SGIM Forum

If Not Now, When? 

07-30-2020 13:17

President’s Column

If Not Now, When?

Our members regularly witness the direct effects that systematic racism has on our country’s healthcare systems and populations. The SGIM statements not only name the problems but also, more importantly, serve as calls to action. We can no longer be blind to the existence and impact of these issues in every patient we see, in our institutions and organizations, and in the communities in which we live and provide care. We must take ownership. SGIM is taking this challenge seriously.

Over the course of several months this spring, SGIM Council approved three statements: first, the “SGIM Position Statement on the Internist’s Role in Social Determinants of Health,”1 second, “A Message on Racial Injustice From SGIM Executive Leadership and Staff,”2 and quickly followed by “Ensuring Equity Amid the COVID-19 Pandemic: A Society of General Internal Medicine Statement to Members.”3 These statements represent the effort and perspectives of SGIM members, elected leadership, committees, and staff. While the documents were developed separately, they address interrelated concepts and are synergistic. Much of the health disparities seen in the pandemic have roots in social determinants of health (SDOH) as well as in long-standing biases in the delivery of health care.

Focus on these issues is integral to SGIM as its vision is one of a just system of care in which all people can achieve optimal health.4 This commitment precedes the attention brought to health disparities through the significant differential impact of COVID-19 on communities of color. It also precedes the attention brought to systemic racism by the brutal and shocking deaths of George Floyd, Breonna Taylor, Ahmaud Arbery, and Rayshard Brooks. In fact, the vision and plan for the SDOH statement long predated any of these current events. The combination of the pandemic and these highly visible examples has highlighted what many SGIM members have been working on and addressing throughout their careers. This expertise is reflected in the programming of SGIM 2020, which offers a breadth of relevant virtual plenaries, special symposia and abstract presentations.5

While these three complementary statements are powerful, their impact will only be as forceful as what we, as a professional society, and as individual members, do. Our actions will speak louder than our words.

This struck me personally on June 4 as our leadership team was deciding how to support students, trainees, faculty, and staff who wanted to participate in the June 5 “White Coats for Black Lives” demonstration. As a clinician, I found myself at a loss for words as I saw patients in my general internal medicine practice that afternoon, with half of my patients that afternoon happening to be black. Not wanting to make any presumptions and attempting to be sensitive to current events, I found myself asking “how are you doing?” while simultaneously sensing the inadequacy of this question. As a leader and as a clinician, I realize that I must identify what I can do from where I sit both professionally and personally to address these issues. Dan Heath, in his book Upstream, identifies three barriers to action:

  1. problem blindness (I don’t see the problem or it seems inevitable);
  2. lack of ownership (It isn’t my problem to solve); and
  3. tunneling (I can’t deal with that right now).6

This problem should not be inevitable. It is the responsibility of each of us to solve. To quote Hillel, “if not now, when?”

The SGIM statements could not be timelier. Our members regularly witness the direct effects that systematic racism has on our country’s healthcare systems and populations. The SGIM statements not only name the problems but also, more importantly, serve as calls to action. We can no longer be blind to the existence and impact of these issues in every patient we see, in our institutions and organizations, and in the communities in which we live and provide care. While it may not be entirely up to physicians and the medical community to solve these complex problems, we cannot ignore the important role that we as a society and as individual physicians have in addressing these issues, as clinicians, as leaders, as educators, and as investigators. We must take ownership. Being intentional within our scope of influence begins with self-awareness. We must make sure that we, and our institutions and organizations, aren’t inadvertently perpetuating the very things that we are railing against. SGIM is taking this challenge seriously.

In addition to heeding and creating action plans related to the recommendations endorsed in the three statements earlier referenced, SGIM is taking a purposeful approach to diversity and inclusion in all that it does. It is our responsibility to each other, to the field, and to the people and communities that we serve to act.

References

  1. Byhoff E., Kangovi S., Berkowitz S.A. et al. A Society of General Internal Medicine position statement on the internists’ role in social determinants of health. [published online ahead of print, 2020 Jun 9]. J Gen Intern Med. 2020; https://doi.org/10.1007/s11606-020-05934-8.

  2. A message on racial injustice. SGIM. https://www.sgim.org/about-us/vision—values/racial-injustice.

  3. Ensuring equity amid the COVID-19 pandemic: A statement to members. https://www.sgim.org/File%20Library/SGIM/About%20Us/Vision%20and%20Values/Equity-COVID19_SGIM-Statement_6-5-2020-final1.pdf.

  4. Vision and values. SGIM. https://www.sgim.org/about-us/vision—values.

  5. SGIM20 On-Demand Program Guide. SGIM. https://connect.sgim.org/on-demand/program/program-guide.

  6. Heath D. Upstream: The Quest to Solve Problems Before They Happen. Avid Reader Press/Simon & Schuster: 2020.


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