I recently completed a book called ‘Why are all the Black Kids Sitting Together in the Cafeteria?’ written by Dr. Beverly Tatum, an expert on race relations in the classroom and the development of racial identity. Dr. Tatum introduces a concept called ‘smog-breathing,’ where individuals who are consistently exposed to stereotypical images, messages, or behaviors in their environment consequently associate these stereotypes with certain racial or ethnic backgrounds. She likens these stereotypes to ‘smog’ and oftentimes, given that the ‘smog’ can be so thick (through media exposure, comments made by others around us, etc.), we cannot help but only breathe it in.
No one likes to be considered racist or prejudiced. As Americans, we embrace ‘unity in diversity’ and flaunt this to the rest of the world.
However, if I sit down and examine my own stereotypes in my workplace, I am astonished at how many I can come up with. I work predominantly in a county hospital serving largely our poor and underserved population in Atlanta, Georgia; therefore, it probably isn’t surprising that different stereotypes and prejudices abound, whether intentionally or unintentionally. As examples, if I see a patient presenting with cocaine-induced congestive heart failure exacerbation, or learn that another patient has a history of non-adherence to medications, or discover that a patient is unable to read his prescription bottles and therefore has not been appropriately taking his medications, I am not surprised when I find out that these patients are African-American. In reality, most of my patients’ behaviors are a ramification of their socio-economic environments rather than their racial/ethnic background. However, over time, after continuously witnessing certain behaviors with a particular race, I inadvertently fall into the trap of associating the behaviors to the racial background. Then, I am stereotyping.
Well, one may ask, are these really stereotypes or prejudices? Sometimes these behavioral associations appear to reflect reality. Maybe sometimes, they are. Health disparities research has shown that there are differences in overall rate of disease burden and opportunities to achieve optimal health among different populations, including different racial and ethnic populations. However, they need to remain as simply observations to not be considered ‘stereotypes’ and ‘prejudices.’ If, however, our ‘simple observations’ affect how we provide care among different racial/ethnic groups in that one racial group may benefit over another, then perhaps we are actually stereotyping. Dr. Tatum defines racism as a system of advantage based on race. Our stereotypes may in fact be perpetuating, even if without malicious intent, racism.
For example, would we educate our illiterate, African-American man with chronic obstructive pulmonary disease who continues to smoke 1 pack per day on the harms of smoking with as much tenacity as we would our educated, Caucasian male? Would we provide the same aggressive and invasive treatment options to a poor African-American man as we would to the wealthy Caucasian man? Sure, socio-economic factors have a tremendous role in our management, but perhaps we may need to examine our racial stereotypes a little more closely as they may also be influencing our decisions.
I have personally witnessed many health care professionals (myself included)—indefatigably working long hours to provide excellent care to their patients—who at the end of the day feel that their persistent efforts to educate their patients are oftentimes hopeless. Often I hear, ‘Well, he [or she] does not have the motivation to change their behavior. We tried our best to tell them what they need to do, but that’s all we can do.’
‘Is that all we can do?’ I wonder.
Perhaps, we are folding much earlier than we should.
Once we all as physicians, individually and collectively, bring our stereotypes to our conscious awareness, realize how our stereotypes affect our care of individuals and different groups of people in society, and strongly affirm that all our patients must be equally treated but within reason given socio-economical constraints, then we can be motivated to action. Let us take those extra few minutes at each patient visit to counsel on tobacco cessation and appropriate dietary practices for all of our patients, despite the seeming absence of motivation in some of our patients. Let us take that cultural competency training class offered to health care professionals at our institution to better educate us on how to close the disparities gap in health care. Let us not let a racial remark by a colleague go unhindered. Let us actively speak out against racial stereotyping and profiling in our workplace.
Let us not become smog-breathers, and let us achieve the ‘unity in diversity’ that America so cherishes.