GRAND RAPIDS, Mich. (WOOD) — Twenty years ago, the U.S. Department of Health and Human Services announced a plan to “achieve health equity, eliminate disparities, and improve the health of all groups” as one of its goals for Healthy People 2020. It still has a long way to go.
Black Americans have some of the worst health outcomes of any racial group in the nation. Black men have the shortest life expectancies. Black women fare the worst in pregnancy. More Black babies die than any other race.
Black Americans still make up fewer than 6% of physicians in the U.S. even though they account for 13% of the population. Those who do enter the medical field say they often encounter an unwelcoming, discriminatory environment.
In emotionally exhausting conversations with News 8, three Grand Rapids doctors who are Black shared their own experiences with racism while working and while simply living their lives. They said they were ready to speak publicly now because more people are ready to listen and they want to make a difference.
People who go through medical school put their lives on hold while their friends move forward, spending between 60 and 80 hours a week studying.
“You can’t be mediocre and be a surgeon,” Dr. Charles Gibson, a board-certified trauma surgeon for Spectrum Health, explained. “You have to be good at what you do. You have to make the grades and do the work.”
More than half of the students who apply for medical school don’t get in and roughly 15% of those who do get in don’t graduate. The students who get the white coat make a promise to do no harm and to do whatever they need to do to help their patients.
Still, earning that white coat doesn’t always bring respect.
“The assumption is not that I’m a doctor when I walk into the room; it’s just not,” Dr. Candace Smith-King, a pediatrician for Helen DeVos Children’s Hospital, said.
She and Gibson, along with Dr. Kendall Hamilton, have all run into cases in which the color of their skin mattered more to their patients than their expertise, their passion or their promises.
LIFE ON THE LINE, PATIENT DELAYS SURGERY
In his 10 years as a trauma surgeon, Gibson has performed thousands of operations. One is burned into his memory. A woman showed up to the emergency room with a hole in her intestine.
“(It) was making her really sick. It was really painful,” Gibson said. “She said, ‘I have 12 out of 10 pain. This is the worst pain I’ve ever felt in my life.’ So you can understand my confusion when … after going through the medical jargon and talking about the procedure, she had this kind of quizzical look on her face and said, ‘Well, I understand all that, but I really don’t want a Black doctor. Is there anyone else available?'”
Gibson explained to the patient that there was no one else available and if she was going to have the procedure at that hospital, he would be the one to do it.
“I explained to her that this isn’t something you can sit on and wait until next week or even tomorrow. It’s something where if we don’t intervene right away, you will get worse. You will die within the next 24 hours,” Gibson said.
Still, in the worst pain she’d ever felt and knowing her life was at stake, the woman waited half an hour before she agreed to the operation.
Gibson took her to surgery and said he “treated her just like I would treat my own mother, just like I do all of my patients.”
She survived and Gibson moved on to the next emergency, but the woman’s dismissal of him because of his race stayed with him.
“It does make you think like, what am I doing differently?” he said. “Or what could I have done better? Or did I come off wrong? All of these things that are completely irrational because racism, by definition, is irrational behavior.”
Gibson experienced blatant racism like this many times growing up in the South. He and a friend noticed classmates wearing Confederate flag T-shirts to school, so they created their own T-shirts with the Confederate flag crossed out and were told that was not allowed. Police officers have called him ‘boy’ as an adult.
The racism isn’t always so blatant.
“Even though nobody’s waving a flag or burning a cross or doing anything wild, like you see on movies in the South, it doesn’t mean that it’s not happening,” Gibson said. “It doesn’t mean that people aren’t tossing one job application and keeping another in favor of somebody that looks like them.”
He said he wants people to realize that the America they see, a land of opportunity, is a world away from what Black people may live with.
“To have the end result of all the opportunities that are presented to us, to have that sort of glass ceiling or the limits of your upward social mobility limited by something as ultimately meaningless as skin color, it’s incredibly frustrating,” Gibson said.
Gibson’s experiences with racism aren’t limited to his time in a white coat and neither are his colleagues’.
AN ALLY AT WORK, TREATED WITH SUSPICION ELSEWHERE
Dr. Candace Smith-King has seen the difference it can make for a patient to have a doctor who looks like them. She notices Black moms relax when she walks into the room.
“It’s like, OK, I don’t have to prove myself to this other Black woman who’s going to help me take care of my kids. She’s not going to assume that I’m trying to hurt my kids. She’s going to answer my questions,” Smith-King said.
That difference goes beyond a trust or vulnerability factor. It can also change patient outcomes.
“I’ve had a (white) resident tell a mom to wash the child’s hair every day when a Black family would never wash their child’s hair every day. So when I walk in, they were like, ‘So, I was told to wash his hair every day because he has this or she has this.’ And I’m like, ‘Yeah, you don’t have to do that. Let’s reframe the conversation and figure out what’s feasible for the family and for you guys to do to take care of whatever’s in the scalp,'” Smith-King explained.
Though there have been times when she’s been in a room and a patient has assumed she’s a nurse, she feels respected doing her work. Things change when she leaves the hospital.
“When I take the white coat off, I really do feel as though I am not seen as a professional woman. I feel as though the assumptions that society has about Black women tend to raise themselves up,” she said.
Those assumptions often come out when she’s with her children and her husband isn’t there. In one case, a clerk followed her through the store as she shopped for a birthday party.
“Knowing that I was being followed around as though I couldn’t (pay), it struck a nerve with me. Actually, we just walked right out of the store,” she said. “It’s disappointing that in 2020, the assumption is that I probably can’t pay for what’s in my cart, and it just shouldn’t be that way.”
Smith-King has four children ranging in age from 9 to 23. Her parents also live with her and she lovingly refers to them as “two additional older children.” She pointed out that multigenerational living is common among Black families and it has led to a wonderful relationship for her children with their grandparents.
Smith-King’s mom turned the tide for her family. She was the first to go to college or even finish high school, graduating in 1968 in New Orleans, a segregated city at the time.
“To see her push through, knowing that she probably did not get a wonderful education, to see her break through barriers, go to college, get her master’s in social work, and then, when I was in medical school, she went back to get her Ph.D. in clinical social work. To see my mom push through like that, it made me realize there really wasn’t anything that could stop me,” Smith-King said.
It’s clear that family is everything to her, but with that love comes a longing for a better future for her children.
“The ache, I think, comes from having to continue to have the conversations that I know my parents have had with me and their parents have had with them,” she said. “I feel like it’s almost a ruining of their childhood experience when they realize that my skin actually matters more than who I am as a person. Having to acknowledge the fact to my 12-year-old son, who, to me, still looks like the sweetest, gentle little boy, to have to almost say, ‘You’re not that to anybody else, though. That’s just to me and to your family, but outside this home, you are a threat.’ That’s the ache I feel as a mother of a Black son.”
‘IT’S HARD. IT HURTS.’
Dr. Kendall Hamilton, a colleague of Smith-King, is an orthopedic surgeon specializing in sports medicine and arthroscopic surgery. He has spent time as the assistant team physician for several professional sports teams, including the Houston Astros and the NASA Astronaut Corps.
When he meets with a patient at his practice, it’s usually someone who has a serious injury and will need further care, like surgery. One day, he became worried because he had expected to have a consultation with a man who had been in an accident.
“After about 20 or 30 minutes had passed, the patient hadn’t shown up, so I was concerned,” Hamilton recalled.
Kamie Geerling is the operations manager for the office. An athletic trainer came to her about the patient who was supposed to see Hamilton. The patient wanted another doctor.
“I honestly didn’t know what to do,” she said. “I’ve never experienced it. I was just shocked that someone would say, ‘I don’t want to see that provider because he’s Black.’ I was absolutely shaken. I went back to my office and cried. I was just frustrated and confused.”
She didn’t tell Hamilton because she was trying to protect him.
“I went in and talked to the patient and let him know that he could not choose his doctor based on discriminatory reasons,” Geerling said.
When Hamilton asked the staff to reach out to the patient because he had not shown for his appointment, they told him that he did show up but they took care of the situation. The doctor didn’t accept that and they eventually told him the truth.
“They wanted to protect me from hearing that story,” Hamilton said. “We immediately got our risk and legal team and some of our senior leadership team involved just to get some clarification about, legally, how could we still support this patient or help this patient but at the same time not honor any requests that were based on discrimination.”
Hamilton said he was impressed with the support he got from Spectrum Health leaders, who told him that he was correct in his assessment that racism wasn’t a legal reason to not see a physician.
But it doesn’t change what happened.
“It’s hard. It hurts, because I can get more training, I can get more education, I can get better at what I do with experience and practice, but I can’t change how I look. I can’t change my skin color. I can’t change how I was born,” he said. “So it does hurt. It’s always with you. It sticks with you.”
A NEW PUSH FOR RACIAL EQUITY
The death of George Floyd at the hands of a Minneapolis police officer earlier this year sparked protests across the country calling for police reform.
In Grand Rapids, Smith-King struggled.
“Watching him die and going to work and not hearing anybody at work talk about it, not seeing any emails go out like, what just happened in our country?” she said. “Having to go to work and just function was probably one of the lowest points in my life. By that Friday, I sent an email out to everybody I knew who I could email at Spectrum and I said, ‘The silence is deafening.'”
Spectrum Health President and CEO Tina Freese Decker called Smith-King within an hour of her sending the email and asked what the hospital could do to support its team members and what they should do to work on changing the health care system. Freese Decker had already drafted an email to send to the staff that day.
“It made me feel better knowing that I wasn’t on an island by myself, because that’s how it felt at the time,” Smith-King said.
Spectrum had already initiated plans to improve diversity and equity, joining the #123forEquity Campaign and establishing a diversity officer position in 2018.
Ovell Barbee, who grew up in Grand Rapids and returned after spending 15 years in other parts of the country, currently holds that role and is also the senior vice president of human resources for Spectrum.
“I recognize that, as a leader, oftentimes I’m sitting in rooms, and I may be the only person who looks like me in that forum,” Barbee said. “I feel a duty and an obligation to represent individuals who look like me, who may not be sitting at the table.”
On Nov. 9, he was named to the National Diversity Council’s Board of Directors for the National Coalition for Racial Justice and Equity because of his work in Grand Rapids, which included a call to “Stop the Silence.” He spent a year meeting with leaders in the area to understand the perceptions and attitudes toward Spectrum Health. The most measurable commitment the system has made is promising at least $100 million over the next 10 years to accelerate and expand efforts in addressing racial and ethnic health inequities.
Floyd’s death was only the most recent incident in a long history of police brutality in the U.S., but his story garnered more national attention than many others. Smith-King attributes that to the pandemic.
“The pace is slow… without COVID, George Floyd could have just been like Trayvon Martin, the Sandra Blands and the other Black people who have been killed needlessly, you know?” she said. “I definitely think the slowness of the pace because of the pandemic allowed our experiences to be heard.”
She was involved in the uncomfortable conversations Spectrum Health hosted to better understand what employees were dealing with, as was Gibson.
“We’ve had tough conversations where they’ve asked people like me and others, Black nurses or social workers or surgeons, to say like, ‘What’s going on? Do we have a blind spot here? Is there something we’re missing in our own house?'” Gibson said.
Sometimes, yes, Gibson said.
He recalled a situation in which he spoke with co-worker who was dealing with a family going through the difficult process of making a decision about organ donation.
“(He) said to me, ‘I could just put on some black paint and then talk to the family and see if that would make them feel better.’ And he thought it was a joke and kind of chuckled. I was just dumbfounded. I didn’t say anything. I didn’t even know how to react,” Gibson said.
That person is no longer employed at Spectrum Health, but Gibson referenced it as one of the things Black people worry about when they go for care.
“It’s become more and more zero tolerance for this sort of thing. There are two sides to a story every time, but if we vet the story and figure out that it truly did happen the way people are saying, then there’s just no place for that anywhere, but certainly not at Spectrum Health,” he said.
The conversations with co-workers have included questions about what they can do to improve equity in their lives. Smith-King has suggested looking at what books they read in their families, where their children play on the playground, who they surround themselves with and decide if everyone looks like them or there is a good mix of people, socially and economically. She encourages everyone to be involved in their children’s education and find out who is on the school board, making decisions about what they learn in class.
Gibson suggested not bringing up big topics with new friends right away but rather inviting them to lunch and building a relationship so that when more serious topics come up it’s easier to have a genuine conversation.
“People do care, they just don’t always know how to approach the problem,” Gibson said. “I’ve told my other (Black) colleagues that you can’t sound the alarm and say we want this change, and then when we get people who are willing to step outside of their comfort zones, we have to be sensitive to the fact that they may need a little help, a little guidance.”
INEQUITY AS A HEALTH CRISIS
All three doctors see glimmers of hope in the quest for change, but get frustrated with the pace.
Smith-King pointed to how quickly the hospital shifted to respond to COVID-19.
“It was overnight. They set up a command center and we had 10 teams doing 10 different things,” she said. “The same thing should happen with systemic racism in health care.
“I have to realize that it’s going to take time to change culture, but the fact that not only has the seed been planted, it’s watered and I tend to see it coming out of the ground, it’s going to take a while for it to grow, but it’s coming,” she continued.
“I think the awareness is there,” Hamilton said of progress. “We’re still having the conversation about what activism looks like, but I think awareness is one of the first major key steps.”
Gibson’s final statement on the matter was a powerful one, a call to stand not behind those fighting for change but instead side by side and make it a movement and not a moment:
“Understand that we’ve been screaming at the top of our lungs about injustice and racism and oppression and things like that for over 450 years,” he said. “Welcome to the party.”