After George Floyd died with a police officer’s knee on his neck, protests broke out across the world. Most were peaceful demonstrations against racism and for changes to U.S. policing policies.

Many healthcare organizations, including the American Medical Association, the Association of periOperative Registered Nurses (AORN), and others, joined hundreds of businesses in condemning racism and the brutality that led to Floyd’s tragic death.

The American College of Surgeons (ACS) issued a call to action on racism as a public health crisis, calling it an ethical imperative, particularly as the COVID-19 pandemic takes a disproportionate toll on the African American community.1

“These unprecedented crises call for enlightened and innovative leadership, inspired intervention, and compassionate service from all members of the ACS,” the group wrote on June 9.

The ACS said the organization is committed to creating a more just and inclusive environment for everyone and to ensure the development of a culturally competent and inclusive environment.

AORN’s statement calls for everyone to stand together against hatred and discrimination.2 “It is our belief that those who bear witness, but remain silent, are collaborators. Silence is consent and, in their silence and inaction, collaborators are as guilty as the perpetrators who commit the crime,” AORN President David A. Wyatt, PhD, RN, NEA-BC, CNOR, said.

The emphasis on addressing racism and health disparities is welcome, but should not be the only action physicians and nurses take, says Stephen B. Thomas, PhD, director of the Maryland Center for Health Equity at the University of Maryland.

“Where were they before that?” Thomas asks. “How do we hold them accountable for what they said? Is it just a statement? Is it window-dressing or accountable? Let’s give them credit for stepping up, but it’s late in the game. We’ve been dealing with health disparities and access to surgical care for a long time, not just in this time of COVID-19 and racial reckoning in America.”

Clinicians can advocate for and share evidence-based information. One traditional format for speaking publicly is through opinion pieces in medical journals. In July, The New England Journal of Medicine published a perspective piece, titled, “Stolen Breaths.” The authors, including two physicians, used George Floyd’s dying words, “Please, I can’t breathe,” to highlight the health effects of racism in America, including on Black men and boys killed by police, the legacies of segregation and environmental racism, and the higher rates of asthma and cancer among black communities.3

Physicians also are speaking out on newer platforms, including social media, about the pandemic, racism, gun violence, and other issues. For example, one physician posted on Twitter in July: “Hi, ER Doc here. If you think wearing a piece of cloth makes it ‘hard to breathe,’ then trust me, you do NOT want COVID-19.”4

Rob Davidson, MD, who uses the hashtag #WearAMask, frequently tweets about misinformation about COVID-19 and what he personally sees in the hospital emergency room.5

Another physician, Leana Wen, MD, tweeted in: “All 62 residents in a single nursing home in Kansas have tested positive for #covid19. 10 have died. This is so tragic & yet another reminder that ‘herd immunity’ does not work. You can’t wall off the vulnerable from an extremely contagious disease.”6

Before the pandemic, medical professionals used Twitter, Facebook, Instagram, and other social media platforms to advocate for solutions to gun violence. They formed @ThisIsOurLane on Twitter.7 Healthcare workers also have joined protests in support of Black Lives Matter and to demonstrate against police violence.8

Disparities go beyond racist policing and gun violence tragedies. Poverty and limited access are huge contributors to inequities. Surgeons are witnesses to this, although they might not recognize how inequities and access issues have contributed to disparate outcomes.

For instance, Thomas worked with surgeons and cardiologists who showed him a list of patients diagnosed with a heart problem who needed valves replaced. Before that procedure, patients needed to receive clearance from a dentist to confirm there are no active cavities or gum infections. Such confirmation reduces the chances of postoperative infections.

Patients on the list had not secured dental clearance, which led to delays for some as long as one year. In the interim, certain patients would present to the emergency room for heart-related conditions. The problem was they did not have the money to pay for dental work that was necessary before they could receive the clearance.

“Many people are not able to have surgical procedures because they don’t have dental insurance,” Thomas notes. “Surgeons can speak up about that, about how it’s important for patients to access dental care, and how it’s necessary for their surgical procedure.”

This is a problem that disproportionately affects low-income people and Blacks, Hispanics, Native Americans, and Alaska natives.9

One solution to the dental access problem is the Mission of Mercy emergency dental clinics that provide weekend-long free dental care on a first-come, first-served basis. A study of one Mission of Mercy clinic in Maryland showed how 66% of those who received free dental services lived with one or more chronic conditions or risk factors. The clinic provided dental services to more than 1,000 people, of whom 49% were Black and 23% were Hispanic.10

“Physicians know that you cannot do some surgeries without dental clearance, but they say that’s somebody else’s job. I have a problem with that,” Thomas says. “They have to speak up. If COVID-19 does anything, it’s exposed the broken parts of our infrastructure.”11

Thomas calls on white surgeons “to use their privilege and rank” to help advance fairness. “That’s what health equity is all about. We’re not asking them to end poverty in America, but to do what they can where they are,” he adds.

REFERENCES

  1. American College of Surgeons. American College of Surgeons call to action on racism as a public health crisis: An ethical imperative. June 9, 2020.
  2. Association of periOperative Registered Nurses. Message to perioperative community and AORN staff.
  3. Hardeman RR, Medina EM, Boyd RW. Perspective: Stolen breaths. N Engl J Med 2020;383:197-199.
  4. Sam Ghali, MD. Twitter. July 5, 2020.
  5. Rob Davidson, MD. #WearAMask. Twitter.
  6. Leana Wen, MD. Twitter. Oct. 20, 2020.
  7. Twitter. @ThisIsOurLane.
  8. Williams D. They spent months helping Covid-19 patients breathe. Now health care workers are kneeling for George Floyd. CNN, June 8, 2020. https://cnn.it/3jkWyNf
  9. Centers for Disease Control and Prevention. Disparities in oral health. Page last reviewed May 1, 2020.
  10. Jackson DN, Passmore S, Fryer CS, et al. Mission of Mercy emergency dental clinics: An opportunity to promote general and oral health. BMC Public Health 2018;18:878.
  11. Gold JA, Rossen LM, Ahmad FB, et al. Race, ethnicity, and age trends in persons who died from COVID-19 — United States, May-August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1517-1521.