Petrina Craine, Discrimination in medicine

LLP154: Discrimination in the Medical Field with Dr. Petrina Craine

Petrina Craine, Discrimination in medicine

Let's talk about Discrimination in the Medical Field…

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Petrina Craine from Memphis, TN. She is an Emergency Room Physician currently practicing in New York. Her interests include advocating for underserved communities, promoting diversity and inclusion, and creating health media as a physician journalist.

This week she is on the show to discuss her recent contribution to the anthology “The Chronicles of Women in White Coats Vol 2”. Find out how she has been able to deal with racism throughout her process of medical education, the toughest part about being a black woman in medicine and what she is doing to help bridge the gap.

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Introduction

Dr. Berry
Welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com, as well the CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, affirmation and education This week, we have Dr. Petrina Craine, who is a Board Certified Emergency Medicine Specialist in the great state of New York. And she is here to talk to us about the need to address the discrimination that's in our healthcare system. Specifically as a black female physician, we talked to her a lot about her struggles as she came up throughout the process of medical education and some of the trials and obstacles that she's had to face, especially as a black female physician here in our Health Care System. She is a strong advocate for underserved communities, promoting diversity and inclusion, and she's also a brand new author, and we're going to be talking a little bit about her recent contribution to the Chronicles of Women in White Coats.
And we're going to talk about her story, and we're going to get a little bit into her business today. So always remember subscribe to podcasts. Leave us a five star review if you have not done so already let us know how today's episode was and remember to tell 10 friends, when you get a chance. So you guys be blessed and have a great day.

Episode

Dr. Berry
Alright Lunch and Learn community. Just heard another amazing introduction for our guest. I'm definitely very excited to talk to. She is an accomplished author, Emergency Medicine Physician, and, most importantly, she's going to be talking about a subject that I think really needs to be screamed from the rooftops, especially as a physician, as a program director in graduate medical education. This is something that I really kind of keep a keen eye on kind of across the landscape. Dr. Petrina Craine, thank you for one, joining the podcast. Obviously we're going to talk about of your journey. I love talking to my physicians. It is really just talking about their journey as being a physician. But most importantly, the fact that you're an accomplished author, we want to talk about we're going to get into that business as well. So again, thank you for joining the podcast.

Dr. Petrina Craine:
Dr. Berry, thanks for having me. I'm excited to be here.

Dr. Berry:
So before we gave it to the books, obviously I know the book is important. But again, I'm getting to your business a little bit, tell me who Dr. Craine is? And, how did she get to the point where she's at right now, the glory?

Dr. Petrina Craine:
Okay, sure. So you want me to chronicle of my life as a part of the book? I see what you're doing. Well, my name is Patrina Larissa Craine. I was born and raised in Memphis, Tennessee. It's a great place, great food, great culture, great music. I have a big extended family and that's always a lot of fun. After graduated from high school, I went to college in North Carolina. I went to Duke wonderful place. Fabulous. So I'm a blue devil. So if you have any sort of UNC people listening, I'm sorry, we can't be friends. After my time there I left Duke, spent some time in Atlanta. Loved Atlanta. And this is before I went to med school. And actually I returned home to attend my medical school at home University of Tennessee wonderful experience. And I probably, definitely the barbecue is much better than North Carolina.

We'll say that, but I did leave the Southern United States to actually go, I do my emergency medicine residency in California in the Bay area at Highland hospital, a wonderful place and amazing place to train. I didn't start a tech company. I know people when you're out in the Bay, you do have that impetus to want to do that, but I didn't do that. I did attempt skateboarding, but I did very much fail at that. So it seems like what I'm good at doing is being an emergency medicine physician. So I left California to actually come where I am now to NYC where I currently practice under these NYC skylines. And I take care of patients dealing with all kinds of issues, ranging from coronavirus to gun violence and trying to teach new Yorkers how to cook a Memphis barbecue.

Dr. Berry:
And especially being in New York with, uh, you know, obviously depending on how much light you may depend on when you're listening to this really for you guys really the down tick of the coronavirus. This COVID-19 cases just in general when it's like popping up and I'm in Florida. So we're actually like on the up, unfortunately. So, especially a frontline worker being in emergency medicine, so definitely hats off kudos to you. Because I know how hard you guys are working up there. So, especially shout out on top of everything that you're doing amazingly for that.

Dr. Petrina Craine:
Oh yeah. Thank you for that. Definitely when it hit NYC, it was an experience like no other dealing with coronavirus. So all my good wishes and good luck to them, the new epicenters now. Because it's something that it's texting on you just mentally as provider, but also emotionally, physically, it's suffering, not just for patients, but also ourselves. So please, I always encourage people to especially when you're in the heat of it. So you have to do your own self-care because it's going to be a rough time.

Dr. Berry:
So let's talk about, especially as an emergency medicine physician, just some of your interest in, it's led you really up to this point where you say, you know what, I think I need to write something down.

Dr. Petrina Craine:
I write something down, well, I do have a lot of varies interests, and I do have interesting health disparities and health inequities. And I think that interest started pretty much early on just given my background of where I'm from, like I'm from Memphis, it's a place where there's grit and grind and grace. That's why I had to tell people, but there's also this unique lens of growing up there because you have such prominent, institutions that are reminders of issues with racism and also working against racism, such as the civil rights museum. And it's unfortunately location where our prominent civil rights leader, Dr. Martin Luther King was assassinated. So I'm a black woman now I promise you. But I was once a little black girl and I can distinctly remember even then having experiences dealing with racism. So for example, when I was in kindergarten, I used to be like six years old and I did have a white male classmates who I played with many times before, all throughout the school year and this particular time, I can't exactly remember what we were arguing about, but he became so angry at me and we were arguing about whatever six year old argue about it with like a bro, I remember a broom and like the place in, or maybe we were arguing about who was going to do the sweeping action of kids like to do chores, at least at that age, not when they're older.

And I just remember him just beginning becoming so angry at me. And he told me at some point that I was just black and I argue with him because I was like, how dare you even call me that? Because I'm Brown. I am my six year old mind thought he was insulting my ability to tell my colors, which I knew backwards and forwards could even spell some for you. My teacher actually stopped this conversation, but I remember her and also talking to my mother about it and me talking to my mother about it in my little six year old way. But I remember her sitting me down at home to talk about the implications of the sentiments. It wasn't so much the color of my actual skin, which I'm brown skin, black woman, but it's not dealing with color with rainbow. He was dealing with the colors of race and what that meant to be just black.
So even as a little black girl, I've been confronted with these issues and it's just a company throughout my whole journey in medicine. And I actually provide a snapshot of my experiences in the book, the Chronicles Women in White Coats too. And my chapter was called black plus woman doesn't equal MD. And so from dealing with my experiences, I feel like I have a voice that needs to be heard. I'm a black person, I'm a black woman. I'm also black female doctor. And unfortunately I don't see my story being told all over different platforms, whether it's books or podcasting or radio, TV or magazines. And so given the opportunity to talk about my story, I wanted to do that. And when I got the opportunity to work with an amazing group of other authors on this book, it was a chance for me to actually sit down and write and tell my story, which is important to do. Because my family, like I told you, I have a big extended family. I mean, Christmas is like having a football team going over our different homes and stuff like that. It's serious.

And my family raised me to understand you have a voice and you do have to use it. And especially when you have a certain platform that others may not have to use that voice to affect change, then you very much should do that.

Dr. Berry:
Let's talk about Dr. Craine, especially as a medical student and as a resident. Was it like, obviously your first experience unfortunately was when you were six years old. But when you become a medical student you're resident and you're definitely aware of the world around you, was there very obvious instances where you definitely noticed that like, okay, I'm being treated differently because I'm black and a woman, which I think, I think a lot gets lost in the story a lot, especially, for women because especially for black women, because I think a lot of times they get lumped into the black physician struggle per se. But a lot of times they're not even afforded the ability to say like, no, we also have a struggle being a woman in black as well. Was there any obvious experiences, the one that happened as you're six when you're a student or a resident? How was that life?

Dr. Petrina Craine:
Yeah, definitely seems so long ago, but it really wasn't that long ago. And I tell everyone that I wear my white coat with pride it looks great on my black scan especially if I wear some sunglasses, I need a pink stethoscope. I look wonderful. But it doesn't protected me from different forms of racism. And I can talk, like I said, a little bit more about that. But I first wanted people to understand and say, you know, their race itself is not scientific at all. It's a sociopolitical construct and racism is about how a dominant race can use its power to devalue and dis empower a non-dominant race and take advantage of the opportunities to benefit the dominant race. And so racism, unfortunately permeates all aspects of society. And so medicine, unfortunately it does have racism in it. So maybe you were surprised to hear that the medicine is as a part of society. And so for instance, in medical school, I'm so happy when I got accepted in medical school, because I was going to go to a place where you learn about scientific concepts of human anatomy, physiology, disease, pharmaceutical treatments, and how to objectively process and analyze the information. But amongst doing this, some of my experiences in medicine, we're colored by dealing with racism. So for instance, I distinctly remember I have a large SUV. I know gas closer, sorry about that. Love the car, but I was actually…
Climate change, you are part of the problem. So I gas SUV. But I love my SUV because I can basically you can put a tree in the back of it and do whatever you want. I can go to camp, I'll pick up a tree today, no problem. So, for me, I actually, it was going to a school fair drive for an underprivileged area. And so I had spent time collecting all these different donations for this particular school of underprivileged children who unfortunately, most of them were African American and I, on my way there, I pulled over to the side. This is like a hot day in Memphis. And I opened my trunk and I'm just organizing the donations better because they were in these different gift baskets and presents, and they were just beautifully decorated.
I'm so excited to deliver this gift to the children. When all of a sudden a police officer comes over to where I am. And I know this particular officer he's patrolled the area before and he comes up to me, he's sort of looking at me and I'm like, you know, not even like, hi, how are you? He's like, yeah, I'm doing okay. I got a report that there was a black female and breaking into this large SUV. And I'm like, what, what do you mean? I thought he was joking. I'm like, this is my car. Like everyone sees me in this car and he's like, no, we're getting reports. That's you? And I'm like, are you telling me that someone just some, and again, I'm in my white coat. I'm doing things with the presence, I'm going to give to my children, to the children. And someone has accused me of breaking into my car, my own car, breaking into a car, not realizing that it's my car. And I just remember an officer. It was a fine interaction. And, he left me alone. But I just remember sitting in the car for a little while, just thinking about the experience and I'm like, wow, I'm being accused of doing something wrong when I'm in the process of trying to do something right. And that's just an experience that very much stuck with me.

Dr. Berry
Okay. And that's a tough, because you're like, there is nothing you could have done differently that would have made that person who apparently said like, oh no, this person has to be breaking in. Because that was their only logical explanation of why you would be in that car which is like dumbfounded.

Dr. Petrina Craine:
And I'm in my white coat, organizing presence. I'm near the medical school place where I'm go all the time at this time in my life. And so, and at that moment, the white coat didn't protect me. And so even though there may have been, and I don't know who called for all, I know could have been a colleague that called it could have been just a random person off the street. I have no idea who called, but the fact that someone called about that just sticks with me.

So even as a resident, I talk about this a little bit in the book and I'm not going to give it all away, but I unfortunately have had some experience where my being a black female in medicine and being a doctor was questions. So just for people to know in California, when you're a resident, I know there's different per States. There was a time in the state where you even get your license before you graduate from residency. So you're technically fully licensed doctor in California to do certain things after for me, it was particularly after my second year of residency. And I'm seeing this patient in emergency department, she's like an older white lady. And she unfortunately failed slipped had just a little cut laceration that just needed some stitches just put in to be repaired. And, I see her, I've talked to her about this, what we're going to do. And she just was adamantly saying to me that you will not touch me. I don't think you have the credentials to do whatever you're talking about. I need to see your license. I need to see your degrees. I need to see just asking for my credentials, for me to do something that it's a simple medical procedure. And I remember going to my attending at the time, telling him this story. And there was a white female attending who absolutely very much advocated for me in terms of saying you're being inappropriate. She has the proper credentials to do this. It's not how you should treat, she's your doctor. And the patient just adamantly refused. She felt I was unqualified, but couldn't tell me specifically why she felt like I was unqualified and left without having her laceration repaired.

Dr. Berry:
Wow. So she was like, you know, I'm not even going to get treated.

Dr. Petrina Craine:
No, she was like, if it's you, who's going to do it, not doing it. And in that moment you're like, wow, especially I imagine the emergency room you're going about your day. And you have to keep going, like seeing patients, that's a unique thing about our specialty…

Dr. Berry:
Exactly, you have the ability to chill because I got probably five more people and I got people coming on the way in EMS

Dr. Petrina Craine:
There's a cardiac arrest coming. And maybe someone who didn't make it to L and D as quickly as they should. You're dealing with all of that and have to deal with also racism in that moment. On top of that was just a lot, a lot. And it can cause you to questioning yourself. That's one thing that for me, that I actually have talked about that experience. I'm like, wow, am I, am I good enough? I've done all these different things. I have all these different accolades. I've been valedictorian. I've gotten this award. And that award at some point I was an intern of the year at my residency. But all of the accolades, the white coat, all this stuff doesn't matter because for some people, all they see is my black skin. And for them that has a negative connotation with whatever for them. And so regardless of me having all these accolades, being a doctor I feel like I'm a fully licensed emergency medicine physician now, that doesn't matter. And so how do you navigate that being a nonwhite doctor, how do you navigate the struggle and those questions, and also dealing with all that and so that she can still take great care about your patients. It's something that I've struggled to do, but it's something that over time that I try to develop, and I do talk about this more in that book about strategies, about how to navigate the twist and turns of racism in medicine.

Dr. Berry:
Now, question I have in it. And obviously I have a personal experience as well too. Do you find the system at hand being as big as a corporate as the patients we typically have to take care of in terms of where have you felt a lot of the brunt from more? Was it like from the systems administration, attending’s, or the patients who if you to, I guess choose one facet?

Dr. Petrina Craine:
I think for me, my experience has unfortunately been more on the patient side. And I guess fortunately has not been so much on the administrative side. But in terms of what we get what. I've given you, you have to just think about going into understanding how racism is so entrenched in medicine. I mean, you think about different, definitely examples of systemic racism, such as, you bet the STD study where you have black men who didn't get an informed consent before they we're may study participants for this natural study of syphilis, the course of syphilis. There's numerous documentation about the grave robbing of black corpses and bodies after funerals like the 19th century in Baltimore to sell to medical schools, to do different anatomical dissections. There's a history of even certain diseases being thought to be attributed to black people in the slaves.

So for example, there's this disease that was particularly that to be a Negroid disease. And it's called drapetomania where slaves were running away. If that's what that disease process was called. And also this disease called kickxia Africana or African wasting. And this year when, why people deserve in their slaves, they were mounted, nourish and wasting away and also eating dirt. And we know that this is pica because obviously among all the different nutritional deficiencies, we could imagine slaves have. They also had like an iron deficiency. And, so that was looked at as a uniquely negroid thing to have pica. And that was not a human thing to do. So you could imagine instead of having human treatment for such a disease, so such as, maybe a white plantation owner would give the slave better food. They addressed patients who were suffering from pica harshly, like even being, putting iron mask on their face and even decapitating some slaves that were dying from the disease as a lesson to others.
Don't you eat that dirt? And so this is just entrenched in what we do. And it comes up in different ways than medicine. Slaves would even be whipped harshly, as it was thought that black people, their nervous system was different. And so they couldn't dare pain more. And you have those sorts of notions that even continuing today. There was, I think, a study back in 2016 where it talks about the under treatment of a black patients. And because there were a thousand a month, our trainees, especially like medical students and the residents about these false beliefs that blacks had thicker skin and so forth, they didn't need as much medication as a white individual.

Dr. Berry:
And that's probably the set, especially that one amongst the others we're crazy because it's so permeated within the culture of medicine that medical students have been ingrained with the thought process. So it's not as, it's something they've been out for a few years and they got washed in the system. No, no, these are people who they were pre-meds two years ago and all of a sudden they already have the school of thought. That we require this pain medication. We don't hurt as much. And because of that don't have to give them what they need. And I see the last question down here with our sickle cell patients where I just like the bias is so evident that, Oh no, they're just seeking.

I'm like, no, there's actually seeking. Like that's seeking is not a thing, right? It's one of those things where you have to treat the pain and you have to remove your bias from it. And it's so like you said, so rooted and ingrained in our culture of medicine and how we train over and over and over again, that it seems almost foreign. When we start saying like, hey, you know what, we kind of feel just as much pain as you all feel. We would to be treated the same way that people like, look at you crazy.

Dr. Petrina Craine
Yeah. And it's crazy. And this is influencing even other aspects of health, like for racism, there's literature on increased maternal and infant morbidity and mortality, where even if you have, a pregnant black woman, a pregnant white woman, you control for all the different factors, socioeconomics, whatever control for everything that there can be poor outcomes for that black mother. And there's a thought that it's this racism that is influencing maybe on it, even in epigenetic level on these sort of outcomes. There's data about there's more psychological stress and even substance abuse and communities that are much more effective as systemic racism, which you could imagine, for example, including, let's say you have a racist encounter with a law enforcement individual and the kind of psychological stress you can have for that there's literature about heightened food insecurity, being, feeling that you can't go seek access to certain foods because you're under this umbrella of racism.
And even we've seen differential use of potentially lifesaving testing and medication such as even the use of a clot busting medicine for strokes, that was less given to black patients as compared to non-black patients. And so this stuff is very much deep and entrenched in medicine, unfortunately. And it just contributes to, like I mentioned to you, one of my interests, health disparities and inequities, and those are nice terms, We say disparities, it's, they're just polite terms for us to say that there are segments of the population that are dying and they're dying more than other segments of the population and what is causing that. And so I think you have to also look at them how disparities inequities relate to each other. They're very much intertwined, but they're different. So if I can just take a minute like health disparity. The way that I think is healthy people, 2020, they defined it as it's a particular type of health difference.
That's closely linked to certain social determinants of health. So such as economic social, environmental factors and health equity is the principle to reduce those health disparities. Have you can look at health equity, it's like the social justice for health versus like health disparity is the metric we use to measure that progress to achieving better health equity. So if you can reduce health disparities, you can have improve health equity. And just going back to, I'm from Memphis. And so you're under this umbrella of just thinking about civil rights issues. One of the last acts that,Dr. Martin Luther King Jr. himself did, was being involved in the poor people's campaign for the sanitation workers of Memphis, how they were asking for just human treatment. They were being treated like sub humans. They want an equal wages, good working conditions. And so health equity, if you look at it for me, the part of that campaign in the 1960s for that sanitation workers is that I am a man and trying to fight against racism. And medicine is like our health equity. It's like our poster saying, I'm a man. I am a human. And I deserve equitable medical treatment.

Dr. Berry:
As a program director myself and being very involved with especially graduate medical education, but really medication, medical education in general. When I see and I look across the board, right. And I see the students are just the makeup of students. And I see the landscape where as a black male and black a woman, that there just isn't many there to even start the conversation. That's why I want to ask what was like. When you can looked around, I can tell you in our class. I Went to Nova, South Eastern, we had a class of 200 total and there were seven of us. At that time it was lauded as a successful year for black students in the class. Because there are seven of us, because they weren't used to having that many. And I'm like, wow, if they had a 207 raises eyebrows and has people jumping up for joy? I don't even want to know what it looks across the country. What was it like, especially coming up as a medical student, especially as an emergency medicine resident, what was like, as far as there's a general makeup across, what we’re doing and was looking like for you?

Dr. Petrina Craine:
Well, unfortunately I had a similar experience. I can remember being in medical school. My class was probably about that much, maybe a little bit less, but you could fit all of the blacks for instance, black and Latino students in one room and barely double digits. And you can imagine it's interesting. You bring up the story about how schools are like, yeah. There's like seven or eight of you. Like yeah. Like whatever we're doing, that's working. But I mean, not to diminish that success, but is that enough? What we noticed in the last few months, it's like you said, we've been screaming from the rooftops that, Hey, like there are these health disparities, there's no health inequities. There's lack of diversity in medicine. And, medical organizations are, at least through their statements are acting like they want to really answer this call.

And I'm not saying they haven't been answering this call, but maybe what you're doing, hasn't been good enough. It's like, you're just doing just enough to get certain results. And are those results you're getting, is that even good enough for the communities that you serve? And I don't think it's enough. I think that institutions and schools can do more. So just for example in terms of addressing anti-racism, why is that not part of medical school curriculum? You know, for instance, like I basically was a fairly new medical student when Trayvon Martin case happened and Trayvon Martin was unfortunately murdered. And so you can imagine like going in to school at what's your backpack and anatomy books about to break your backpack. And I remember one of my professors trying to take a moment to actually just speak about that case, because this was like a social determinants of health related question, and sort of the positive in the room about, Oh, we can't talk about that here.

That's not the place. And just being like a black person. How is this not the place? Where it's not an appropriate place to talk about this issue, because just like I said, racism is intricate in medicines, intricate in society. So to ignore these issues or to not approach them with the same zeal as we do, as someone who comes in for emergency room, and I think they're having a heart attack and just, Hey, it's just like, go like, that's the same sort of zeal and reaction to stuff that we should have for treating health disparities, and also addressing like racism in medicine. In my residency class, I would say that there were 12 of us. Two of us were black females. And for, you know I went to residency is different first place.

And that was like a good year for them. But at the same time, there's only two of us. And they were even subsequent years where we didn't have, maybe we have one African American person for instance, or one person of color. And I can distinctly remember even not from certain administrators at the hospital, like having a discussion about, it's almost like a competition about, what kind of diverse person we should take this year. Like, can we do a black female? Who's also identifying the LGBT community or should we get like white female LGBTQ? And I'm like, hold on, hold on. This is not like a competition race. It's not like insert here, take this one out. Why can't we have like all these different people in this residency, if that better reflects the type of doctors that we need and also better reflects our patient population, it shouldn't be like a race.

So what I think emergency medicine is like some medical specialties where there is a dearth of emergency medical providers of color. And there needs to be a more concerted effort. And there has been, I think, over time to talk about that and address that and what we can do, but I need people to, for, in terms of medical institutions to think about their efforts, they've been okay, but have they been aggressive enough? And if you're not quite sure what to do, maybe ask those who maybe navigate the space better, such as myself or you about what our ideas, about how to really, really address this problem. Because I feel like, there hasn't been much change. Like if we only make up 12% of the population, for example, black Americans, then that's pretty much been steady. We're still under the amount of percentages we should have for black physicians. And there are some specialty, I think that do this better than others. For example, there are more black OB GYN, then other specialties. And that's something that has definitely changed over time. So what did they do to get to that point to have doctors who, like their patient population?

Dr. Berry:
And I love that. As a suggestion, you say, oh, maybe they should actually talk to the people who are like, a franchise. Because it sounds common sense, but they're actually not doing that. And that's probably the sad part, they’re not taught if I want to see how I can get more black women into the system of healthcare, and into the system of becoming medical students and becoming physicians and becoming attending in respective fields. Maybe I should go to them and see like, hey, what's stopping them in the first place. And surprisingly enough, they don't do enough of that. It's one of those things where like, yeah, you say it, your mission statement says it. You have an office of diversity but what are they actually doing and what do we need to do, especially those who are already in the field who are already on the other side, really to hold their feet to the fire?

Dr. Petrina Craine:
Yeah, exactly. Because if we're able to hold their feet to the fire, I feel like we would have more things like increase education on racism, it's components like discrimination or micro aggressions, and then more exploration about the effects of racism and what it can have on society, such as, even thinking about all these different protests and the different protesters who experienced pain or any sort of medical condition after being subjected to police, riot weapons, like why can't there be research on what happens to them. And then also we need to actually implement the different things that we're talking about strategies to deal with anti-racist strategies, strategies to deal with things like, policy or interactions with law enforcement, even the emergency department, all these things I do feel like maybe the latest things that have happened with George Floyd and other things in the media that you are seeing this call from different medical organizations that's why we really do need to address this.
I know my residency has very much try to do that over the last few months and I applaud them and appreciate them for that. But that sort of zeal just needs to be bigger. I mean, think about like we're dealing with this constant. I mean, dealing with this pandemic. It's been going on for, I know when it hit New York, like the same, like February, just February, March is just like a blur and we're dealing with this pandemic. And like we, as a country have gone to, I'm trying to address coronavirus the PPE and the messages and campaigns and getting resources and getting this and getting that. But black people have lived under well and not just black people, but, you know, non-dominant racist. If you want to say, have been dealing with the pandemic or racism and its affects for way longer than coronavirus has been here way longer. And so I need that same energy applied to what we can do to better, can I get rid of this racism that our communities. And it's affecting our health, I mean, it really is killing us. I really do believe it.

Dr. Berry:
I definitely agree. And I think it's one of those things, especially when you talk about the residency, I remember, especially with joy fluid when they were a lot of the process that go on and actually still go on. Most people don't even realize it because they just really stopped showing it on TV. We actually did a kneel in at our hospital. And I remember the support from our administration was more of, okay, we won't stop you from doing it, but we won't necessarily be out there with you doing it. And I think it was just me and I think probably an eight or nine of my residents who just went out, especially because where I'm in Wellington, Florida. So, pretty well dominated as far as just the white population from majority. I knew that we probably wouldn't get the support from admin per se. Because obviously they got their people answer to. But at least I appreciated the fact that they didn't stop me from doing it, because that probably would have been a difficult conversation. Because I don't think they would have been able to do it anyways. Well, at least they we're not going to hold it over you in that regard.

So I think you said it right on the head, like you have to hold these people to the fire and we definitely need that same energy. Every single day, in every single policy and every single way. And I think what happens a lot of times the stress and burden is put on people like us to have to do it by like, if it's just us, right? We don't the numbers unfortunately speak for itself. We don't even have enough numbers right. To, to make the movement. So we needs to be an inclusive effort to say like, nah, like being black and being a woman and being a black male, being a black woman it's problems. And we all need to get behind this because this is a problem that is affecting not just their population, but everyone in general.

Dr. Petrina Craine:
Yeah, definitely. I think it's interesting when you comment about how no one specifically stopped you from doing what you did in order to honor what's going on. And that's always gets me because I feel like for certain administrative has been there helping whether they won't say no, but we're not saying like with a resounding, like yeah, yeah. But I think that goes back to thinking about how race and racism can be socio-political, but racism is in medicine. Like racism is as American as apple pie. Like if that's her classic classics of American culture, it's that because it's in his lockstep in medicine. When slavery became institutionalized. So this subsystem of health for blacks, for hundreds and hundreds of years that I would say still continues today. There hasn't been a period American history where the health of blacks is equal to the health of whites.

And so I think if you understand that racism is sociopolitical, but also what I encouraged people to look at racism, as what I mentioned, it's like a social determinant of health. And so we, as medicine are addressing other social determinants of health environments, like violence, like climate, there's still that there's a, I feel like a different zeal and energy to addressing those things when racism is a social determinant of health. So understanding, yes, it has a sociopolitical beginnings, but it's even bigger than that now. So as a medical administrator, I shouldn't feel some hesitancy if my doctors and my medical students and my residents want to go out and address how to address racism, because that is what we should do because in order for us to end these health disparities in health and equities, you have to look at it with that lens, not the lens that is completely socio-political. And I think if we had that, then your administrators would feel more comfortable about saying, Hey, let's go for that. Versus sort of, like hehehe.

Dr. Berry:
I just remember it being so funny because I remember when I think it was a week or so had went by. I didn't get. I didn't see no email go out. I didn't see anything. I was like, Hmm, this is weird. And mine, you have guys got a black program director. Like if you don't think it should be mentioned. That's an issue. So of course I shot him an email. I'm like by the way I haven't really heard anything. Me and the residents were planning on doing this. We just wanted to make sure to see if admin want to do too. And they're like, oh, well, you know, you guys can do it, but it will be there. And then when the day came, no one was there and I was like, oh, okay. So clearly like someone above said, no, we can't, we can't do that.

Dr. Petrina Craine:
Yeah. And it's unfortunate. It's like, no, if you had gone and say, hey, there's violence. Like all these people got shot up last night, we need to stand up against violence. The parking lot would be full. Racism is just in a social determinant of health. It should be the same energy. Like I said, like Americans, we don't run away from problems that's part of our apple pie culture. So to speak, we face problems head on and we make solutions. So we need to make our response to racism. I would say, I think of it as a new ingredient in that apple pie recipe about what makes us uniquely American, that if we would come together and just respond to this with the same energy as we have done other things, that's something that it will benefit us all.

I mean, I even tell people that say you are the most racist, whatever person in the world. I mean, there's even data that let's say you come to the emergency room and you're having pain that a nonwhite Dr. may actually achieve better pain control for you faster than a doctor who's white. There's actually some literature on that. So you're a KKK member and that's fine. Like in terms of that's what you want to do. I may not agree with it, but that's what you want to do, but hey, maybe beneficial to you to have a nonwhite doctor in that moment when you come in and maybe you broke your leg from doing some clan rally.

Dr. Berry
Right. I love it. That's funny. So how, especially moving forward. Especially with the book and obviously the motivation clearly was there. How do we help try to improve not only the discrimination that we see in healthcare but address some of these unfortunate number gaps, especially for black women? Right. And then again, I stress that enough and I talk about this a lot during for a lot of my residents this year. This year I was very fortunate that we actually had all women in our class, but three of them were black. And I was of course jumping for joy for that, because that has definitely been a push of minds just to get really more people who look like me in my program. How do we address that? What should we do? Let's say me as a program director. Right? What should I be doing more of to try to help promote the black female physician?

Dr. Petrina Craine
I would say, think about developing a strategy that targets racism and all this different like components. So for instance, let's just say, I try to think about it in different ways. Like there's maybe internal racism, maybe you've been flooded with these messages, like for instance, a black female, maybe you're hypersexual and you don't have the IQ for this. And you're internalizing and believe that? Do you believe when I was having those instances where I encountered racist individuals? I actually good enough to be a doctor, encountering that internal racism that you, especially, I think our physicians of color may actually experience it sometime in their lives and recognizing that's false. You are good enough. And so what strategies you can do to actually combat that internal racism. I encourage one thing I talk about in the book is how to foster your own resiliency.

So does that mean staying up on the literature? Is that reminding you that, hey, you're a great skateboarder. Something that I can't do, like whatever you need to do for your self-care, with the things that you need to do to combat that internal racism. I think that's also important. So then also thinking about the individual level, which is you are experiencing the racism from another person. I think number one, recognize that for whatever reason, we all have our implicit biases and that person is coming at you with an experience and you're coming at them with that experience and acknowledging that this doesn't make you feel good. But just reframing the whole experience, even from my patients that I have, fortunately it has not been a lot of them, but for those that have been racist towards me, I've been able to, I think, take great care of them if they. Except for the case of that lady who left, like I did take the care of her, but I mean, she did want me to continue to take care of her.

She didn't stay for the rest of my care, but just reframing the issue and just say, hey, this is a chance to maybe I'll change their life today. Maybe they'll at this moment say, hey, maybe these black doctors are so bad and this particular specialty or whatever. So taking it in that moment, dealing with that individual racism, how to address it. And then I also think systemically, I'm just thinking about more from like your perspective and graduate medical education and people who are in administrative responsibilities, how do we address the systemic racism? So you can do things to really address this such as if you increase education on it, like actually put it in your curriculum, have a case conference about morbidity and mortality. And M and M that happened. There was racism implied in that because there are cases of that.

Actually have a clinical repository of resources about how we can all work to be more anti-racist. How about actually have funds to address anti-racism research for different things. So talked about if there's under treatment of black individuals for pain, for different reasons that came out of research. But you have to actually someone has to think about that and take the same great grant money that you may get to study. Whatever intervention and for whatever reason and apply it under that lens of how I can address anti-racism. And then I also just on, I would think related to systemic racism on a macro level, like from doing the research and doing the education and addressing all the internal and individual racism. How you can make macro-scale intervention. So can you take what you're learning on that level to something like health policy and helping to inform all our different political leaders of how we can create a better anti-racist community overall.

Dr. Berry:
I love it. First of all, I definitely appreciative of the really a full scale approach to it all because I think you said right on the head. There is so many different levels that need to be really addressed. Really say, hey, this is an issue address and then worked on for us to really get the wide scale results that we're looking for. So definitely thank you for really such an amazing conversation that needs to be had more often especially amongst folks outside of our circle. It needs to get to the point where it is not just happens to be two black physicians who happened to be having this conversation. Especially in regards to health care. We're having it now in regards to law enforcement and police interaction.

I told my residents, I said, unfortunately in health care, we're in a glass house. It's, there's no reason for the color of my skin to make it so that I have higher rates of blood pressure and diabetes and maternal rates are higher and pay. There's no reason that my skin color, for some reason, determines that. So we are living in a glass house as we're looking and seeing, especially the landscape that's happening now around where law enforcement and just the police interaction is being really scrutinized. And I think there needs to be a day where medicine and the healthcare system is really brought to the table and say, hey guys, what are y'all doing over there? Because clearly something's off over there too.

Dr. Petrina Craine:
Exactly. And I tell people as doctors this social activism, if that's the way people want to think about it, this is not unique to us. Like this is not something we haven't done before. This is not unchartered territory for us. We are doctors. Like we are the same people who have given you a debate key and have come up with this individual for that. There's no reason that we can't collectively black, white, whatever, come together and unite ourselves to come up with plans, to address racism and medicine and how that also will just permeate out from the rest of our society. And I really think us doing that will help decrease health disparities and really work towards achieving health equity. And again, I always encourage people to get our book, The Chronicles Women in White Coats.

Dr. Berry:
Where gonna get the book from, tell them that one. I would love to hear it. What's the one goal you would love for them to really pull for specifically from your chapter? More importantly where we can get his book? Where can they read this?

Dr. Petrina Craine:
And you can get this already bestselling book. I'm just putting it out there. I'm not bragging. It is best sellers with Amazon being one of them also available from other Chronicles Women in White Coats, a website. And then I would also say, what do I want people to get from the book? From my particular chapter, I would say, when are you reading my chapter, I like a lot of analogies as I guess you can see, it just how my brain works. And so let's you're driving right. You're in your car or in your bike or whatever. But in my particular chapter, I take you on a personal road trip in medicine, that's the trip we're going on and we're exploring the intersection of race and gender. And so in my chapter, you can see what forks in the road. My perseverance has got to come across. Like what pit stops, am I taking in my identity and what twists and turns, it's my resilience encountering.

And so my words are vehicle and you're the passenger or the driver, but you can use that to explore those different issues as you go along with me on my journey in medicine. And I'm hoping that from that chapter, you'll be able to better recognize and understand like racism and how you can better navigate the system and notice that we can all come up with strategies to deal with the effects. Because I would give me something else to talk about. We have an anti-racist society. I have plenty other things that I can write and talk about. And I would love to just put this to rest.

Dr. Berry:
I love it. And before I let you go. What's next for Dr. Craine? Like, were bestselling author now, right? What should we expect out of you? Where can people follow you? Just kind of follow your journey as well. Give us those details.

Dr. Petrina Craine:
Well, I tell people I'm a doctor, but I'm also a creator. I love to write, so I'm working on some other pieces. There are other books in the future. So look out for that. You can also find me in the position journalist space. I really like to try to educate people about health topics. So look me up. You can find me in different media outlets actually doing that. So look for more of that. You can find me I have a Twitter, but I don't really use that much. So I'm trying to learn how to use it better. I have an Instagram, @trapmd09. That is my handle. So people can follow me there. And sometimes people ask me, why did you call yourself that?

But you know, I'm from the South. I grew up on music, like, hip hop music. And I listen to everything from Memphis. I love Soca and Blues. I love EDM. I listened to a lot of different things, but for trap music for me, and for people who don't know, it is a genre that does talk about different things and a trap. It's like a rundown house where people are selling illegal things like drugs and stuff like that. So there's a lot of negativity that's associated with trap house. But this is a genre that itself has created a million dollar industry. And there's nothing glamorous about the negativity, but how you're able to take negativity, negative experiences, negative environments, and even use that to make yourself and those around you better. I mean, but I think that's amazing and it's that energy and that hustle, that trap music that I appreciate. And then I very much identify with, because I worked to bring medicine and knowledge to all people to the streets where those streets are well paved and they have nice gardens and ivory tower communities or as a wreck, you know, rocky path with dilapidated housing. Yes. So that's me.

Dr. Berry:
Hey, listen community, me and me. Dr. Craine might be like low-key family. Because like everything she was saying, that's me. Yup, yup, yup. Yup.

Dr. Petrina Craine:
A big family. I have to compare last names and get a family tree, the whole thing.

Dr. Berry:
Again, thank you so much for taking the time, really, to talk about a conversation that needs to be had that will likely need to be had next month, the month after the month, it will probably, is there something that's needs to happen? And I'm glad that you're able to really take some time, put some pen to paper and help educate a community that really needs to hear it. And it really needs to hear it from our voice. And I'm glad they're able to hear it from a voice like yours.

Dr. Petrina Craine:
Yeah, thank you so much. And thank you for providing this platform. Like you said, at the beginning, like screaming from the rooftops, and this is an issue that, if we're screaming so much, we lose our voiceover. That's one thing, but it just needs to continually be in the public conversation. What I hate about sometimes with these specific incidents, like things can happen like with George Floyd or other, other people like Brown Taylor and they may disappear. And for a while until the next thing happens and there's like up for, it almost looks like this crescendo-decrescendo, crescendo-decrescendo. And we need to stop doing that. It just needs to be a constant, just straight horizontal line. Just we need to address racism. It just needs to be as important to us as breathing every day.

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