Dr. Uché Blackstock is the author of <em>Legacy: A Black Physician Reckons With Racism In Medicine.</em>

Dr. Uché Blackstock is the author of Legacy: A Black Physician Reckons With Racism In Medicine. / Penguin Random House

When Dr. Uché Blackstock was a medical student at Harvard, she had a near-death experience that gave her a sobering outlook on the state of medical care in the U.S. Suffering from excruciating stomach pain, Blackstock took herself to the E.R., where, after hours of waiting, she was told she had a stomach bug and sent home.

But in days that followed, Blackstock felt worse; it would take two more E.R. visits before she was diagnosed with appendicitis. Because it took so long for the diagnosis, her appendix ruptured, requiring emergency surgery, followed by a painful recovery that sent her back to the hospital. Later Blackstock was left to wonder: Would her treatment have been different if she weren't Black?

"It really took a few years of processing what had happened for me to recognize that it may have been because I was a young Black woman that this diagnosis got missed," Blackstock says.

Blackstock is the founder and CEO of Advancing Health Equity. In her new book, Legacy: A Black Physician Reckons With Racism In Medicine, she explores systemic inequity in health care, tracing its origins back to the beginnings of Western medicine and to her own experiences as a medical student and doctor.

In March 2020, during the early days of the COVID-19 pandemic, Blackstock was one of the first medical professionals to raise the alarm that the virus was having a disproportionate impact on minority communities.

"For years, we've been talking about the Black maternal mortality crisis. But in terms of COVID's impact on Black communities, that conversation had not started yet," Blackstock says. "So I wrote my first op-ed on what I was worried about would happen to our communities from COVID within the first two weeks – before the end of March."

But Blackstock is optimistic about the next generation of Black medical students, who she says are pushing for changes to the existing system.

"With the killing of Mr. George Floyd and Ms. Breonna Taylor ... a lot of medical schools received demand letters from their Black students about what those students thought we should be learning," Blackstock says. "I would say medical schools are on their way. They have a tremendous amount of work to do."

Interview highlights

On her mother, Dr. Dale Gloria Blackstock, who died of leukemia at age 47

My mother was a brilliant woman. She was amazing. She was a trailblazer in her own right. She grew up in central Brooklyn. She had a single mom, she had five siblings, and they grew up in public assistance and so life was always very, very difficult for her. She was the first person in her family to graduate from college and then go on to Harvard Medical School, which is something that she never even probably had thought of as a little girl. But I celebrate her and I celebrate her accomplishments. But I also recognize how both racism and poverty makes the road so much harder, and that there were other brilliant, brilliant children that she grew up with that I'm sure also could have made it to Harvard Medical School and beyond, but did not because of the practices and policies that we have in place that chronically deprive our communities of the resources that they need.

On always wanting to be a doctor because of her mom

This is what happens when you have the most loving mother who is also incredibly well respected by her patients and by her colleagues. So it was sort of like, I think both Oni and I looked at her and said, you know what? We want to be just like her. We also want to be a doctor. And I think also, we were surrounded by Black women physicians: Our pediatrician, all of my mother's friends, on our block we had other Black women physicians. So it was a reality to me. ...

Dr. Dale Gloria Blackstock with her twins, Uché and Oni — both of whom followed in their mother's footsteps by graduating from Harvard Medical School.

Dr. Dale Gloria Blackstock with her twins, Uché and Oni — both of whom followed in their mother's footsteps by graduating from Harvard Medical School. / Courtesy of Uché Blackstock

I'm getting a little emotional, but this book is also an opportunity to give her a voice to people who may not have heard of her or have met her. I always say that when people meet [my twin sister] Oni and me that they're meeting our mother, because this woman literally poured blood, sweat and tears into us. I think because she had grown up in poverty, because she was the first to go to college and med school, she wanted a very different life for us than she had for herself. And sometimes I worry. I remember when we turned 18, she said, "I'm so tired," and I don't know if she may have been in the early stages of her illness then, but she said, "I am so tired. I put so much into you both."

On how students in medical school are often taught that there is an essential biological difference between Black and white bodies — and how that teaching impacts care

That is sort of the take home-message we get. We're taught that there are different normal values for kidney functions, that Black patients have a certain set of normal values than non-Black patients. We're told that about lung function; that there's a difference between Black patients and non-Black patients. And this isn't something that is necessarily recent. A lot of these beliefs are centuries or decades old. ...

So often you would read a textbook and it would say that the risk factor for diabetes or the risk factor for high blood pressure is race. Race cannot be a risk factor because it's a social construct. What is the factor is racism or the impact of the practices and policies of systemic racism on our communities and on our health. ... A lot of these studies have come out more recently to show that that so-called "race correction" factor that is used for kidney function has actually led to a delay in Black patients being referred to for specialty kidney care. Also, it's led to delays in putting them on kidney transplant lists. So it's compromised their care even further. They have not gotten the health care that they need for this chronic and potentially deadly disease. It almost compounds the everyday racism that they face, that there are these beliefs that are inherent within the health care system that prevent them from getting the resources that they need.

On the 1910 Flexner Report, which closed most of the historically Black medical schools in the U.S.

The Flexner Report was a report that was commissioned by the American Medical Association and the Carnegie Mellon Foundation. And essentially they commissioned an educational specialist named Abraham Flexner to go around to the 155 medical schools in the United States and in Canada, and to essentially standardize them, compare them to the standards of Western European medical schools. And so, of course, the Black medical schools, because of the legacy of slavery and the lack of wealth and resources, did not have the resources to remain open. So, essentially, Flexner recommended that five out of seven of those Black medical schools be closed and they were closed, leaving Howard and Meharry. ...

In a study that came out in 2020, in the Journal of American Medical Association, it was estimated that those five schools, if they had remained open, would have trained between 25,000 and 35,000 Black physicians. When I read that, I started crying because that is such a large number of health professionals that could have cared for hundreds of thousands, probably even millions of Black patients, who could have mentored medical students, who could have done research in our communities. And so it is a tremendous loss when you think about the closure of those schools. But it also makes sense when you look at the percentages today of Black physicians. We are less than 6% of all physicians in the U.S. – and that is one of the reasons.

On how the Supreme Court's 2023 ruling against affirmative action may impact Black medical students

I compare it to the Flexner Report. So you have a policy that impacts schools, led to the closure of schools, led to that tremendous number of Black physicians not being educated, essentially eras[ing] them. And I thought about the recent SCOTUS decision, it's going to affect academic medical centers, it's going to affect medical schools, and, I think that, long term, if it's going to affect the diversity within medical schools, then we know that ultimately [it] will affect the number of Black physicians. And we are actually more likely to go back to our own communities to care for patients. We are more likely to work in underserved areas. ... We may not see it for generations, but I think that SCOTUS's decision is going to have a long-term impact on Black health, if medical schools and other higher-education institutions are not able to ... have legal workarounds to address those changes in race conscious admissions.

On tangible ways to improve the system

Academic medical centers and medical schools ... need to work on focusing on how to train students and residents to adequately and competently care for a diverse patient population. That is your priority, whether it's in terms of developing curriculum that is focusing on anti-racism, or making sure your faculty understand how to teach in a way that really respects the honor and dignity of all the students that they're teaching and the patients that they're going to serve, or even to policymakers, making them understand that health is in all policies. ... So I tasked different groups, even white health professionals. I said, this is not just our problem. This is not just the problem of your Black colleagues. This is not just the problem of your Black patients. They are dying prematurely. It is up to you also to speak up. It's also up to you, to us to work on behalf of our communities. I think ultimately every health professional would say I want the best for my patients, right? But that is not happening.

Sam Briger and Thea Chaloner produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.

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