Portside

At noon Pacific Standard Time on December 10, 2014, thousands of students from 70 medical schools throughout the United States held silent “White Coats for Black Lives” die-ins. These demonstrations, the largest coordinated protests at U.S. medical schools since the Vietnam War era, were initiated by medical students in California and spread across the country in response to the following call to action posted online at thefreethoughtproject.com:

“We feel it is essential to begin a conversation about our role in addressing the explicit and implicit discrimination and racism in our communities and reflect on the systemic biases embedded in our medical education curricula, clinical learning environments, and administrative decision-making. We believe these discussions are needed at academic medical centers nationwide.” Though the stimulus for the die-ins was the nationwide protests in response to the killing of unarmed black men by police officers, the students demanded an examination of racial bias within our country's academic medical centers.

What are the systemic biases within academic medical centers, and what do they have to do with black lives? Two observations about health care disparities may be relevant.

First, there is evidence that doctors hold stereotypes based on patients' race that can influence their clinical decisions.1 Implicit bias refers to unconscious racial stereotypes that grow from our personal and cultural experiences. These implicit beliefs may also stem from a lack of day-to-day interracial and intercultural interactions. Although explicit race bias is rare among physicians, an unconscious preference for whites as compared with blacks is commonly revealed on tests of implicit bias.1

Second, despite physicians' and medical centers' best intentions of being equitable, black–white disparities persist in patient outcomes, medical education, and faculty recruitment. In the 2002 report Unequal Treatment, the Institute of Medicine (IOM) reviewed hundreds of studies of age, sex, and racial differences in medical diagnoses, treatments, and health care outcomes.2 The IOM's conclusion was that for almost every disease studied, black Americans received less effective care than white Americans.