After George Floyd’s death from a police officer kneeling on his neck, I began to reflect on how I can guide all my patients to be anti-racist. I decided to approach the topic in the same breath as counseling about safety, which is discussed at every well visit. Though racism is only mentioned briefly, it signals to parents and kids “Hey, it’s important to discuss racism, and this is a safe space to ask questions.” After writing a blog post to guide parents on how to have these conversations at home, I learned that many primary care providers were looking for tips on how to have conversations about racism in the office. It might take a while to figure out how and when to bring it up. It will probably take a little bit of reading to appreciate the historical context and adverse health effects of racism. It will definitely feel awkward at first.
When I first started addressing racism during office visits, I worried how the family and kids would react. Many times, my hands would get sweaty. My cheeks would get hot and flushed. My tongue would trip over itself to get the words out. But, my worry of how my minority patients might suffer weighed heavier on me, and I kept going. Each time, I tried a slightly different variation. Each time, the conversation flowed more smoothly. After about 6 months, the words just became part of my routine. I’m still trying to refine the words, but for now, I will share the scripts I developed for each of the following age groups:
“… It’s important for the baby to stay in a rear-facing car seat until 2 years old. Another important safety topic – it’s important to start introducing diversity to babies even at this young age. Babies as young as 6 months old already react differently when they see someone of a different skin color than themselves.1 Make sure you read books to the baby that include characters of all different skin colors and cultures.”
2 years-preschool age
“… It’s important to talk to kids about good touch, bad touch. When I examine them, I’m going to remind them of that; that I can only check them because I’m a real doctor, because a trusted adult is here, and because it’s a well visit. I wouldn’t check their privates if you left the room or if they came in for ear pain. Another conversation that’s important to have is about racism. Even young kids can internalize bias.2 Be intentional about not promoting stereotypes, and surround your kids with people and book characters from all different backgrounds.”
Elementary school age to ~11 years
“… Are you having conversations about bullying? Another conversation that’s important to have is about racism. It’s okay to talk about how we are the same and different from our friends. Expose your kids to people from different cultures through your social networks and characters in books. Celebrate the differences.”
12 and older
“… Are you having conversations about smoking, vaping, drugs, alcohol, safe dating, and the importance of consent? Another conversation that’s important to have is about racism. While we teach our kids to be kind to everyone, it’s also important to talk about how the world is not kind to everyone and to empower our kids to stand up to injustices that we see.”
Afterward, I pause.
Many times, parents have nodded and shared examples of how they have been intentional when purchasing books and when discussing current events. Sometimes, parents will mention cousins and other family members who are of various ethnic descent as evidence of their immunity to racism (having a diverse family does not automatically make one free of racial bias,3 but I just keep that to myself for the moment and nod along).
Occasionally, the above conversations have led to deeper conversations:
One kid asked: I’m confused. Why is it Black lives matter? Why not all lives?
Me: Thank you for asking. That’s a really common question. The phrase “Black lives matter” does not mean “Black lives matter only.” It means “Black lives matter, too.” Black kids have a higher risk of asthma attacks than White kids.4 Black babies have a higher risk of dying5 and being born early than White babies.6 To say that “Black lives matter” means that we are committed to exploring why things are not equal and trying to tell adults to make rules and laws that will protect Black lives just as they do White lives.
One mom replied: My kids don’t see color and they don’t notice race. Should I bring it up?
Me: That’s a great question. Thank you for asking. This is a great opportunity to bring up racism. Talk to the kids about why it is that they don’t notice racial bias. Discuss their privilege that this is something that doesn’t affect them. Explore how hurtful racial bias is. Use books, current events, and magazine articles to talk about how things are not fair and about things you can do as a family or things your teens can do or things you have already done to help make the world fairer and to stand up for those affected by racial bias.
One medical student responded by laughing with the dad.
Me (after the appointment): I appreciate you trying to lighten the mood with laughter, but it’s not funny. Our patients are hurt by racial bias. Our patients die because of racial bias. Let’s talk about the data. Black people are not adequately treated for pain when they go to the emergency room, compared with their White peers.7 Black women are at much higher risk of pregnancy complications and pregnancy-related death compared with White women.8 We have a lot of work to do in our own house of medicine.
“Practice makes progress” is a phrase I often use, and it’s a helpful mindset for talking about this uncomfortable and loaded topic. Quite honestly, I don’t know if I’m doing this right, and that is okay. Not discussing racism is not okay. If we never practice talking about racism, we never make progress. If we never mention racism, we never get the chance to confront it and heal from it. The more I talk about it, the more the words just flow. The more I talk about it, the more I learn how to do it better. While I write this to educate, I also write this to put my process out there for others to examine and critique so that I can be educated on how to improve it.
I’m not an expert in the history of racism in America, but I know my patients’ stories, and I understand how racism affects their health. It doesn’t take an expert to start a conversation about racism. It doesn’t have to be a long conversation, just the start of one that can be carried on by the patient and their parents, the patient with their friends, or the parent with their family. Our patients’ lives depend on it.9 To my fellow primary care providers, I encourage you to just start.
- Quinn PC, Lee K, Pascalis O, Tanaka JW. Narrowing in categorical responding to other-race face classes by infants. Dev Sci. 2016 May;19(3):362-71. doi: 10.1111/desc.12301. Epub 2015 Apr 20. PMID: 25899938.
- Perszyk DR, Lei RF, Bodenhausen GV, Richeson JA, Waxman SR. Bias at the intersection of race and gender: Evidence from preschool-aged children. Dev Sci. 2019 May;22(3):e12788. doi: 10.1111/desc.12788. Epub 2019 Jan 23. PMID: 30675747.
- Guilbert T, Zeiger RS, Haselkorn T, Iqbal A, Alvarez C, Mink DR, Chipps BE, Szefler SJ. Racial Disparities in Asthma-Related Health Outcomes in Children with Severe/Difficult-to-Treat Asthma. J Allergy Clin Immunol Pract. 2019 Feb;7(2):568-577. doi: 10.1016/j.jaip.2018.07.050. Epub 2018 Aug 29. Erratum in: J Allergy Clin Immunol Pract. 2019 Mar;7(3):1096. PMID: 30172020.
- Matoba N, Collins JW Jr. Racial disparity in infant mortality. Semin Perinatol. 2017 Oct;41(6):354-359. doi: 10.1053/j.semperi.2017.07.003. Epub 2017 Aug 31. PMID: 28864275.
- Manuck TA. Racial and ethnic differences in preterm birth: A complex, multifactorial problem. Semin Perinatol. 2017 Dec;41(8):511-518. doi: 10.1053/j.semperi.2017.08.010. Epub 2017 Sep 21. PMID: 28941962; PMCID: PMC6381592.
- Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016 Apr 19;113(16):4296-301. doi: 10.1073/pnas.1516047113. Epub 2016 Apr 4. PMID: 27044069; PMCID: PMC4843483.
- Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019 Oct;20(10):e561-e574. doi: 10.1542/neo.20-10-e561. PMID: 31575778; PMCID: PMC7377107.
- Farmer HR, Wray LA, Thomas JR. Do Race and Everyday Discrimination Predict Mortality Risk? Evidence From the Health and Retirement Study. Gerontol Geriatr Med. 2019 Jun 27;5:2333721419855665. doi: 10.1177/2333721419855665. PMID: 31276018; PMCID: PMC6598315.