The death of Dr. Susan Moore. The death of Dr. Susan Moore. The Death of Doctor Susan Moore. Should make our ears ring and blood boil.
Medicine failed her, not just because she was a ‘fellow physician’, but because we’ve failed in our practice; her death is an object lesson in how racism trumps humanity, not just professional identity.
The very nature of healthcare practice is tradition: not ‘art and science’ but a social construct shaped by history and culture. Training in the healthcare professions is an exercise in submission to authority in order to achieve acceptance: we unconsciously shape our mental models and behavior because it mirrors the thinking and ways of being of those who hold the keys of entry to a world to which we aspire to belong. Subsequent success in practice and academe means sustaining these ways of thinking and acting because they are the benchmarks by which our “competence” — as a member of the community or ‘key opinion leader’ — is judged. While we like to think these benchmarks are objectively grounded in science, they are susceptible to ideological distortion: pro-attitudes that are shaped by perceived threats or unconscious bias.
Systemic bias is fundamentally exclusionary, but also self-perpetuating and self-protective; the systems themselves are structured to effect and sustain the oppression and discrimination of individuals and groups based on assigned identities. Only systemic change can genuinely eliminate bias. Ecosystems that grow in complexity until they achieve a steady state and become self-perpetuating are sometimes referred to as “climax communities’ — a reference to their having reached a pinnacle of maturity. At a fundamental level, the healthcare ecosystem has all the characteristics of a climax community.
As a climax community our healthcare ecosystem continues to preferentially select those “species” (disciplines, roles, mental models, and cultural mores) based on their “fit”. This is supported by a parallel evolutionary construct of “convergence” which is where otherwise unrelated species must evolve similar phenotypical features (like white coats, the biomedical model, or respectability politics) in order to survive; species that don’t converge are forced out (or into extinction).
Our systems will not change until we stop protecting the elements that a) support reproduction of the same “species”, b) narrowly defines the life stages they to go through to maturity, and c) sustains the forces that shapes their social behavior and subsequent assessment of their fitness for survival. By omission and commission, we invest significant resources to sustain these systemic structures. We must face the facts that fundamental change is necessary; in evolutionary ecology “destruction events” open the door to new species having the opportunity to find their place in the ecosystem: some current members of the population adapt; others may not survive. In healthcare, if we are to achieve true equity and inclusion, not every practice should be preserved, not every habitat protected.