Dismantling structural racism in the academic residency clinic
I am very excited to share my recent publication in the New England Journal of Medicine, “Dismantling Structural Racism in the Academic Residency Clinic.” This piece has been a few years in the making. It grew out of conversations with Dr. Vanjani, an attending physician in an academic primary care clinic, from a desire to explore the work of Frantz Fanon, a revolutionary psychiatrist and anti-colonial philosopher whose writings during the 1950s and ‘60s continue to resonate today. As a medical student at the time, I cannot emphasize enough how special and rare this type of mentorship was from an attending as I was attempting to make sense of the sociopolitical forces shaping my early interactions with patients.
When Dr. Vanjani introduced me to an analysis of Fanon’s writings on the patient-physician relationship by Dr. Pitts, a professor of philosophy, things began to click. In “Examining Carceral Medicine through Critical Phenomenology,” Dr. Pitts brings to our conscious awareness that the “dual loyalties” clinicians face today in carceral settings between their patients and the prison administration are eerily similar to those described by Fanon between his patients and the French colonial state. Dual loyalties continue to have a significant, often insidious impact on the quality of care patients receive. When we reached out to collaborate with Dr. Pitts to examine the dual loyalties in academic residency clinics, they were excited and immediately enriched our discussions by bringing in the history of the Young Lords, a group of young activists inspired by the Black Panthers and student movements in Puerto Rico. What emerged was a new and exciting bond as the world around us was isolating because of the COVID-19 pandemic. We persisted through a rejection letter. Now, words cannot fully capture how good it feels to see our work finally published.
For all its flaws, the academic residency clinic will always be essential for training future generations of physicians. We believe academic residency clinics hold tremendous potential to help bridge health disparities and rectify the structural causes that perpetuate health inequities. I hope this article will stir deeper reflection and discussion, and maybe even some change.