A Black physician’s memoir looks at the legacy of medical racism in America

John Yang:

Dr. Uché Blackstock has seen firsthand how medical racism shapes America's health care system. She's seen it both as a physician and as a patient. She's dedicated her career to work at the intersection of medicine, health equity and systemic racism.

She's an emergency medicine physician and is CEO and founder of Advancing Health Equity, an organization which works to dismantle racism in health care. And now Dr. Blackstock has written a memoir entitled "Legacy: A Black Physician Reckons with Racism in Medicine," details both historic health care inequities and her own family history.

Dr. Blackstock, thanks for joining us. I love the title Legacy because there are really two legacies that run through this book. I want to start with the family legacy. Your mother was what was very rare in the 80s and 90s. A black female physician, how did watching her work seeing her go to work every day and actually seeing her at work? How did that affect your decision to become a physician? We should mention your twin sisters also a physician

Dr. Uché Blackstock, CEO and founder of Advancing Health Equity: Yes. Well, obviously she was a huge influence on us. She had a very different upbringing than we did. She was born in poverty and public assistance the first person in her family to graduate from college and then she went to medical school, Harvard Medical, then she came back after medical school to practice in the community in which she grew up in.

And so that was a powerful message for us that you know, you go, and you know, you get a great education, you come back and bring those resources back, and you help — you help those that are your family and neighbors. And that's exactly what she did. And she would get together with other black women, physicians in our community and hold community health fairs, really to help out the folks who lived in our neighborhood. And I love that message that she sent to us.

John Yang:

Your mother died relatively young, she was 47. She died of leukemia. And also you had an experience that you detail in the book where you had appendicitis that was misdiagnosed and became very, very seriously, your appendix burst.

Do you think the outcomes or the treatment might have been different if you weren't black women?

Dr. Uché Blackstock:

I think it's very, very likely. And it's not just because of my own anecdotal experiences. It's because we have we have a lot of data that shows when black people, when women, when black women go to seek care, often, their concerns are ignored, dismissed or minimized.

When I had appendicitis, I was a first year medical student. And I went to the ER three times, my appendix ended up rupturing. I had long term complications, I have to be out of school for a month. And after that happened, I looked back and said, but that had happened if I wasn't a young black woman. I have to think that the fact that I was a black woman really impacted how I was cared for.

John Yang:

The first physician you saw the emergency underestimated your pain, so that's can't be appendicitis. She's not in that much pain.

Dr. Uché Blackstock:

Exactly. And that's something that we see a thread in terms of how that black patients are cared for. There is something called pain in equity, where we have seen a trend and it's in the research that black patients their pain is often undertreated.

And that connects to really deep rooted systemic beliefs back from slavery days, that somehow we are biologically different, that we feel pain differently than other people do.

John Yang:

Leads me perfectly into my next question is the two legacies sort of come together at Harvard Medical School, you and your sister with your mother became the first mother-daughters graduates from Harvard?

Dr. Uché Blackstock:

Yes.

John Yang:

But you also write about things that are taught in medical school as fact, that date back to the 19 century, or to Jim Crow, talk about some of those?

Dr. Uché Blackstock:

Yeah, you know, and I talked about this idea that whether explicitly or implicitly, in medical school, where we're taught this idea that our patients who are black are biologically different. So for example, there's something that is called the race correction factor that is associated with assessing or measuring kidney function.

And for a very long time, up until very recently, there was a different set of normal values for black patients and non-black patients. And that was based on this, this myth, this idea that black people had higher muscle mass, which somehow translated into a different set of normal values for kidney function.

But anyway, what that has led to is black people being deferred to or to having delayed specialty care for their kidneys are not placed on transplant list. So these ideas that are deeply rooted that we are taught in school actually end up having a detrimental impact on our patients.

John Yang:

And it's also — the sort of institutional racism or systemic racism also has that effect on the number of black physicians.

Dr. Uché Blackstock:

Yes. Yes. And so I write about in the book, the Flexner Report, which came out in 1910, that was actually commissioned by the American Medical Association and Carnegie Mellon Foundation, they sent an educational specialist, Abraham Flexner, to assess all of the medical schools in the U.S. and Canada, and to hold them against the standards of Western European medical schools are in the U.S., Johns Hopkins.

And that led to the closure of five out of seven of the historically black colleges and universities that up to that point had trained about 1,600 students. But it's estimated at those five medical schools at the turn of the century, those black medical schools had stayed open, they would have trained between 25,000 and 35,000 black physicians.

That is such a tremendous loss not only in the workforce, but the patients they could have treated the students they could have mentored the research that could have been done.

John Yang:

Back to the title Legacy, we see your mother's legacy in your work your sisters work, what would you like your legacy to be?

Dr. Uché Blackstock:

My legacy I would love to be able to, especially with this book to help connect the dots for people in terms of how did we arrive in 2024, to the place where we have these very horrific racial health inequities? How can people do better and I have a call to action at the end of the book, how different groups of people even in their personal lives can help address this problem.

John Yang:

Dr. Uché Blackstock, the book is "Legacy: A Black Physician Reckons with Racism in Medicine." Thank you very much.

Dr. Uché Blackstock:

Thank you for having me.