Very few of us would readily be able to name an overtly racist colleague. However, we must consider racism (personal or systemic) or subconscious bias as a contributing factor. We can educate residents and medical students on these concepts and further teach them that even when we try to do “everything right,” we can still be part of harmful outcomes for our patients. That said, we cannot let ourselves become defensive because of confusion about systemic racism. To combat this, we must continue to review the evidence that says that these differences in care are not entirely explained by other factors. Every department can approach these evidence-based realities behind the data from the vantage point that every member of the department is complicit in the creation of these disparities.

Unfortunately, there are also some who think that this systemic racism is imagined, that the evidence is a fluke, and that black patients should inherently trust the American health care system. Those folks need a reminder that the last survivor of the Tuskegee experiments (the one where we just watched black people with syphilis suffer while there was a cure available), Ernest Hendon, died in 2004.

3 Participate in hospital policies.

As we continue to answer the demands of The Joint Commission and other regulatory bodies, we can be wary of unintended consequences of new policies and initiatives. Today, everyone from rappers to President Barack Obama point at medical professionals as both the cause and the solution to our country’s opioid problem. In 2012, Mehgani and others performed a meta-analysis of the oligoanalgesia in health care and found considerable racial disparities in pain control.⁶ Ironically, some researchers suggest that there is a “silver lining” to this oligoanalgesia that has protected non-Hispanic blacks from the rise in heroin overdose deaths. Although this epidemic is sad for all races, participating in the guidance of hospital policies that protect ED patients from being collateral damage could be an actionable item. In many guidelines and among expert panels, opioid pain medications remain the mainstay of therapy for severe pain in a sickle cell pain crisis.⁷ Combating policies that make it harder or more demeaning for sickle cell patients, who are essentially all black, to get pain medications is an example of how an individual department can address systemic racism. In our individual shops, we can advocate for this often at-risk group. You don’t have to be a diversity expert to be a part of the change.

To combat this, we must continue to review the evidence that says that these differences in care are not entirely explained by other factors. Every department can approach these evidence-based realities behind the data from the vantage point that every member of the department is complicit in the creation of these disparities.

4 Grasp opportunities to discuss.

We cannot be afraid to have an open dialogue about messaging during times of crisis (perceived or actual). The conversations about systemic racism can occur simultaneously with any other. In drafting guidelines for management of pain or the treatment of acute coronary syndrome, we should overtly discuss how to avoid disparities in care. Let’s take it one step further: We should talk about disaster preparedness in the setting of a nearby demonstration, regardless of its cause, and we can talk about how most emergency physicians neither report nor know how to report brutality toward persons in custody.⁸ Failing to address such issues insults our position in society.