle Christopher @michellethedoc and Sonia Malhotra (@SoniaMKhunkhun)

The silence was palpable. Two of us continued to speak about our concerns about the way Black lives were treated and how important it was to address these concerns among us for the betterment of our patients. If we couldn’t understand this among colleagues, how would we ever understand what our patients, a predominantly Black population at a safety net hospital, went through?

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As the COVID pandemic started and we saw the first surge of patients flood our hospitals, we watched our patients, colleagues and broader community come together to share stories and experiences. After asking patients how they were coping with the anxiety that social isolation and fear of infection brought, our patients would often thank us for holding space for them to speak on these challenging times. Each week, our colleagues would gather to share the high and low points of our week, often focused on how the pandemic was affecting us personally and professionally. Our multidisciplinary team would speak openly about feeling empowered at times and discouraged at others when attempting to serve the complex needs of our patients, whose families were being ravaged by this virus. The connectedness felt with our patients and colleagues during this time was an inspiring reminder of how open communication and a sense of community is integral to sustaining collective physical, mental and spiritual health throughout a pandemic.

A few weeks later, we noticed another global response in the form of a civil rights movement for racial justice in response to the murder of George Floyd. The feeling of connectedness subsided and was swiftly replaced with tension and uncertainty of how to speak with each other about racism and how it affects the health of our patients and us.

I don’t see color,” were the words our colleague used as protests broke out about the injustice faced by George Floyd that ultimately led to his death. We knew our colleague was concerned and well-meaning when stating she saw everyone the same. However, we wanted to hear that she saw color and acknowledged this as an important part of the beauty of our individualism as well as the cause of injustices faced. It was not uncommon for us as Palliative Medicine physicians to address death. The manner in which Mr. Floyd’s death occurred, however, was a tragedy that stuck with many of us, especially those of us who identified as persons of color. To see a man treated less than how an animal would be treated made us worry about our patients, friends, colleagues and our own children who could (and probably would) one day be targeted by the systemic racism that led to Mr. Floyd’s death.

It was hard to imagine how people didn’t see color. As brown women in Medicine, we didn’t have the luxury of not seeing color – it was something we had to contend with on most days. However, these experiences didn’t compare to that of our Black friends and patients who experienced far greater injustices due to their color. These experiences included one of our Black friends carrying her badge and stethoscope everywhere so if stopped by the police, they knew she was a working professional and didn’t assume otherwise. Another of our colleagues in Medicine, a young Black man, often spoke about his experiences with being pulled over by police and having a gun pointed at his head. The luxury afforded to our white colleagues was not one that persons of color had – the ability to not see color. And as we looked at our colleagues during that conversation, we noticed the only people speaking in the room were those who identified as persons of color.

It made us realize as physicians in one of the largest Palliative Medicine programs in the Deep South, that we needed to do better. EVERYONE NEEDED TO DO BETTER. As Palliative Medicine clinicians, we pride ourselves on communication skills and quality of life. How could we attend to this with our patients if we were not attending to this in our own backyards and with our colleagues? Seeking to understand the disparities faced by our own colleagues could only help us understand some of the disparities faced by our patients including lack of access to opioids, maltreatment when seeking opioids, medical mistrust which often led to prolongation of interventions not promoting quality of life, a reluctance to seek medical care and often a reluctance to seek hospice care when appropriate.

The prospect of discussing racism with our colleagues and patients can be daunting. However, for those of us practicing Palliative Medicine, we are no strangers to having tough conversations. In fact, we can utilize Palliative frameworks to approach conversations around race and inequity. Some steps to take toward this include:

1) Asking permission to start a conversation about racism, an often triggering or uncomfortable subject for many.

2) Offering a safe space for patients to share how racism might be affecting their access to healthcare and quality of life including physical and/or mental health.

3) Providing space for colleagues to share how racism has impacted their own personal and professional lives.

4) Normalizing conversations around racism for multidisciplinary teams in the contexts of collaboration and professional growth and for patients in the context of psychosocial stressors.


Starting these important conversations within our teams can help us better understand how to align with our Black colleagues to change a system that has not historically welcomed nor encouraged their professional upward mobility. Similarly, this open communication with patients provides opportunities to improve the medical and psychosocial support we as Palliative Medicine teams can offer our most vulnerable patients.

In these unprecedented times, we as Palliative Medicine clinicians have a unique opportunity to utilize our communication skills to lead discussions on racism for our colleagues and patients. Similar to how our field prioritized serious illness and end of life care, we need to prioritize changing patterns of silence and inaction that have led to the current injustices and health disparities our Black/Indigenous/Persons of Color (BIPOC) colleagues and patients are facing. It is time for us to collectively use our voices, our time and our training to unite in support of our patients and colleagues and to proclaim Black Lives Matter.

For more reading material, the following sites have excellent information:

https://www.nationalpartnership.org/about-us/racial-equity/racial-equity-reading-and-learning-resources.html
https://www.racialequityinstitute.com/rei-blog

Michelle Christopher, MD is a palliative medicine physician at University Medical Center, a safety net hospital in New Orleans, and an Assistant Professor with Tulane University School of Medicine. She enjoys cooking Sri Lankan food, exploring the cultural and culinary wonders of New Orleans, and traveling.

Sonia Malhotra, MD, MS, FAAP is Director of Palliative Medicine and Supportive Care at University Medical Center, New Orleans and Tulane School of Medicine. She loves cooking, reading and the arts which include a passion for dancing. In her past, she was Captain of her college’s Bhangra and Hindi Film Dance teams.


Monday, July 13, 2020 by Pallimed Editor ·

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