George Floyd’s murder magnified attention to police brutality and inspired collective activism leading to structural reforms and demands for abolition. His death provoked a national reckoning with the racism infecting all major American institutions, including American medicine. Health care providers (HCPs) have since called for diagnosing and treating systemic racism and promoting antiracism in medicine. But during this important turning point in history, they can additionally challenge medical brutality, an unnamed form of medical violence mirroring police brutality.
Police brutality is the excessive, unwarranted, and often illegal use of force against civilians including but not limited to physical or verbal harassment, injury, intimidation, or assault. Similar to police brutality, medical brutality transpires when HCPs abuse their power to harm rather than help patients, thereby rejecting their most fundamental oath. It assumes various forms: excessive punishment or force, refusing to provide treatment, violating basic standards of care, silencing pleas for help, and subduing threats to medical authority. Sometimes it is directed against HCPs, especially students and trainees. It warrants special attention because existing medical competencies and literatures, such as structural competency, cultural competency, implicit bias, and the social determinants of health fail to name and condemn its uniquely assaultive and racist nature.
Police and medical brutality both derive from individual power and authority amplified by broader racist policies in their respective systems. The judicial system has historically protected officers committing police brutality, a pattern solidified by the failure to convict Breonna Taylor’s murderers. Medicine’s wall of silence and white male predominance protect HCPs committing abuse, discrimination, and medical errors driven by racist behavior. Both forms of brutality proceed unchecked due to lack of public accountability, significant power differentials between perpetrator and victim, and hierarchies that prevent witnesses beholden to these systems from reporting. They are costly to health and can ultimately be fatal.
For example, nurses inject a grade-school Black child with intramuscular antipsychotic medication for “agitation” with no additional justification or effort to use less restrictive measures documented in the chart. They do not deliberate whether their pro-white implicit bias or anti-Black anger and adultification biases have influenced their decision to use unnecessary force. The child remains sedated and uncommunicative for 24 hours, and no one informs her mother until the following day. No scrutiny of this clinical decision-making transpires, despite the well-established disproportionate use of violence and punishment directed against Black children and the heightened risk of traumatizing this young child as a result.
Two Black parents, overwhelmed by their intellectually disabled son’s violent behavior at home, refuse to pick him up from the emergency room, pleading with his HCPs to admit him for stabilization. The HCPs, insisting “we’ve done all we can do,” instead angrily confront the parents and contact child protective services. They reinforce the disproportionate reporting of families of color to family services with no penalty or regard for the downstream consequences suffered by the family. The parents have no recourse for implicating the medical staff’s failure to admit their child.
A white faculty member tries to fail a Black medical student for being “quiet” during a pre-clinical course, claiming that he has “refused to participate,” while failing himself to assess whether the student has felt discriminated against by himself or his all-white classmates. He makes no recognition of the student’s vital contribution to offsetting the “crisis” of Black male medical students or the harm he exerts by punishing a student enduring rigorous and discriminatory medical training. Only when a more senior faculty member intervenes by consulting a medical school dean (of color) are the white faculty member’s efforts to fail the student thwarted. However, the faculty member is not sanctioned or remediated to prevent his behavior from happening again.
Police and medical brutality’s interrelated historical arcs originating in slavery illuminate their characteristic racism and anti-Blackness. Policing began with colonial-era slave patrols that enforced oppressive Black codes and endured through the Civil War. During the Jim Crow Era, Ku Klux Klan members, many of whom belonged to local police departments, terrorized newly enfranchised Black people exercising civil liberties. The War on Drugs begun in the 1970s aimed to repress the Civil Rights Movement’s gains, advancing the modern policing system and its omnipresent surveillance and mass incarceration of Black and brown lives.
Mid-19th century architects of American medicine promoted Black people’s mental inferiority, insusceptibility to pain, and physical suitedness for slavery and scientific exploitation. Organized medicine banned Black physicians from local medical societies and hospitals through the 1960s, and today medicine remains dominated by white men with no increase in the number of Black male medical students in over three decades. Forced-sterilization campaigns directed at minority women and lasting through the 1970s continued the assault on Black women’s reproductive health, so foundational to slavery. Racism in clinical care is well-established and captured in a multitude of enduring health disparities, but prevailing strategies such as cultural competency and diversity in the workforce initiatives, have done little to change them.
An annoyed white nurse does not wash her hands before doing a pelvic exam on a “demanding” pregnant Black woman who makes multiple clinic visits to evaluate pelvic pain in one week. A white hospitalist physician refuses an immigrant mother’s daily pleas to discuss her gravely ill child’s care because he finds the interpreter phone “inconvenient.” These providers are not sanctioned by their colleagues or the system. HCPs must, therefore, go beyond avoiding medical brutality and broaden the collective gaze scrutinizing it. If 17-year-old Darnella Frazier could endure the trauma of filming George Floyd’s murder for the world to see, sparking an unprecedented movement, certainly HCPs have the power to do the same. Social media has become a powerful tool for leveraging collective activism to challenge the public health crisis of police brutality. HCPs can use #medical brutality themselves and teach their patients, too. Tweeting and hashtags are not typical clinical tools. But they could be a more definitive public health intervention so that racism’s time in health care is finally up.
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