How racial issues affect both doctors and patients [PODCAST]

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How do racial issues affect patients’ physical and mental health, and how do we address them during regular visits? For those without the lived experience of the black community, how can we learn and educate ourselves? How are the current protests different from those in the past? In order for us to make enduring changes that arise from the protests, what needs to happen?

C. Nicole Swiner is a family physician and can be reached at Docswiner and on Twitter @docswiner.

She shares her story and her perspective on the country’s racial climate and how it affects both doctors and patients.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Dr. C. Nicole Swiner. She’s a family physician, speaker, author, publisher. Is there something that you don’t do? Probably not. Nicole, welcome to the show. So I was wondering if you could start by sharing your story and your journey to where you are today.

C. Nicole Swiner: Yeah, well, I have been in family medicine in private practice now for about 13 or so years, and that’s been most of what I’ve done since residency. I started out as a person that worked with a hospital clinic, and then we kind of forcibly became entrepreneurs, and we have a private practice now back home. But that’s my main gig.

And then shortly after becoming a working physician and entrepreneur, I soon learned that I had trouble balancing all these things I was supposed to do, because then I got married and had two kids and was running a business, etc., and had a lot of stress and felt overwhelmed and was not getting enough sleep, etc. And so I started to learn more and more about the superwoman complex, which is what I talk about and speak about and write about a lot.

And so that’s kind of become my side gig slash passion, because from that I started doing some writing for local magazines and articles and in the newspaper. And then with the help of KevinMD, I’ve been able to travel locally and nationally and do speaking engagements. And then once I started writing books on the superwoman complex, I had more and more friends and colleagues ask me how I did it, “Can you teach me?” and “Can you help me publish?” And that’s literally how Swiner Publishing was born. So now I kind of do that as well, and I’ve been able to cut back more and more on clinical practice and do a lot of these other things that are fun, and thankfully I’m able to make a little bit of money from that, too.

Kevin Pho: Fantastic. Well, it’s clear that we are going through historic times. We have twin public health crises: We have the pandemic, and we have the nationwide protests against racial injustice. I was wondering if you could share your perspective on the protests and the current racial climate in our country.

C. Nicole Swiner: You know, it’s been very interesting, living as a black person, practicing as a black doctor in general, clearly, and having to deal with a lot of these injustices my whole life. It’s just kind of part of what you know. When I was growing up, my parents taught me how to navigate and move in different circles and how to protect yourself and behave in certain instances, like if you were pulled over by the police or if you were approached in certain situations. So it’s always, of course, been a part of me.

But this time in the world is particularly interesting, because we’ve been dealing with racism as a public health issue forever. But I think because now people are at home and we are all kind of stuck to the screens, we’re watching all the news, all the social media, looking at our phones 24/7, I think it’s literally in our face more now, and so you have to deal with it. The horrible killings of George Floyd and Breonna Taylor and multiple, multiple others have unfortunately been broadcast for the world to see, and have fortunately brought these things to light, and now we have to deal with it. And the protests have been very vocal about now being the time to address it. So it’s a very interesting time we’re living in right now.

Kevin Pho: So is there something about these protests that makes them different from those of the past?

C. Nicole Swiner: Sure, they’re different. I mean, I love the fact that our young folks are, you know, young. I’m 42. But I love the fact that the millennials and the Gen Xers are now getting heavily involved. I think there was this misconception, particularly with those younger folks, that racism was over, that we’re one big happy world, and the things that happened in the civil rights era, we’re through with that, we’re done with that, when clearly we weren’t. So I love that they have become more vocal, they have become more involved, they understand more what’s happening, what our ancestors were fighting for, and now they’re ready to really address it and get something fixed.

Kevin Pho: And so in order for us to have any enduring change, what do you think needs to happen going forward?

C. Nicole Swiner: Well, I think racism is present everywhere. It’s present in society, it’s present in medicine. There are many biases that have been present in medicine since the birth of medicine and OB/GYN. If you go way back in history, you’ll see where black women were used as research subjects without their consent in horrible ways, and so some of that unfortunately has been carried through to now.

So one reason I even brought this topic up to you was because I had a talk with my staff after the protests really got started and these things were happening, and we talked about how we need to be more aware of it when we’re addressing and talking to our patients. Actually, my PA, who is Caucasian, brought this up to me and said, “You know, I just had a visit with my black patients.” And she was very sensitive to what’s happening, has been very aware, has been educating herself, but the patient actually asked her, “You need to ask your black patients how they’re feeling about this. Don’t just brush over it. We all need to talk openly about it.” And I said, “That’s a really good point.”

And so as a staff, we’ve been trying to be more proactive and more intentional in talking to our black patients, our patients of all types really. We treat all patients, but particularly our black patients and patients of color, asking them, “How are you doing? This is a very, very tumultuous time. The protests are happening, these killings are happening, the fighting is going on with this police brutality. How are you dealing with it?” It’s almost yet another layer of things we have to think about now during the clinic visit: How are you dealing with all these things happening? Ask me about it.

Kevin Pho: So tell me some of the issues that race has on our patients, the behavioral and physical aspects of race. How does it affect our patients?

C. Nicole Swiner: Yeah, it’s another level of stress. It’s something else that is on their mind when it has to do with just living and walking. I was talking to one of my middle-aged black male patients dealing with prostate cancer and hypertension, and we were having a regular follow-up visit, but I was heartbroken talking to him about how he’s been trying to get healthy. He wants to be able to come off his blood pressure medication, so he’s working really hard on his exercise and his diet, but he hasn’t felt comfortable with walking in this neighborhood recently. So he hasn’t been exercising as much, because he’s afraid, literally, of having the police called on him in his own neighborhood. I mean, think about that. That’s heavy.

And so the fact that he has that extra level of stress, of fear, which clearly, as we know, impacts all parts of mental and physical health, but now he’s not even able to exercise the way he normally would because he’s fearful. So it just takes that little extra thought, just to kind of think, what kind of environment is the patient living in? We have to ask him about it and see if we can fix it in some way.

Kevin Pho: Now, for those of us who don’t have the lived experience in the black community, what are some ways that you can suggest for us to educate ourselves? Where can we find resources to help?

C. Nicole Swiner: Yeah, well, the Black Lives Matter movement. If you research or search the hashtag Black Lives Matter, there are lots of resources online, on the internet, and different organizations that you can become a part of or donate to that can be very helpful and educational.

I’ve been overwhelmed with the amount of colleagues and friends that have reached out to me, non-black colleagues have reached out to me saying, “You know, I’m embarrassed. I know that I’ve contributed. I want to intentionally be anti-racist. What do I do?” After about the tenth person, it became a little exhausting, although I’m very appreciative of folks learning to be awake during this moment. But doing your own research definitely helps.

So I think there’s another, my other favorite book that’s been talked about a lot, is called White Fragility, and that’s another one that brings, you know, it’s very controversial, but it talks about honest things when it comes to uncomfortable discussions that we need to be having with our family, with our friends, and helping folks to realize what their own biases are.

Kevin Pho: Let’s take a step back. I was wondering if you could share with my audience something that you’ve been curious about or something that you’ve been passionate about recently.

C. Nicole Swiner: I guess this, more, I mean, dealing with COVID-19, with quarantine, and having to stay at home more and be present with my family, all this is happening at the same time, and then the extra layer of the protests and brutality happening. I’m not, and I’ve never been, someone to really speak out from a political perspective, but because this affects so many different parts of people’s lives, I feel like I need to be more vocal. So I have gotten more involved and more vocal in the movement towards anti-racism and how our non-black colleagues can be more involved and have less prejudice. So I guess this is what I’m passionate about.

Kevin Pho: So we’re talking with C. Nicole Swiner. She’s a family physician, and she’s also an author, speaker, and publisher. So my final question, Nicole: What’s your take-home message for the KevinMD audience?

C. Nicole Swiner: Just be present. Be present. We tend to shy away from those uncomfortable conversations and things that make us feel uncomfortable. If you see something happening that is negative, if you hear your relative making a racist comment at the Thanksgiving table, if you see police brutality occurring, or if you have that feeling of needing to call the police, take a step back and think what can happen to this other person, and address it right then and there, because it could literally save someone’s life.

Kevin Pho: Well, thank you so much for sharing your advice, insight, and wisdom. How can people find you?

C. Nicole Swiner: I’m at DocSwiner on almost all social media, Instagram, Facebook, LinkedIn. So let me know if you need my help.

Kevin Pho: All right, thank you so much for joining us on the show.

C. Nicole Swiner: Thank you.

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