Conversations: Uché Blackstock, MD

Uche Blackstock
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Emily Silverman
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You're listening to the nocturnist conversations. I'm Emily Silverman. In today's episode, we speak to a physician about her remarkable family history, her journey to uncover the racism that influences medicine, and her relentless quest to build a more equitable healthcare. Her name is Doctor Uche Blackstock, and she's a Harvard trained emergency medicine doctor, fierce advocate for racial justice, and entrepreneur whose consulting company, advancing health equity, is reshaping the way we address racism in healthcare today. Uche is also the author of the New York Times bestselling generational memoir, Legacy a black physician reckons with racism in medicine in my conversation with Uche, we talked about her mother, a nephrologist who paved the way for Uche and her sister to pursue careers in medicine.

Uche's personal experiences with the healthcare system, including a delayed diagnosis of appendicitis and two very different birth experiences, and the process by which Uche found her voice. As an advocate, I hope you enjoy this conversation as much as I did. But first, here's Uche reading a few lines from her book, Legacy.

Uche Blackstock
My sister and I were only 19 years old in 1997 when we lost our mother to leukemia, and she was just 47. She died too young, but by then her influence had indelibly rubbed off on us. Our mother's passion for learning, her dogged perseverance, and her commitment to serving her community heavily influenced our own decision to become physicians. Oni and I both graduated from Harvard University and then attended Harvard Medical School, the school's first black mother daughter legacy. Graduates.

Like her, we both went to work with historically underserved populations. After graduating my sister at a hospital in the Bronx while I went to train at Kings county in SUNY downstate in Brooklyn. Following in my mother's footsteps in the years since then I have felt her by my side in so many of my own interactions with patients. Her ability to listen and truly care continues to be a model for me, and it's something that our patients are crying out for now more than ever.

Emily Silverman
I am here with doctor Uche Blackstock. Uche, thank you so much for being here today. Thanks for having me. So this book offers an unflinching look at racism and medicine, and it's deeply personal. I had always known your work from afar, but didn't know as much about your personal story.

So it was a real gift to be able to learn more about you and your upbringing and your family. For example, your mother, as you mentioned just now in that reading, doctor Dale Gloria Blackstock was a nephrologist, and you talk about how you and your twin sister grew up playing with her doctor's bag. Tell us a bit about your mom's practice and what it was like to be a child witnessing that through the eyes of being her daughter. I didn't realize it until I was much older, like what rare and unique experience I had just having her as our mother. She was someone who was very, very committed to her work, incredibly purpose driven.

Uche Blackstock
And given the kind of childhood that she had, growing up essentially in poverty, being the first person in her family to go to college, it was really important for her, even though she went to Harvard Med School, to come back to her own community to take care of, essentially her family, friends, and neighbors. So that was the example that our mom set for us. And this idea of always working in service to your community was something that always resonated with my sister and me and continues to influence the work that we did. But our mother was essentially doing what we call health equity work in the eighties and nineties, when there wasn't that term or expression being used, she was working together with other black physicians in our Brooklyn neighborhood, organizing community health fairs, doing diabetes screenings, high blood pressure screenings, connecting them with the social services that they needed. So that was the influence that I had from a very, very early age, and I just feel so incredibly fortunate to have been able to witness that.

Emily Silverman
And she chose to go into nephrology, which you write, is both because it's an intellectually stimulating and very difficult specialty, but also because kidney disease does disproportionately affect black communities. So talk a little bit about nephrology and kidney disease and how your mom worked around that. Yeah, the hospitals where my mother worked, they're in a neighborhood that has some of the highest rates of chronic kidney disease in the country. There's even a term that was coined at my mother's institution called flatbush diabetes, because people were very likely to have diabetes and kidney disease. And we're seeing disproportionate number of patients there.

Uche Blackstock
In that neighborhood where she worked, there were high, high levels, not just of chronic kidney disease, but patients who were kidney transplant patients. And actually, one of the hospitals that she worked at, SUNY downstate, is one of the only transplant centers in Brooklyn to this day, and actually, unfortunately, is at risk of closing, which would be a tremendous disservice to the community. But anyway, I think that she felt like she could have really maximum impact on the community by working in that specialty, and she definitely did. Black patients, while they disproportionately have a higher burden of chronic kidney disease, it's not because of anything that's biologically wrong with us. It's really a consequence of risk factors like diabetes and high blood pressure that lead to the development of chronic kidney disease.

And while that was something that my mom probably at the time, was not so aware of in terms of the systemic factors, she definitely felt like her presence was much needed in caring for that patient population. She did a lot of work in health equity, just as you said, and was well aware, obviously, of the anti black racism in american society. And yet you write in the book that your parents did everything they could to teach you and your sister to take pride in being black. So introducing you to black authors, black musicians, black playwrights, they took you on trips to Africa and gave you african names to kindle that relationship to the homeland, as you said. And they were also determined to teach you about the racism and prepare you for it.

Emily Silverman
So it seems like a very tricky balance for a parent. And I'm wondering, what was it like for you and your sister to be held in that balance? I think about even today, because I have two sons, and I'm raising two black boys in this country and trying to prepare them for the future, or actually even the present, but still also trying to embrace that they really should have a quote unquote, normal childhood. My parents were very, very candid and honest about their experiences at work, and they really shared them with us at a very, very young age. One thing that I do appreciate about how my parents raised us is that, yes, in a society where there's anti black messaging all around us, they really instilled in us a pride for our history, our background, our role in society.

Uche Blackstock
And that foundation really helped my sister and me navigate predominantly white spaces in undergrad, in medical school, and beyond, and kept us very, very grounded. So I have a deep appreciation to my parents for that. Like, they didn't know what the future would behold for us, but I think they tried to prepare us as much as they could while still making space for joy and love and good times in our lives. It's so devastating to read the chapter in the book about your mom being diagnosed with leukemia and dying at age 47. You and your sister were 19 years old.

Emily Silverman
Talk a bit about walking that journey, including some of the ways in which, in retrospect, you realized racism may have contributed to her disease, to her diagnosis, potentially to a delay in diagnosis, her. Diagnosis, and then losing her. One of the most pivotal series of moments in my life really felt like the rug was pulled out from underneath us. My sister and I, we were very, very close to our mother. People called us the three Musketeers.

Uche Blackstock
My mother took us everywhere. I mentioned us attending meetings of the local black physicians together. People, even to this day, say the two of you were always trailing behind her, and she was always just a very vibrant and energetic person. She ran almost every day, took up running in medical school. She really took great care of herself.

I think she was trying to do everything that she could probably to counterbalance the childhood that she had. And not getting the medical care that she needed, not getting the dental care that she needed in her adult life was really trying to take care of herself. And so we were running a race together in Central park in the summer of 96. We were 18 at the time, and our mom was 46. She still was much faster than we were.

Like, she would come in before us. And so this particular race was a ten k. And she came in after us, and we were like, mommy, are you okay? And she says, I'm just really tired. A few months later, the diagnosis was made, and it was just so incredibly devastating because we knew from the very beginning that the kind of leukemia she had, mild dysplastic syndrome, was very difficult to be treated, and she never was able to get into remission from the chemotherapy for a bone marrow transplant, even though her brother was a match.

And, yeah, it just was like. Just, yeah, very, very, very hard. Even though we were 19 years old when she did die, it was about eight, nine months later after her diagnosis. Miss her terribly every day. And I think even doing the work that both my sister and I do now in terms of health equity, advocacy, and doing it in her memory and trying to continue her legacy, it hurts even more now.

There's so many questions that I would have had for her, actually, even in medical school, even in residency, and even when I was faculty, just, like, wanting her perspective and her advice. Having been through very similar experiences as I was going through in the book. You talk about how there are so many factors that influence health. One of them is where you are. So even with your mother, you talk about how people who have been exposed to higher levels of contaminants in the environment, for example, like radiation, are at higher risk for leukemia and wondering if maybe that was part of her story.

Right. There's also a lot of talk about zip code, which determines health more than your DNA. And stories of housing are big in this book. The section about your dad and his dream for home ownership was really striking to me and that rocky road toward buying a home. Tell us about your dad and show us all the barriers that it took for him to own a home.

Emily Silverman
And then a little bit about neighborhoods and how that influences healthy. So my father, he's an immigrant from Jamaica, came here when he was 17 years old. And I think for him, like, for so many people from the Caribbean, home ownership is the goal. That is the sign of success. And in the seventies, he and my mother were looking for a house to buy for us, especially right after my sister and I were born.

Uche Blackstock
It was very important for him that we grow up in a house, something that we owned. And so even though they both were professionals, we had a really hard time qualifying for a mortgage. We grew up in Crown Heights, and a lot of it was because that neighborhood was a formerly redlined neighborhood. So even though in the seventies, redlining was no longer legal, had been outlawed, there were still the remnants of it. And so the only reason my parents were able to actually get a mortgage is because my father was a veteran, and there was a nonprofit called the Bed Stuy Restoration Corporation.

And their goal was really to help increase home ownership for black people living in that neighborhood. And so they had a veteran's loan, and my dad got that, and he and my mom were able to buy our home. But for many, many years, they actually lived in the home without mortgage insurance because they were not able to qualify for mortgage insurance because of the legacy of redlining. And it wasn't until I recognized as a practicing position what discriminatory housing policies like redlining, which was around in the 1930s and forties, how it continues to impact us today. But one thing I think is important for listeners to understand that I think a lot of health professionals don't understand is really where you live, like you said, it determines how healthy you are more than your genetic code.

With redlining. So, redlining was this policy that graded neighborhoods based a lot on who was living in those neighborhoods. If it was a white, affluent area, that neighborhood got an a. It was mostly racial and ethnic minority. It's got a c or d.

And the importance of the grading system was that it determined whether or not you were able to get a federally backed mortgage and mortgage insurance, and just by nature of living in that neighborhood, not by anything else. And so what happens is, when you actually map the neighborhoods that were redlined in the 1930s, those are the same neighborhoods today that have the very worst health outcomes. And the reason why is because redlining caused chronic disinvestment in neighborhoods. People couldn't own property, so you can't generate wealth and generational wealth. Businesses are less likely to come to redline neighborhoods.

And if businesses don't come, jobs don't come. And then even for education, property taxes go towards funding public schools. So if there is a low rate of home ownership in a neighborhood, then there's not a very large tax base for those schools to operate on. And so all these things we call the social determinants of health, all of that ultimately impacts health. But that wasn't something I understood clearly until my residency, when I was working at a public hospital and seeing how disease and illness manifested in my patients.

Emily Silverman
In the book, you say, I don't think it ever occurred to Oni and me to do anything else with our lives but to follow in their footsteps. Going into medicine, just like your mom and you land in medical school, you haven't been to residency yet, like you said, so haven't necessarily realized the impact of social determinants of health fully. And you say that in med school, there was just a lot of absence of talking about these topics in more than one way. So, first of all, people weren't discussing the shadows of racism that exists in medicine's past. And we've had a lot on this show about forced sterilization and Tuskegee syphilis experiments and things like that.

Henrietta lacks but even aspects of social determinants of health that impact health every day. Right now, you say information was presented in a vacuum without any sociopolitical context. So tell us more about what we lose when we strip all that context away from medical education. And it's interesting because we know there's a lot of ongoing debate about that, about whether having I consider, like, a more holistic way of caring for your patients, whether that is important, whether that's something that physicians and other health professionals should understand, and I can't see how it could not be. I talk about how my mother, when she was caring for her patients, I think one part of why she was such an effective physician was because she really understood the social and political context in which they live.

Uche Blackstock
She understood that when she was in the clinic room or exam room with them, it wasn't just them. It was their families, it was their friends. It was the kind of employment that they have, where they live. And one thing that I often quote, one statistic, is that between 70% to 80% of what makes someone healthy are systemic factors, and that's beyond their control. And so that's something that I feel like in medical school, we're not really taught about.

We're taught that our clinical interventions, prescribing medications, patient education, that is important. And yes, it's important, but when you look at what has the largest impact on how healthy our patients are, it really is systemic factors. So I do think it's an obligation of physicians and other health professionals to really understand intimately how those factors impact their patients. Because if you do not understand that, then you are blindly caring for them. You are not giving them equitable care.

You're not recognizing what are the barriers they face. So you can say, oh, yeah, you need to work out, you need to exercise. But if they're living in a neighborhood, like a high crime neighborhood, or a neighborhood like mine, growing up, where we didn't have any green space, and that was also related to redlining, my mom had to drive 20 minutes to the nearest park, then that is going to be incredibly unhelpful for your patients. And so that's what I mean. Like, people are making this out to be a politicized issue, when, no, what it is is this is the very best way we can care for our patients.

And we see that even in the statistics, that we are not doing well overall. Americans in terms of health, but people of color, black and indigenous people, are doing the worst. Yeah. To me, it seems like another way of storytelling. We know that in medicine, it helps a lot if you know who your patient is in addition to which organ is failing and why.

Emily Silverman
And this seems almost just like a larger form of storytelling at the population level or at the level of a city or a country. Absolutely. When I was in medical school, I remember we were talking about nephrology, seeing the estimated GFR calculated differently for white and nonwhite or white and black. I can't remember how they divided it. And I'm ashamed to say that I just kind of glossed over it and didn't think very much about it.

And in the last several years, I've realized, like, wait, why do we report out these numbers differently by race? You also talk in the book how it's not just kidney function, even pulmonary function. We do these calculations to stratify by race what is going on with that, and where do we stand on addressing that? I was taught in medical school that race is a risk factor for certain diseases, and that language is incredibly unhelpful, because while there may be some inherited diseases that are based on geographical ancestry, sickle cell disease, that is based on geographical ancestry from sub saharan Africa, but also from the Mediterranean, also from India. But the difference is, what is the impact of racism on our bodies, practices, and policy?

Uche Blackstock
So I think it's really clear for your listeners to understand that. But when we talk about kidney function, for example, I was just like you. I didn't even question it. I didn't even say, why is there a different set of normal values for black patients and non black patients? But that was based on a deeply rooted belief that's decades old, that black people had higher muscle mass and that correlated with GFR, and they had a higher normal GFR.

And I think what was so dangerous about that is that, whether explicitly or implicitly, it implied that there are biological differences between black people and other people that were somehow different. It almost pathologizes us what that different normal value caused was a delayed in referral for kidney care, for specialty care, and also delayed in being placed on the transplant list. And so there's an article that just came out that said about 14,000 patients were not placed on the transplant list, black patients, when they should have been placed, because of this different set of normal values. So that's why it's so important for health professionals to understand what is the harm that's caused when we are treating people of different races as biologically different. Kidney is just one of them.

Pulmonary function tests, there's also a race correction for that. There's also for vaginal birth, after c section, the VBAC. There's race in that. And so I love that there's this movement to really think critically about, is it race or racism, and what is the evidence for using these different set of values? How is it potentially harming our patients?

That's such an important conversation, public discourse that we have to have. How are we doing on getting rid of some of those things like the kidney function, for example. Is that still being used today in hospitals around the country? Have there been some hospitals that have gotten rid of it? Or where are we at in fixing this?

So some of the kidney specialty societies and the National Kidney foundation have really been pushing for the removal of that distinction. And there are some hospitals that actually have stopped using that in their laboratory values, not all hospitals. So obviously, it's an ongoing struggle to make sure that hospitals are doing that. Obviously, there's some pushback about this. I'm like, why would there be pushback about this if it's harming our patients?

But I think what it's important is that we really educate everyone, make sure people are informed. Even, like, for example, during the height of the pandemic with the pulse oximeters, how we found out that even though it had been known by the FDA for three decades that pulse oximeters were inaccurate in people with darker skin or melanated skin, that's something that, as health professionals, we should understand, because that's going to influence how we care for patients. So if our patient says, my oxygen saturation is 94%, but I'm just still feeling really horrible, we want to look at the full picture, because we know that this piece of technology may not be as accurate in people with darker skin. We know that implicit bias is a problem in healthcare. It can be hard to tease out definitively whether bias was at play in any given situation, which can be kind of maddening.

Emily Silverman
And you have this great quote from Toni Morrison, where she says, the function, the very serious function of racism is distraction. Sometimes you just don't know if that's what's going on, and you waste hours of your life trying to figure it out. In the book, you tell us the story of when you got appendicitis, and I was wondering if you could bring us into that story a bit and talk about what it was like to live inside that question of, was there bias here? Interestingly, when I had appendicitis, as a first year medical student, at the time, I didn't think, oh, am I being treated differently because I'm a young black woman? It was actually, in retrospect, once I had more information, I was more advanced in my career.

Uche Blackstock
Yeah, as a first year medical student, I was in pharmacology, and I got very bad abdominal pain and ended up in the ER at one of our teaching hospitals that evening. And it's interesting. I was, like, repeatedly questioned about my sexual activity. I was told that I didn't seem to be in that much pain, I ended up being discharged. I ended up having to go to the ER a total of three times in the span of a week before I was accurately diagnosed.

And by that time, my appendix had ruptured, and I ended up developing an intra abdominal abscess after the appendectomy. And I had to be rehospitalized and have additional procedure to drain the abscess. And I was out of school for a month. But in retrospect, it reminded me of experiences that probably so many of our patients have where they feel like they're not truly listened to something that sounds so basic. And actually, that Toni Morrison quote, resonates with me in that situation because.

I don't know. Was it because I was a young black woman? I'm not sure. But we have data that shows that black patients, patients who are identified as women, are more likely to be spoken over. They're more likely to have their concerns minimized.

And the harm in that is that misdiagnosis, delayed diagnosis, will lead to complications like, I had harm and sometimes even death. So I know most health professionals are like, oh, my goodness, I provide the best care possible to all my patients. But even something as simple as. Are you really listening to your patients? Are you really listening?

Emily Silverman
This comes up in your book when you're talking about getting pregnant as well. You get pregnant, there's a lot of joy, but there's also anxiety that creeps in. You had this experience with appendicitis. There are very alarming statistics about maternal mortality in black women when compared to white women, which you point out, interestingly, in the book, persist even when you adjust for socioeconomic status. So even the queen of America, Beyonce, or Serena Williams have had complications.

So tell us about that first pregnancy and some of the data that we have about pregnancy in black women and what that time was like. Yeah. If you didn't see me on a daily basis or you weren't my close friend, I did not tell you that I was pregnant or I didn't put it on social media because I was so, so scared and nervous just because what I had known about the statistics, even though I have an undergrad and medical degree from Harvard, I'm still five times more likely to die from pregnancy related complications than my white counterparts. And people want to ask, wait, why is that? You have great healthcare insurance.

Uche Blackstock
You have access to quality clinicians. Why would that be the case? I say for several reasons. I mean, the same thing that happened with Serena Williams, where she is the greatest athlete of all time, knows her body very well and still told her medical team that she needed an ultrasound of her leg to make sure that she didn't have a blood clot and was not listened to. And by the time she did get it, the clot had embolized.

So I think it's so important, this whole listening piece, but also the other pieces, and I talk about weathering. Arlene Geronimus, the public health researcher, talks about this and described this a while ago. But this idea that living with chronic stress, whether it be from poverty, whether it be from sexism, racism, that causes a chronic wear and tear on your body that prematurely ages you, makes you susceptible to complications, makes you susceptible to chronic diseases, premature death. So that's something that is not necessarily protective based on socioeconomic status or educational level of attainment or your profession. If you think about those factors when we're considering these statistics.

Emily Silverman
And for your second pregnancy, you used a doula. And in the book, talk about the vital role that doulas, midwives, and community centered models of Ob gyn play in the black community, but also just in the community. There's an example of a success story. I think it's called roots community birth center. Talk about how some of these ways of delivering care might be a path toward eradicating some of these disparities.

Uche Blackstock
For my first delivery, I didn't mention, but it was complicated, and I required a forceps delivery and episiotomy, and it just was very difficult recovery. Also, I was having numbness in my right leg. It started after the delivery, and then I remember asking the covering Ob GYN, how long is this going to last? And she kind of brushed me off. They lasted for several weeks, and I was worried, like, is this something?

I'm always going to have this neuropathy. So the next time I was like, I definitely need to have some help. And actually, I didn't know about doulas. I'm so centered in the western biomedical model until someone mentioned to me having a doula. And I'm like, what is that?

So I did my research, and the data is really convincing that having extra support before delivery, during delivery, and after delivery improves health outcomes. And so I did have a doula for my second delivery, and that was really tremendously helpful for me. When we talk about community centered solutions, there are so many organizations around there that are supporting the work of doulas and trying to make sure that people who don't have insurance that would cover it do have access to doulas and do have it, whether for free or at an accessible rate. The other thing is, this birthing center that I talk about in Minneapolis is, I think, a model for what could happen. This freestanding birthing center that was founded by a black midwife who really founded it with a mission of providing respectful and dignified care to black birthing people and people of color.

And they've shown through some preliminary studies that they've been able to decrease maternal complications and preterm delivery. And they're doing it in Minneapolis, which is for people who don't know, it has some of the very, very worst health inequities and racial inequities overall in our country. So the fact is, there are community models of care that we can replicate and use. So you finished medical school at Harvard, and you match at Kings County, SUNY downstate, which is a homecoming for you. This is you following in mom's footsteps, wanting to serve the community, and you talk about how there were a lot of really wonderful things about working there and also a lot of really hard things about working there.

Emily Silverman
Tell us about that homecoming and what that phase was like for you. I think after my Harvard medical School experience, coming back to Brooklyn was so important. I felt like coming back to Brooklyn was just home because I'd grown up there. I was so familiar with SUNY downstate in Kings county because my mother had worked there. I definitely felt like her spirit was in Brooklyn.

Uche Blackstock
I just needed to feel more grounded after medical school, and I wanted to be in an environment where I was around patients that looked like me were from my community. And it was probably one of the best decisions that I ever made in terms of my journey as a physician, because really going back to Kings county was where I started connecting the dots. It was a really tough environment to work in. I mean, it's incredibly under resourced. Some of our patients are in the ER for, like, even admitted for, like, three, four days with acute medical issues or acute surgical issues.

It's a challenging environment to work in. I really wanted to stay after residency, but I felt so burnt out by the experience of working there. And I think it's something that is very, very common for health professionals that work in that environment. You move on to do an ultrasound fellowship for a year, and then you take a job on faculty at NYU. And there's a chapter in the book that's called a tale of two ers.

Emily Silverman
So tell us about these two ers at NYU and the stark contrast that you notice there. So I had this experience at Kings county, which is a public hospital, and SUNY downstate, which is a state hospital. But it was the first time that I was working, I would do, like, alternating shifts in the same week, and I really saw the contrast in terms of resources available to our patients, even the quality of the facility, the availability of follow up care for our patients. At Bellevue, the public hospital, which is the oldest and largest public hospital in the country, that hospital serves not just people of color, people who have recently immigrated, people who are uninsured or underinsured, but in terms of the resources available there, it is just a stark contrast to what was available at NYU and even down to how our patients are treated. There's a very casual way of treating patients at Bellevue that kind of goes unsaid, whereas at NYU, where there is specialty care, everyone has a primary care doctor.

Uche Blackstock
Everyone's very well connected. You arrive and you get automatically brought into a room, even down to EMS. When the ambulances would come and they would bring a patient who was unhoused or intoxicated, it would be a problem. If they brought them to the Nyu er. They would get pushed back by our staff and say, hey, bring that patient to Bellevue.

So these are the things that go on on set that become part of the culture. And in a way, sometimes not. Sometimes we, even as clinicians, just accept it for what it is, and we don't speak up on behalf of our patients.

Emily Silverman
I want to pivot for a minute away from health inequities for patients and talk about the composition of the healthcare workforce. So, at NYU, you get a leadership role in diversity. There's a lot of different parts of that role. One is mentorship, thinking about the pipeline of trainees coming up in medicine. In the book, you say that your mom's class at Harvard, which was back in the seventies and eighties, I believe, was one of the most diverse in history because of diversity initiatives that were started after Martin Luther King Junior was assassinated.

You say that a full 10% of your mother's class at Harvard were black. By contrast, in 2013 at NYU, of the 206 incoming students, only one was black. So are things getting better? Are things getting worse? And what is happening with this?

Uche Blackstock
Well, definitely, we know the percentages haven't changed much overall in terms of the percentage of black physicians, even when you compare it to the beginning of the 19th century. So they haven't changed. And then some schools are doing appallingly worse than others. And one thing that I write about at NYU is that a lot of our black students actually took on the work of Dei. They were the ones that were hosting recruitment events that were trying to get more black students or students of color.

And I felt like that shouldn't be the burden on them to do that. That should be on the administration. Even today. I mentioned that Howard and Meharry, which are two historically black med schools, they still put out the most black physicians. And those are two schools.

Are the more predominantly white schools. Are they doing the work? And no, they're not doing the work because it really shouldn't be up to two schools to be putting out the most black physicians. I talk in the book because I want people to understand how in 2024, we're at these still very low numbers that are not representative of our patient population. About the Flexner report in 1910, that's something that I did not learn about until I was a practicing physician.

Abraham Flexner education specialist he was tasked by American Medical association and Carnegie foundation to assess all 155 us and canadian medical schools and compare them against the gold standard of Johns Hopkins. Assess percentage of physician scientists on faculty, laboratory facilities, their quality admissions criteria used. And of course, historically black colleges and universities didn't have the endowments or resources because of the legacy of slavery. But that report led to the closure of white med schools, too. But also five out of seven of the black medical schools.

We don't know for sure that they were not properly educating medical students, maybe not in the same way that medical schools with more resources had. But there was a study in 2020 in JAMA that showed that if those five schools had stayed open, they would have educated between 25,030, 5000 black physicians, which is just a staggering number. When you think about how many patients they could have cared for, how many students and trainees they could have mentored, and just the loss of brain potential within medicine and talk about why it's. So important to have black doctors. It seems like an obvious question, but I know that there's actually a rich literature on the benefits of having a physician that reflects the community that patients are from.

And I think what people should really understand is that, obviously, I would love for every health professional physician, regardless of their race, to be able to adequately care for all their patients. But when you have from the data that racial concordance, where the patient and the physician are the same racial background, is actually important for black patients. More important that those patients leave the interaction with a more positive affect. They're more likely to follow their physician recommendations and more likely to take their vaccines and their medications. There was even a study last year in JAMA, and this is an association we don't know exactly why, but even the presence of one black primary care physician in a us county improved the life expectancy not only for black people in that county, but everyone in that county.

We don't know what the mechanism is behind that, but it's really, really important that there are physicians that look like the patient population that they're serving. I think your book even opens with an anecdote where you're covered in COVID gear so the patient can't really see you. And they say, doctor, are you black? And you smile, and you say, yes, I'm black. And then the patient says, okay, good.

Emily Silverman
That means I can trust you. Yes. Yes. That's why I included it in the book, because it was such a powerful moment for me. It was clear to me that I was the doctor that she needed in that moment.

Uche Blackstock
It made me sad also, because it was also obvious that she had had interactions with other health professionals where she felt like she had not been listened to. But that was one of the powerful moments that emphasized my commitment to health equity and this advocacy work that I do. Tell us about your decision to leave NYU. It's very hard to leave academic medicine for anyone. Yes.

Emily Silverman
You in particular were going through a really difficult situation where you held this role in leadership in improving diversity, equity, and inclusion, and just were not set up for success and made the decision to leave. So tell us about that. It was a really painful decision. I had always thought that I would stay in academic medicine. I love the environment.

Uche Blackstock
I found it very intellectually stimulating to care for patients, to mentor students, to work with trainees, to do research. I really loved it. But it became really clear after I took on that role that was really just performative, that I would not be empowered in that role. And it really also got me thinking about, am I somewhere where I am thriving? And it's interesting because I was there for almost ten years, and I think on the outside, people would say, oh, my gosh, you looked so successful.

You had multiple roles and titles. But I actually was really unhappy because I didn't feel valued and I didn't feel appreciated. I write about how I'd actually gone up for a promotion to associate professor, and I thought I had checked all the boxes, done everything I was supposed to do. Even my department had voted unanimously for me to go up for promotion, and I was denied the first time. And that just felt like a slap in the face because I felt like I had worked so, so hard.

But it kind of was a radicalizing moment for me where I started thinking, okay, ucheh, is this really what you want to do? And then other things happened where, like, my social media was being monitored, where I wasn't empowered to actually do the work that I thought I would be doing. And I just said, you know what? It's probably going to be like this at most institutions, and you are just at a place in your life where you are feeling muzzled, you're feeling stifled, you're feeling boxed in. And I said, I have to go.

But before I left, I actually had founded my organization, advancing health equity, about a year and a half before I left. And my hope was to do that part time and maybe work in academics part time. But it really became clear that I had to just leave fully, and so I left. And that was a hard decision because I had really put a lot of my self worth into being affiliated with an academic institution. I thought that gave me value.

So really I had to wipe those thoughts off of me and really say, like, uche, you are enough. You don't need an affiliation with any academic institution to be worthy or to be successful. I can relate to that struggle to snip the umbilical cord, I guess you could say, to academic medicine. Yeah. So your company, advancing health equity, has been extremely successful.

Emily Silverman
You're giving talks, you're doing workshops. This work is so important and can be really difficult. As you said, there's a lot of pushback to the way that it's implemented. There's critiques of the work. As you're doing this work, what have you found works and what have you found doesn't work.

Uche Blackstock
A lot of the work that we do, we get lucky because there's a selection bias in terms of organizations. A lot of them want to do the work, but some of them actually are just checking boxes. So we have a vetting process where we ask people who's doing the asking, how much resources do you have to go into this? How committed are you to this process? So we're very, very candid with potential client organizations about their commitment to doing this work.

It is reassuring that there are academic departments out there, there are hospitals, health systems that really are committed, that have people that really want to do right by their patients and their workforce. But the work is not easy. It's not easy at all. I have been very lucky that over the last five years, I've been able to develop a strong team, team members from all different backgrounds, from organizational psychology, medicine, nursing education, who really come in with distinct perspectives but are very much committed to health equity. This is my way of doing the work, feeling like I'm contributing to the solution.

I think otherwise I would just feel incredibly frustrated. I think I saw online somewhere that you were just invited to speak at the UN, and I just thought I'd ask you about that. Cause that seemed like a neat experience. It was amazing. It was so amazing.

I was asked to speak for the commemoration of the International Day for the Elimination of racial discrimination. First of all, I was like, how did they find me? And so I was asked to give remarks. Well, I'm sure the New York Times bestselling book helped. Yeah.

But I got to be the president of the General assembly, and I gave remarks to the General assembly. And it was really wonderful because I was able to do some storytelling and talk about statistics, kind of like what I do with the book. I have a vision board. I haven't shared the entire vision board yet, but the vision board was for my book. I forgot the United nations was on that vision board.

I have the logo on it. The day before, I looked at the vision board and I saw the UN was on there. There are spaces that I never thought that I would be able to speak in or to contribute in that I'm contributing now. And I think for me, I needed to leave academic medicine because I have opportunities that I would have never had if I had stayed. Because I also had forgotten my own gifts, my own value.

I needed to leave to remind myself of that. What is it like to have packaged up so much of this work into this book and to have this book out in the world, to have the book being so successful? I'm sure you're getting a ton of response to the book. What is post book life like? I know.

Yeah, it's been a whirlwind. It's been magical in so many ways. I loved what I've been able to do with the book in terms of sharing my own personal story, my family story, but also using it to talk about these larger, important issues. And I think by doing that, I've been able to reach a broad audience. And that was my goal, just to help people with their understanding of this.

And then hopefully, when I end the book with a call to action, people to feel like I have something I can walk away with. Yeah, I just feel incredibly fortunate. My publisher, Penguin, Random House and Viking, they have been so incredibly supportive from the beginning. From the beginning, my editor said to me, I just want to help you tell your story. This is going to be such an important book.

And it has been, and the response has been really beautiful. Every day I get messages from people saying thank you for this book. This is my story and I'm so appreciative of you. I couldn't ask for anything more. What is next for you?

I know a few things. I would love to do a docu series talking about some of these issues. Maybe something called zip code where I help amplify the work of community groups that are already doing such wonderful work and say, like here we have some of the solutions but also to bring more awareness as well. The other thing I would love to do is just more policy work. Work with our legislators around policy that impacts health, because ultimately I feel like that's what makes the biggest impact on our communities.

Emily Silverman
Well, we have a lot of listeners in healthcare, doctors, nurses, students, to end. Just wondering if you had a special message for the nocturnist audience. Yeah, I think sometimes a lot of these issues that we talk about can seem really heavy, complex, overwhelming. I think a lot of the solutions are closer to us than we realize. I encourage people to look hyper locally and locally at what's happening in their areas.

Uche Blackstock
Are there community groups that are ready, embedded or trusted messengers that are already doing really wonderful work around health? Whether it looks like housing or education, employment, food sovereignty? Look and see what's happening. How can you amplify their work? How can you volunteer?

How can you donate? How can you make a difference? I have been speaking to doctor Uche Blackstock about her book, a black physician reckons with racism in medicine. Uche thank you so much for coming on today. Thank you for having me, Emily.

Emily Silverman
This episode of the Nocturnes was produced by me and John Oliver. John also edited and mixed. Our executive producer is Ellie Block. Our head of story development is Molly Rose Williams and Ashley Pettit is our program manager. Original theme music was composed by Josef Monroe and additional music comes from blue Dot sessions.

The nocturnal is made possible by the California Medical Association, a physician led organization that works tirelessly to make sure that the doctor patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org dot. The Nocturnus is also made possible by donations from listeners like you. Thank you so much for supporting our work in storytelling. If you enjoyed this episode, please like share, subscribe, and help others find us by giving us a rating and review in your favorite podcast app.

To contribute your voice to an upcoming project, or to make a donation, visit our website@thenocturnist.com I'm your host, Emily Silverman. See you next week.

Conversations: Uché Blackstock, MD

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1: Introduction

2: Family Legacy and Personal Journey

3: Systemic Racism in Healthcare

4: Solutions and Advocacy

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