Rewrite Your Script
Date Published: July 1, 2020
Lynne Richardson, MD, wanted to become a doctor ever since she was a kid. But society has other ideas for a black girl born in Harlem in the 1950s. "I remember the first time I told my family physician. He said, 'Don't be ridiculous. You'll get married and have children,'" she recalls. Dr. Richardson went on to become an emergency medicine physician and renowned health equity researcher. On this episode, she talks about how rewriting society's "script" helped her build resilience, and explains why she's hopeful that COVID-19 and the Black Lives Matter movement will lead to progress on healthcare inequities.
Dr. Richardson is Co-Director of the Institute for Health Equity Research, Professor, Emergency Medicine, and Population Health Science and Policy, and Vice Chair for Academic, Research, and Community Programs, Icahn School of Medicine at Mount Sinai
This episode also features Ernest J. Barthelemy, MD, MA, MPH, Chief Resident, Department of Neurosurgery at the Icahn School of Medicine at Mount Sinai.
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about overcoming adversity. I'm Jon Earle.
Dr. Ernest Barthelemy: 00:10
So I go in to Elmhurst Hospital for morning rounds.
Dr. Ernest Joseph Barthelemy is the Chief Resident of Neurosurgery here at Mount Sinai.
Dr. Ernest Barthelemy: 00:21
I grabbed my scrubs and went into a lounge for health care staff, nurses, other residents. And another woman comes in, sees me sitting at the table. And her first question to me, actually, the first thing out of her mouth is, "Are you housekeeping?" I don't even remember what I finally did answer. I mean, I do remember sort of this silence, like, just trying to, you know, I was reeling basically and trying to figure out, who is this person? And how did she arrive at this conclusion? As a black man in this health care environment, I'd like to not see it through the prism of race and racism, but episodes like that just make it so much more challenging. I asked myself, "What does it take to prove to these people that I am who I am?"
Dr. Barthelemy says it happens at least once a week, and sometimes every week. He'll be talking to a patient, and at the end of the conversation, the patient will go, "Can I speak to the doctor now?" Sometimes other health care workers will just assume he's somebody else—anybody else, except a doctor. It got to the point where recently he went on Amazon and he bought himself a name tag. It says, "physician."
Dr. Ernest Barthelemy: 01:44
I thought, well, maybe this will help. Maybe they'll take time to look at it, read it, and recognize that, "Oh, this is a physician." And I have seen people sort of studying it. And I'm left kind of thinking to myself, what's the process they're going through to connect what they're reading with who they're looking at.
No amount of achievement exempts a person of color from experiencing racism. But that's the obvious point here. The more subtle and important one is this.
Dr. Ernest Barthelemy: 02:13
This is about so much more than the minority of white Americans who are openly racist. This is actually about a truly systematic, structural racism that if you are not actively taking on the transformation of the system, you end up participating in the perpetuation of the racism. So in some ways it's as bad or even worse than being openly racist, because it's sort of being okay with life being more difficult for the people who suffer from racism.
Systemic racism explains why black and brown people have suffered disproportionately during the pandemic. And it's the subject of my conversation today with Dr. Lynne Richardson. In addition to being a practicing emergency medicine physician, she's a renowned researcher on health care inequity. In May, she was named Co-Director of Mount Sinai's new Institute for Health Equity Research. In our conversation, she talks about why people of color so often get the short end of the stick when it comes to health care, and what we can do about it. She also shares some of her own experiences with racism, and reflects on how rewriting society's expectations for her--her "script," as she calls it--has helped her to become the leader she is today. Dr. Richardson, welcome to Road to Resilience. I'm so glad to have you on the program.
Dr. Lynne Richardson: 03:41
Glad to be here, Jon.
I want to begin with a statistic that I read yesterday. According to the Brookings Institute, the age-adjusted COVID-19 death rate for black Americans is 3.6 times the rate for white Americans. What goes through your head when you hear that number?
Dr. Lynne Richardson: 04:01
Well, obviously the emerging data is very disturbing. In some ways, I guess it is not surprising. What we have is the COVID-19 pandemic layered on top of long-standing inequities in health and health care that have plagued vulnerable communities for a long time. And so I think what we're seeing is the accumulation of a new, very destructive virus and longstanding inequities in our health and health care systems.
For someone who has been studying racial and ethnic disparities in health for a long, long time, did COVID-19 teach you anything?
Dr. Lynne Richardson: 04:43
I don't know that it taught me anything. I think, though, it has uncovered in a way that is now very public and very troubling to large numbers of people, just how deep-rooted the inequities in our society really are. The differences in COVID-19 outcomes mirror exactly differences in health outcomes from diabetes, from hypertension, from heart disease, from kidney disease. And they really are due to underlying inequities in education, and housing, and employment, and the effects of racism and discrimination in our society.
I want to back up a little bit and just give listeners a sense of the scope of your work. I was really kind of stunned by the number of different things you've studied and the number of different ways you've looked at this question of disparity in health care. So just to give some examples, you've studied disparities in biomedical research. You've studied how likely people of color are to receive certain procedures. You've studied the interplay between the many factors that produce both worse access and worse outcomes. Where does your passion for the subject come from?
Dr. Lynne Richardson: 06:01
I'm sure that my experience, my lived experience as a black woman, born in Harlem, growing up in America, certainly has informed the things that I'm passionate about studying. And I went into medicine because I wanted to help my community. And then I think I realized that while there are some very powerful encounters that I have one-on-one with patients as a physician, the larger problems really need to be addressed. And all of the things that affect a patient's health before they land in the emergency department. And so my research has really focused on issues of disparities and equity.
So I guess I'm wondering if you can point to kind of specific experiences that you feel propelled you along your path.
Dr. Lynne Richardson: 06:57
Yeah, well, my desire to become a physician goes back to when I was quite young. I did not get a lot of encouragement outside of my immediate family. I remember the first time I told my family physician that I wanted to be a doctor and he said, "Don't be ridiculous. You'll get married and have children." But my parents were very supportive and told me that I could do anything I wanted to do if I was willing to work hard enough. And even though that's not actually true, believing it, I think, helped me to overcome the obstacles that were put in my path.
Tell us about one of the obstacles that you encountered and how you reacted, or maybe even how you wish you'd reacted?
Dr. Lynne Richardson: 07:48
One very vivid memory I have from when I was a college student. In fact I was a freshman at MIT and I think we were maybe a month before the end of the semester. I had only taken one of the 10 modules in this self-paced physics course. And the teaching assistant had called me in and said, "Look, I see that you've only passed one exam and I'm sure there isn't time for you to complete this. It's really not your fault. You know, it's really unfair they bring 'you kids' in here and you're not really prepared for the kind of work that is expected here at MIT." And I think he thought he was being kind. Now, the only reason I had not taken any more of the self-paced exams was because I had been enjoying being a freshmen and on campus and having a good time. It was not that I could not do the work, but I had not done the work. And I was sitting there thinking that what I had done now had confirmed this well-meaning TA's--and he was a white man--belief that I could not do the work. And so he asked me if I wanted to drop the course, I told him I did not. I went back to my room. I started reading the exams. I took all of them. I passed the course. But it taught me that when I don't perform, people believe it's because I cannot perform. They don't assume that I'm not being diligent or whatever. It's that I cannot. So there are many, many instances like that. There are microaggressions all the time, even now. And this is, I think, something that, finally, there is an emerging understanding on the part of white people in this country of what that lived experience is like for black individuals.
Do you feel a sense of progress?
Dr. Lynne Richardson: 10:05
I hope this is a pivotal moment. I hope that the combination of the COVID-19 pandemic and the very stark disparities in who is getting sick and who is dying, then followed by the murder of George Floyd by a white police officer, that we all saw a video of on the evening news, that perhaps this combination of events really is going to lead to sustained change.
I want to bring it back to health care and ask a question that maybe even has an edge of naivete to it. Why aren't all people treated equally in our health care system. What in your view is at the heart of the problem?
Dr. Lynne Richardson: 10:51
Well, you know, it's a very good question, Jon. But it's actually a very complicated question, because health care disparities, just like health disparities, are really multifactorial. It is not just one thing. There are real differences in access to care, but even if we separate that out—and as a researcher, I would say, if we sort of adjust for that and just look at the quality of care that's delivered—there are real differences. Some of that is a lack of information. Some of that is implicit bias. Some of it is structural racism. Some of it is learned behaviors on the part of both patients and providers. And so it's really important to understand how complicated it is because if we're going to change it, we have to first understand it.
So given that this is, I mean, to say it's a multifaceted problem is a huge understatement. It's a multi-multifaceted problem. What would you say—what should be our priority in terms of tackling it? Like how do you even begin to focus your resources? You're now the Co-Chair of the Institute for Health Equity Research. Where do you go first?
Dr. Lynne Richardson: 12:19
Well, in terms of health care disparities, you start by monitoring it. Obviously I'm a scientist, I believe in data. And with the advent of electronic health records, it's much easier to monitor differences in the care that's delivered and to really drill down, to see where those disparities are happening and to implement solutions to actually change the kind of care that patients get. We even know some of the interventions that make a difference. We just have to have the will to implement them. And this is going to be a major initiative.
That's an interesting thing to think about--the will part. I feel like you've got the research part down. There's no question, we have tons of researchers who know how to do the research. What do you do about the will part?
Dr. Lynne Richardson: 13:11
Well, again, this is why I'm hopeful about this being a pivotal moment, because I am hearing leaders, not just leaders in the black community or the Latinx community, but leaders from every sector of our society from Fortune 500 CEOs to people who run health care systems say, "This has to stop. This has to change." And so I'm hopeful that now there will be the will amongst those who have the power to make those decisions to actually do this work and make these changes.
Given how many industries are involved and given the historical, and social, and economic context of inequality, where does health care and a health care institution fit?
Dr. Lynne Richardson: 14:02
I think health care is very important because if you are not healthy, then you are at an even greater disadvantages dealing with all of the stresses and challenges of being black or Latinx in this society. And one of my favorite quotes from Martin Luther King is that, "Of all the different types of injustice, injustice in health care is the most inhumane." And so we have to go first. We should be leading the way. We are healers. We're dedicated to saving lives and making people's lives better. This is so much a part of our core mission in health care. And I think we can live up to it.
How will we know when we've achieved equity?
Dr. Lynne Richardson: 14:58
I think we will probably stop talking about it. So I think we're a long way away from that, because this is not just about health care. It is about all of the things that you need to sustain health. It's about having nutritious food, and a safe place to live, and safe places for children to play, and adults to exercise, and living in housing that doesn't have toxins, and breathing air that's not polluted. It's all of those changes that have to be made. So health equity is quite a ways off, but it is something that we should be working on until we get there.
Do you ever have days when you come to the office and you look at just the complexity of the problem and how tough it is, and how intractable, and how old it is, and you just get frustrated?
Dr. Lynne Richardson: 15:56
I certainly have days—
Do you ever just throw your hands up?
Dr. Lynne Richardson: 15:57
I certainly have days when I am frustrated, but usually it is about smaller things than that. Well, I'll tell you, I do have the perspective that much has changed. Forty years ago, only sociologists were talking about social determinants of health. Now, even lay people understand that there are these social determinants of health that are important to health outcomes. And so I guess for me, sort of throwing my hands up and giving up is not an option because then I just have to accept all of this as it is and not try to change it.
We have a couple more minutes left, and I think I want to spend them on this FemInEM lecture. So everybody should watch this lecture, we'll put it in the show notes. It's really, really great. And you talk about some of the qualities that great leaders have. You talk about taking responsibility for yourself, committing to core principles, and you talk about acknowledging the role of luck. And I don't want to ask you to reprise the whole lecture, we don't have time for it. It was a few years ago now, but I'm wondering if there's one of those that you've been thinking about recently, and if you could talk about how it's played a role in your life and your thinking.
Dr. Lynne Richardson: 17:17
Well, again, I think one of the things I talk a lot about with young people and something that I think really made a difference in my own life is this idea of taking responsibility for yourself. We're all born into situations. We're born into a context. We're born into a family where there are expectations that people have for us. So if you think of it, we're sort of born into this script, and many people simply play out the script they're born into. Maybe your parents or your family had expectations that you would go to college and that you would be in a certain profession, or you would grow up and run the family business or whatever that script is. And many people live out their lives, some happily, some not happily, but, I think, for those of us who realize that we do not have to live out the script that we were born into, that we can decide that we are going to write our own script. And that is both incredibly freeing and really scary because it means that I'm responsible for what happens to me. I'm responsible for the choices I make. I can't blame someone else if things don't work out because I really have been steering this ship myself. But I think once you start assuming responsibility for yourself, that's when everything becomes possible and you don't have to accept the limitations that other people may try to place on you. You don't have to be limited by the expectations of others. And learning to write your own script is, I think, one of the most important ways to remain resilient, because if you're in a situation where you're unhappy and things are not working out, leave it. Change it. Rewrite it. You can take that story in another direction. You're only trapped if you allow yourself to be trapped. And once you get that knack of writing your own script, then the sky's the limit. And it's only your imagination, and your hard work, and determination that will limit how far you can go. But you do have to believe it and you have to take responsibility for it.
Do you feel like at this point in your life and your career, that you're still rewriting the script that you were given as a child?
Dr. Lynne Richardson: 20:07
Oh, for sure. I mean, from time-to-time I start on a new chapter. I think that the newly formed Institute for Health Equity Research is a new chapter, where now I get to do the work that I'm passionate about from a different and really powerful platform. So yeah, the story goes on. There's always another chapter. You turn the page and, what's next?
This has been such a pleasure, Dr. Richardson. Thank you so much for being on the podcast.
Dr. Lynne Richardson: 20:49
All right. Thank you.
Dr. Lynne Richardson is a Professor of Emergency Medicine and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. She also serves as Vice Chair for Academic Research and Community Programs. To learn more about the Institute for Health Equity Research and to access anti-racism resources, check out the links in the show notes. Road to Resilience is a production of the Mount Sinai Health System in New York City. It's made by Katie Ullman, Nicci Hudson, and me, Jon Earle. Lucia Lee is our executive producer. If you enjoyed this episode, please leave us a rating and a review on Apple Podcasts. It helps other people find the show and it makes us feel good. Thanks. We'll be back soon with more episodes and until then, stay safe and be well.