Winter 2019

Leveling the Playing Field for All Patients

How health-care pros can combat bias.

By Monica Jimenez

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John Rich, left, and Roy Martin. Photo: Alonso Nichols

At a time when homicide is the leading cause of death for African American men between the ages of fifteen and thirty-four, health-care professionals must find ways to stem the violence, said physician John Rich, a professor at Drexel University School of Public Health.

“If you follow those who have been shot or stabbed, five years later 45 percent of them will have been shot or stabbed again, and 20 percent will be dead. It’s unacceptable to do nothing, knowing those rates of morbidity and mortality,” Rich told Tufts School of Medicine students at an October 22 talk about his 2008 book Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men, which was the Common Reading Book Program selection for all incoming med- ical students this fall (the initiative is supported by Jonathan M. Tisch College of Civic Life).

But assuming what helps one person will help everyone can do more harm than good, said Rich’s friend and colleague, Roy Martin. One of the subjects of Wrong Place, Wrong Time, Martin grew up in the Boston area immersed in violence, but working with Rich changed the course of his life. Today he mentors troubled youth as a case management director at the Safe and Successful Youth Initiative in Massachusetts. “We make mistakes when we decide the score of the game before we play it,” Martin said.

What should practitioners do instead? Rich and Martin offered the audience some concrete ways to understand and support victims.

NOTICE UNCONSCIOUS BIAS. “As you train, keep an eye out and watch carefully what happens to patients. See how differently patients get treated,” said Rich. Black patients often get denied pain medication or are treated as though they deserve what happened to them, Martin added—and there isn’t enough recognition that perpetrators of violence can be victims, too. “If you don’t feel you can be other things, that’s the one thing you can be: violent,” Martin said.

CHOOSE YOUR BATTLES. “In medicine, we can be very polite about how we talk about stuff—there’s no right, no wrong, it’s very nuanced,’” said Rich, who previously served as the medical director of the Boston Public Health Commission and created the Young Men’s Health Clinic as a primary-care doctor at Boston Medical Center. Calling attention to unfair treatment can impact your career, he said. “You have to be creative: What are your opportunities to identify bias in the system and to affirm what you know, because studies show disparities in the health system?”

SEE THE WHOLE PERSON. Rich cited his early encounters with Martin, which were driven by curiosity and recognition of each other’s humanity. “We have to engage people as human beings without judgment or prescription,” he said. “The people closest to the problem are the people who are closest to the solution.”

BE A GOOD ROLE MODEL. Martin said black youth are often drawn to violence because rappers and drug dealers are their best models of wealth, power, and success. Growing up, he didn’t have any role models who attained status through education—and then he met Rich. “I’m like, well, damn,” Martin said. “You just threw another possibility in for consideration.” Rich was living proof that there was a way of making it that didn’t hurt people, but helped them, Martin said. “What we must do is show folks with swagger who are not rappers,” he said.

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