From the President                                     Rajneet Lamba M.D.

Here we are at the halfway point of a very thought-provoking year. It has been a pleasure to reflect on the times in these columns with you all.  I am very grateful at this moment to have a platform to share my musings, hone my analytical skills, and encourage discussion of issues in healthcare.  I would like to thank our CEO and executive council for the opportunity to lead a diverse and nimble board as President of the society. 

On February 20th, I shared information with readers on the SARS-CoV-2 virus, first identified in the US in Snohomish County.  Exactly 1 week later, CDC guidelines were updated to reflect person to person transmission in the United States and I found myself with a very plausible cause for the many cases of ARDS that I was seeing that day.  I successfully advocated for testing in a patient under my care that would ultimately become the first reported death from COVID-19 in the United States.  Over a hundred thousand deaths later and America is still constrained by the optics of our messaging.  Local, state and national case counts are raising concerns that we could overwhelm contact tracers and hospitals again.  
 
Last month, King County declared racism a public health emergency.  During dueling pandemics, I have been reading of dueling consciousness.  Dr. Camara Jones, former APHA President, has shared a highly effective framework in her national campaign against racism which encourages public health advocates to begin with these three tasks:

1. Name Racism,
2. Ask, “How is racism operating here?” 
3. Organize and strategize to Act.  

Naming Racism is the key step towards the antiracist action thinking and action of subsequent steps.  I have sprinkled additional touchstones from Dr. Jones through this article in italics.  

Although racism manifests on several levels, attention to dismantling institutionalized (structural) racism is key.  Interestingly this framework seems appropriate for any of the –isms that sap the strength of our society through the waste of human resources.  Challenging the –isms that are embedded in our society takes a significant degree of effort.  Acknowledging saneism may sound counterproductive to medical professionals, but with 40% of hospitalized patients having comorbid psychiatric illness, it may help us provide better care for diagnosed or undiagnosed patients to be conscious of this form of discrimination in our practice.  At the intersection of saneism and racism is a uniquely American psychiatric diagnosis of “Freedom” frequently applied to Black Americans into the 20th century.  Described in Stedman’s medical dictionary as Drapetomania, this label illustrates problems that occur when medical institutions apply their biases to behavior.  

American Exceptionalism and an ahistorical perspective often limit our ability to identify –isms and while many of us are part of great institutions, it is important that we not let our confidence in their exceptionalism prevent us from doing good work to improve culture.  Racism is a system, not an individual character flaw.  Regarding sexism, nearly 80% of the healthcare force are women and they make up perhaps 20% of key leadership according to a US Bureau of Labor Statistics report.  

Mechanisms of institutionalized (structural) racism are identifiable and addressable.  These mechanisms are in our structures, policies, practices, norms, and values of decision-making, especially as these pertain to who is and isn’t at the table.  Last year’s WSMA annual meeting provided an opportunity to hear from Dr. Patrice Harris, the first Black woman to serve as President of the AMA.  Under her leadership, the AMA has created an Office of Equity with Dr. Aletha Maybank serving as the current Chief Equity Officer.  She has been sharing excellent content across the platform and I highly recommend her webinars which center underrepresented groups in medicine.  Please see Dr. Girolami's info below on how to serve as a KCMS delegate to this year's WSMA annual meeting to push priorities at the state level.  

There has been a strong interest in expanding diversity, equity and inclusion (DEI) committees within universities and hospitals given the current interest in social justice.  The greater business community has already demonstrated a practical value in providing cost savings in employee retention, recruitment, and risk management.  Providing a voice for underrepresented groups allows an organization to address blind spots for employee and patient satisfaction and find efficiency gains.  I commend those individuals and institutions seeking to create justice-oriented culture, but must also acknowledge that individuals in the minority who advocate for systemic change have always faced challenges of tokenization, further marginalization, and even retaliation.  Please encourage their efforts, make space for their opinions, and see DEI resources below.  

With ongoing hope for a more equitable society,

Raj