A Place for Anti-Racism in Crisis Response

During the Special Edition Chats for Change on Tuesday, April 21, seventeen staff, students and faculty from across the health system and the Icahn School of Medicine at Mount Sinai (shout out to Mount Sinai Queens and the Corporate Offices) began to brainstorm the strategies, actions, and practices that challenge and counter racism, inequalities, prejudices, and discrimination based on race during this public health crisis.

It started with a check-in.

Like most Chats for Change, we kicked things off by checking in and finding out why folks have joined the session. The top four reasons were justice, change, action and education.

We got on the same page.

To get on the same page, the co-hosts provided a frame or collective understanding of an anti-racist crisis response. It’s hard to engage in a productive dialogue when there are so many interpretations and definitions. Here are the definitions we used (these aren’t the “right” definitions, they are what we used for this session and may change over time):

Crisis response defined: Crisis Response refers to all the advance planning and actions taken to address natural and man-made disasters, crises, critical incidents, and tragic events. Ideally, crisis management practices are engaged before, during and after a crisis.

Anti-racism defined: Anti-racism is the practice of identifying, challenging, and changing the values, structures and behaviors that perpetuate systemic racism.

Racial equity defined: Racial equity is a component of anti-racism. It is the condition that would be achieved if one’s racial identity no longer predicted how one fares.

Identified what we are witnessing and experiencing now.

In order to identify the strategies, actions or practices that counter racism during this crisis, we first examined what is happening now. Here are two of our insights that either counter or perpetuate systemic and individual racism during this crisis:

  • “Wearing a face covering (I understand and support the reason and importance but it does perpetuate racism)…not equally safe for all to do because they may be targets of racism/suspicion.”
  • “Focusing on those who are most in need and equity instead of being fair (counter)”
Dreamt what could be and the challenges to implement.

We spent most of the time in small break out rooms brainstorming an ideal anti-racist crisis response. What would it look like? Who are the people and/or groups involved? What are the mindsets, strategies, actions and/or practices? What would happen before, during and after the crisis? What challenges or roadblocks might you encounter if you implemented your ideal anti-racist crisis response?

These are some of the actions, strategies and practices that we dreamt of:

  • “Centering equity in crisis decision-making, response and recovery.”
  • “Anti-racist response doesn’t try to get things back to normal; it’s about building a better system for next time.”
  • “Practices to tap into the heart, not just the mind. This isn’t an intellectual exercise.”

Here are some of the identified challenges:

  • Resistance
  • Power hoarding
  • Transparency: Who makes the decisions? Who is at the table? Who holds those in power accountable?
Next steps.

This Chats for Change was just the initial brainstorming session. A smaller group of students, staff, and faculty are continuing the work to formally develop a framework that could be shared more broadly within the Mount Sinai community and with other medical schools and teaching health systems. If you want to get more involved, please reach out to Leona Hess. Stay tuned for updates as we dream into and actualize an anti-racist crisis response.

In the meantime, check out the upcoming Chats for Change schedule.

Special thanks to everyone who contributed to this body of work and shared their stories.

About the Author

This post was written by Leona Hess, PhD, Director of Strategy and Equity Education Programs.

Navigating Biased Patient Behavior—What Next?

On Monday, April 14, nearly 30 students, clinicians, and administrators responded by logging into a zoom call to engage with the topic of navigating biased patient behavior. Sponsored by the Racism and Bias Initiative (RBI) and facilitated by the Dean of Diversity and Inclusion, Ann-Gel Palermo, and the Dean for Medical Education, David Muller, this group joined together to tackle a powerful force in this crisis: racism.

To metaphorize the crisis, one might think of COVID-19 as an orchestra, each nefarious gene a different instrument, producing the vibrations that directly impact the listener, our patients. Racism then is one of many conductors (this is a special orchestra), determining tone, frequency, and direction. What we know from the news is that vulnerability to COVID-19 is inequitably distributed across this country, targeting Black, Brown, and Indigenous communities.

As many RBI discussions begin, we started with visualizing the issue at hand.

What comes to mind when we think of patient bias? Broadly, we could qualify patient bias as happening when patients make assumptions or assertions about clinical competency based on race, ethnicity, gender, etc. A definition however does not quite capture the spectrum of bias that physicians experience. From a patient jokingly asking for a Jewish doctor, to a comment about a physician’s “attractiveness,” all the way to refusing care from a Black physician, our group quickly came to understand that that bias takes many forms and therefore so must our responses.

One of these sites of response the group focused on was resilience. Some physicians shared personal experiences on how they learned resilience from patient bias. An interesting point was that resilience itself takes different shapes over one’s career. It may start as “anticipatory protection,” that stealing away before seeing a patient. But with time, resilience may look more like “embrace,” respectfully engaging the patient on their bias. When the patient asks, “But where are you really from?,” you may no longer feel this as a direct hit but rather smile, answer the question, and move along. While there was an unspoken sense that resilience can and will be learned, particularly by physicians from marginalized groups, Dean Muller posed a lingering and troublesome question to the group, “What happens to empathy for our patients when we are on guard?”

For students, this discussion not only fostered the passing down of lessons learned, but also modeled the oft unseen introspective work that a physician must do to ensure they provide the best care possible. While first-year students have limited clinical exposure, they have ample life experience. One student succinctly described the effects of bias as, “making you feel small.” Delving into the effects of “feeling small,” one student wondered if a patient’s bias towards them might stunt their burgeoning self-confidence and negatively impact quality of care in that moment and in the future? One of the greatest strengths of RBI Chat’s for Change is the diversity of the group in attendance. Not only are the possibilities for learning widened, but even student speech becomes powerful as it radiates across different spheres of stake-holders. While we do not end with formal “to do’s” administrators and faculty might leave with an eye towards the student burden of “feeling small.”

This Chat for Change came to its close around a dialogue on the roles of whiteness, silence, and bystanders in enabling patient bias. One participant asked, “Do your white colleagues understand this reality? Is it part of their education? Are they equipped to be allies?” Some barely audible “no’s” and “yeah’s” came through, lost to the muddling that sometimes happens on Zoom.

Undeniably, there was no resounding “Yes!” To this point, participants discussed the need to be “upstanders,” trained on how to professionally intervene on behalf or yourself or other healthcare providers. One participant offered Mount Sinai’s Morchand Center as a site already offering practical training along these lines. But “upstanders,” cannot be trained into existence; this work needs to be sanctioned and supported by the institution.

A physician shared that one way health institutions undermine “upstanders” is the lack of policy on acceptable reasons to transfer care to another physician. One participant shared how the carte blanche granting of change of care silently corroborates a patient’s belief that a differently raced, gendered, or identified physician might provide better care. Despite an institutional barrier, this physician became an agent of change when they consulted with their leadership and found them to be receptive, even garnering a verbal commitment to more closely examine these requests.

Deeply imbricated in the history and present of our health institutions and health crisis, racism is not a task, nor even a conglomeration of tasks. We did not leave this chat knowing what to do, instead, we challenged ourselves to be troubled by “what’s next,” and to ask it of ourselves with frequency and rigor.

To return to the metaphorwe have an orchestra (the virus), a conductor (racism), and this leaves us with the composer. From week to week, when we show up for this work, facilitated through RBI, we take on this role: the composer. We look down at all that has ever been written, what we have learned from it, and what we have today – and we dare to write something new. This work is collective composition and it will take time, and drafts, but we are here, we are doing it, and it is a part of what crisis response looks like at Mount Sinai.

About the Author

This post was written by first-year medical student, Paloma Orozco Scott.