How do you fight racism in medicine?

I bleed blue and gold. No, I am not talking about Michigan, West Virginia or Notre Dame. I am definitely not talking about UCLA Bruins (by the way, UCLA fans, a bruin is a brown bear). That’s right — I am a die-hard Cal Bears fan.

Thanks to Cal football, and particularly to legendary Marshawn Lynch, my college days were filled with excitement. (I am counting on you, Coach Wilcox.) Marshawn, an Oakland-native running back, is one of the best football players to graduate from Cal, and he happens to play for my team, the Oakland Raiders. Known for his power running style and ability to break tackles, he is one of the best running backs in the NFL, and I think he makes the world a better place. You think I am dramatic? Let me prove you wrong:

Marshawn blesses us with his famous unfiltered one-liners.
Sometimes he will grant an interview, but mainly so that he doesn’t get fined.
Fam1st Family Foundation, which Marshawn helped to co-found with his relative, Josh Johnson (NFL QB), provides education and empowerment to underprivileged youth.
Have you ever seen anyone better at “ghost riding the whip?”
Marshawn Lynch sat down during the national anthem at Raiders preseason game against Arizona Cardinals. Judging by the national uproar that followed, actions still speak louder than words. Just ask Marshawn about it. Oh, wait — he might not answer your question.

Marshawn did not immediately elaborate on his action, but his sit-down happened in the wake of the violence at the white supremacist rally in Charlottesville and followed Colin Kaepernick’s protest against racial injustice and police brutality against people of color. Marshawn’s simple action, or inaction, polarized the football community and ultimately achieved its intended purpose: to sustain and stimulate conversation about what happened at Charlottesville and across the nation.

When pressed by the media about his anthem sit-down, Marshawn said:

“So my take on it is, sh-t has to start somewhere, and if that was the starting point, I just hope people open up their eyes to see that there’s really a problem going on, and something needs to be done for it to stop. And if you’re really not racist, then you won’t see what he’s doing as a threat to America, but just addressing a problem that we have.”

Individual and structural, overt and implicit — pervades every state and every industry, and medicine is not immune to it. While we doctors use objective measures, such as lab tests, to diagnose patients’ ailments, we also use heuristics in our medical decision-making, depending on our categorizations of people based on physical characteristics, such as race and ethnicity. And sometimes, a patient’s race becomes a confounder: A black patient’s pain is treated differently from a white patient’s pain.

The patients also bring their own biases and stereotypes to the hospital. A typical male Floridian octogenarian, meaning a white-haired transplant from New York or a “snowbird,” presented to our emergency department for acute heart failure exacerbation. He was huffing and puffing until we put him on a noninvasive positive-pressure ventilation. Remarkably, between his gasps for his next breath, the patient managed to point at one of our residents of Middle Eastern heritage and to spurt out the following string of words: “I … don’t want … his kind … treating me.” It was a paradigm of how not to start a vulnerable yet trusting relationship between a patient and a physician.

The story might seem to show an isolated incident, but our hospital has been getting such requests, with increasing frequency, in the past few months. Why? We are not sure, but we know that since the last presidential election in the U.S., there have been multiple reports of racist- and hate-fueled harassments and acts of intimidation around the country.

How do we approach such a sour situation in medicine?

Our duty as physicians is, first and foremost, to treat and to stabilize patients. Once patients are stable, those with competency have the right to refuse care under informed consent. In other words, patients can refuse care from unwanted physicians. In turn, physicians are also freed from our Hippocratic Oath to “consider for the benefit of my patient and abstain from whatever is deleterious and mischievous.” It would be deleterious and mischievous to force a professional relationship that was built on bigotry.

While letting patients choose physicians based on race, ethnicity, gender or sexual orientation seems like allowing hate to win, stepping away from the “fire” helps physicians to protect themselves from unwarranted verbal assaults and constant emotional abuse. Physicians are allowed to acknowledge their human emotions, too.

We must perform our duties as physicians, but we do not have to tolerate hate. I recommend physicians to remove themselves from hurtful encounters, but I also encourage physicians to advocate for or at least try to understand, someone from a different background. Unfamiliar does not have to equal uncomfortable: See it as a learning opportunity. After this blog, I might even become the recipient of racially charged comments.

I am, however, willing to embrace whatever comments are directed at me. Why? Because that’s exactly what this is about: to break bread and generate conversations as a way to break barriers and hate.