It was a snowy day but my clinic was open for business. I had a new patient—a 23-year-old man—on my schedule. Based on his age and the inclement weather, I assumed he would not come to the appointment. To my surprise, he came early. When I entered the examination room, he was sitting up straight, wearing a do-rag, a thick gold necklace, and a white short-sleeve T-shirt that showed off his well-defined musculature. His arms rested by his side with his hands palm down on his thighs. After introductions, I proceeded with my usual introductory remarks: “Thank you for coming to see me. I am very appreciative of you coming on time to your appointment. How may I help you today?” He sighed deeply while interlacing his fingers, leaned forward as if weighing each word and said, “I am going to be a father and I want to be there for my child.” Then, with a surge of energy, he leaned back, hit his open hand with the opposite fist and said, “I want to be the best father I can be.”
I congratulated him, but I was not entirely sincere. I thought of the time commitment and the enormous emotional and financial demands of being a parent. And he was so young! My biased perception of him as an uneducated and underemployed black man got the best of me, and I went on to preach about the importance of a formal education. He politely informed me that he had graduated from college and planned to go to law school. Visibly embarrassed, I apologized and he shook his head as if to say, “There, it happened again.” He looked at me with a sense of urgency and stated, “I need to be a good role model for my child.”
As I praised his decision to seek preventive health care and to pursue graduate school, he became pensive and teary-eyed. The optimistic young man from a few minutes before had disappeared. He kept looking at his hands and turning a braided bracelet on his right wrist. As I asked what he was thinking, he said, “The worst threat to my life is the color of my skin, and it is out of my control.” His eyes narrowed, eyebrows knit together, and lips tight. I thought to myself, “Just listen.”
“I don’t feel safe walking in my neighborhood—I fear the people who are supposed to protect me. The police have stopped me many nights on my way home from school. They search my backpack, throw everything on the ground, then leave me like a beggar to gather my stuff. Sometimes it’s the same policeman who apparently doesn’t remember me from two nights before. I don’t feel safe driving as I’m usually a target. One time they made me get out of the car, handcuffed me in front of my mother, and I spent the night in jail for ‘lack of cooperation.’”
His eyes were red, his nose sparkled with drops of sweat, and his lips trembled from an exerted effort not to cry. Then he leaned forward, looking at his shoes as he went on, “I must prove myself over and over to the police. What if I’m the next slip-up? Do you understand? Can you hear me? I don’t think there is much you can do for me.”
I had no words to reassure this young man. Would it have been helpful for me to say, “Yes, you’re right! Look what happened to Alton Sterling, Philando Castile, Freddie Gray, and so many more!”? I told him that I understood, but because I was a Hispanic female, I had not experienced the same type of harassment and discrimination. I apologized again for my initial bias, and I offered to be his primary care doctor for as long as he wished.
This appointment left me perturbed. I confided in one of my colleagues that I felt powerless—like I had failed my patient. He acknowledged my feelings and told me that, as a black man and a father, he often had fears similar to my patient. He also shared stories about times when he recognized his own biases while treating patients. By sharing this case with him, we started a critical dialogue about the power and privilege that we as physicians have and how our biases can affect our patients. We now use this case to teach our trainees to be more aware of their own biases. We agreed that addressing the social determinants of health, especially racial discrimination, is essential to the holistic care of our patients. Racial discrimination is a topic very few of us proactively discuss. This case reminded us that racism, both structural and interpersonal, remains endemic in the United States. We are thankful to this patient for sharing his story, and as is frequently the case, for teaching us how to be better doctors.