By Kavita Vinekar, The New England Journal of Medicine, September 23, 2021
"We see such advanced pathology here,” our guide boasted as she glided through the resident Ob/Gyn clinic. It was 2013, and I was among a nervous gaggle of fourth-year medical students, following the resident on a whirlwind residency interview tour. “We see all the Medicaid and uninsured patients, so it’s, like, really great learning,” she continued. I looked at her in awe, with excitement and near disbelief that I, too, would soon be caring for patients in a clinic just like this one.
Years passed. I worked in many clinics throughout residency and fellowship training. I saw lots of “pathology.” I came to realize that this was a term my tour guide had used when she should have said “injustice.” It was the term she used when she meant to say preventable cervical cancer, untreated abnormal uterine bleeding, absent prenatal care. It was the term she used to talk about the segregated care provided to the Black people, Latinx people, undocumented people, poor rural people, and poor urban people within our academic institutions.
Such advanced pathology.
In late May 2020, I received an email message from our institutional leaders. I won’t name the institution, but I don’t need to — because this is not the story of one institution but rather of the institution of medicine at large. This is a story of a culture that pervades the United States. The mass email was one of those “In light of recent tragic events” messages, in this case following the murder of George Floyd. It was a proclamation of commitment to the Black Lives Matter movement. It described our hospital system’s dedication to providing equitable and high-quality care to all communities and particularly to communities of color. I closed my email and went downstairs to the outpatient clinics, where I reached a fork in the hallway. To the right were the “resident” clinics — where Medicaid patients were seen. To the left were the “attending” clinics for privately insured patients. I watched as Black patients turned right and White patients turned left. It was 2020, but it could have been 1950.
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