How Do We Fix the Racism of Every White Doctor?

Apparently, the American College of Surgeons (ACS) has taken the lead in accelerating progress toward Personalized Health Care.

So we are on the same page, let us use this definition of Personalized Health Care (emphasis in the original):

Personalized health care (PHC) is an overarching framework for care that unifies predictive technologies with an engaged patient to coordinate care with the primary aim of promoting health and preventing disease. PHC focuses on patient-centered health care, personalized health planning (PHP), shared decision-making, and patient engagement. It seeks to remedy spending on chronic care by encouraging healthy behavior and planning.

It looks as if the American College of Surgeons has chosen to advance PHC by suggesting, if not requiring, that to accomplish the above benefits, racial likeness between provider and patient is necessary.

Tucker Carlson interviewed a plastic surgeon from Florida, one Richard Bosshardt.  According to the doc:

The ACS leadership went to war against itself. ... It declared the ACS ... to be structurally racist. It also went on to say that surgeons are racists and even the practice of surgery is racist.  What this did is, it produced a type of messaging that now states that, as you clearly put, it's best if patients are treated by surgeons of their own race.

Bosshardt, ostensibly, was interviewed because of an op-ed he authored that was published by the WSJ in September of 2022.  It is behind a paywall.  In it, he wrote:

The American College of Surgeons apparently believes its members are racially biased and provide worse care to patients of color than we do to white patients, leading to disparate health outcomes.

Assuming the doctor was being truthful (I could not find on the ACS website that "it's best if patients are treated by surgeons of their own race" and that the ACS "apparently believes its members are racially biased and provide worse care to patients of color than we do to white patients, leading to disparate health outcomes"), then this may have interesting ramifications for PHC and health care in general.

(Further, I was not able to find any refutation by the ACS of Dr. Bosshardt's statements.)

It means that to provide equal care to patients, we must personalize care according to race — whatever that is, as some believe race to be fluid.  Still, we understand in this context what is meant, as Dr. Bosshardt made it clear that for the ACS, this is a matter of color.  So what is needed is to match, at the very least, black with black and white with white.  (This is the most prominent form of racial distinction today.)  Though not addressed, it would logically follow that it is also necessary to match yellow with yellow, brown with brown, and red with red, and pick your color with pick your color.

This is to result in non-disparate health outcomes.  Per our PHC definition, non-disparate health outcomes promote health and prevent disease.

However, the matter likely runs deeper.  Race is but a single factor.  What of sexual orientation and identity?

Not to go through the various permutations of like-with-like coupling, one can see how expanding the criteria more completely hones the personalization of health care.

Additionally, there is the consideration of socio-economic background.  Clearly, the provider with the personal history of a Barack Hussein Obama may not relate as well with a patient whose background does not include prep school and other privileges of a more affluent upbringing — not to mention BHO's white mom and the white grandparents who raised him.

Without listing the myriad of characteristics that differentiate one of us from another, it is apparent that this matching process will result in the further personalization of health care that will lead to, at last, the elimination of disparate care, as the ACS apparently puts it, and improve patient engagement.

What is a bit more interesting is the dereliction of duty by the ACS (again, assuming Bosshardt to be accurate), other medical organizations, medical insurance companies, health plans, institutions (e.g., hospitals, medical centers, clinics), state credentialing organizations, governmental care providers (e.g., Medicare, Medicaid), etc., which has resulted in disparate outcomes — i.e., patient harm.

It is a near certainty that the ACS is not the only organization to know that disparate outcome is because of (in this case) racism.  This knowledge must be widespread in the national machinery of medicine.  As an example, the American Medical Association is absolutely clear that improving health care outcomes requires greater diversity in the health care workforce.  Plus oodles of medical industry-related entities have diversity, inclusion, and equity training.

If the AMA knows that improved health care is the result of better "matching" between patient and provider, you can bet that it is common knowledge in the industry.

Given that, what perplexes is why those organizations that can almost immediately make a difference to help patients have better outcomes have not taken action.

As examples:

The ACS can apparently sanction members who display behaviors with which the Society disagrees.  Bosshardt was "banned for life from access to members of the American College of Surgeons (ACS) and their online discussion forums."  To mitigate disparate care, the ACS can sanction white surgeons who operate on non-whites.  Likely, so can any other medical society.

Hospitals and other facilities where physicians apply for and receive privileges can, in the best interest of patients, refuse to credential (in this case) whites to operate on non-whites.

How many Medicare and Medicaid patients have had bad outcomes because of white on non-white racism-based disparate care?

And insurers.  As poor outcomes are the result of racial mismatch, these companies should step up and do the right thing for patients and refuse to cover whites who provide care to non-whites (which is, by definition, inferior).  You can bet that by not providing coverage, the killing, harming, and injuring fields of disparate care will quickly disappear.

A medical license is a creature of state law.  States can do their part by conditioning licensure on restricting practitioners to caring for patients racially like them.

(What remains unaddressed, in this piece, and obviously requires consideration, is care by other licensed professionals — e.g., nurses, nurse practitioners, physician assistants, dietitians, psychologists, etc.  That is left to others.)

As these entities have obviously not acted either quickly enough or in the interests of their patients, when they could have, damage has been done.  This means that the Guardian of Health Care, the check and balance to Big Medicine, AKA the Legal System, needs to step up.

Per Bosshardt, the ACS has been aware of racially caused patient harm since at least 2019.  This means that going on four years, the organization has done little to nothing actively to protect patients from the bad outcomes of disparate care at the hands of its members.  Again, the ACS is not in possession of secret knowledge.  The medical field in its various forms is responsible.

Smacks of malpractice.

Where it can get even more interesting is the distinction between a civil wrong and a criminal wrong.

Much of medical harm falls beneath the law of torts.  Medical malpractice is a civil action.  The question can be raised as to whether an entity that is aware of the possibility of disparate care, which can lead to death or injury, is criminally liable.

In Illinois, first degree murder is defined as

(a) A person who kills an individual without lawful justification commits first degree murder if, in performing the acts which cause the death:

(2) he or she knows that such acts create a strong probability of death or great bodily harm to that individual or another[.]

Involuntary manslaughter is

(a) A person who unintentionally kills an individual without lawful justification commits involuntary manslaughter if his acts whether lawful or unlawful which cause the death are such as are likely to cause death or great bodily harm to some individual, and he performs them recklessly[.]

Admittedly, I do not know in instances of race-based disparate care whether the probability is "strong" that a non-white victim of racist health care will die.  Nor do I know whether race-based disparate care is an act that is "likely to cause death or great bodily harm."  (Extra credit: Is one who identifies as neither a he nor a she capable of homicide in Illinois?)

But the racist (by definition) white people who provide care are on notice that their actions result in disparate care, with worse patient outcomes for non-whites.  Should the white person risk it?  Don't know.  Perhaps Benjamin Crump's criminal attorney counterpart will provide us the answer.

Whatever the answer, we know that the AMA's solution is to remake the entire health care workforce.  A solution that big should not be for actions that are "unlikely" or of "weak probability."

To end the death, injury, harm, lost quality of life, etc., that result from racist disparate care, the practitioners of law cannot act quickly enough.

And when they do, the ACS, AMA, and others will experience the Petard Principle in its fullest as they are lifted to new heights of an awareness they brought upon themselves.

Image via Pxhere.

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