NH Doctor: Restrictions on teaching racism and sexism “a threat” to education and patient care

A new law restricts the ways in which racism, sexism and other forms of oppression can be taught in public schools. But this also applies to state-funded medical institutions that provide training and care.

All Things Considered host Peter Biello spoke with Dr. Marie Ramas, medical director of the Gatehouse Treatment Center in Nashua and president-elect of the New Hampshire Academy of Family Physicians, about the impact of these new restrictions on education and medical care. Below is a transcript of their conversation.

Peter Biello: This is all that is considered on the NHPR. I am Peter Biello. Following the adoption of the new budget, the state recently issued guidelines on how topics such as racism and sexism can be addressed in publicly funded institutions, including medical clinics and clinics. schools that receive money from the state. Dr. Marie Ramas is the Medical Director of the Gatehouse Treatment Center in Nashua and the President-Elect of the New Hampshire Academy of Family Physicians. She’s with me to talk about the impact of these new restrictions on medical care in Granite State.

Dr Ramas, thank you very much for speaking with me.

Dr Marie Ramas: Thank you for hosting me.

Peter Biello: How are people trained to work in medicine at any level currently taught about racism and sexism?

Dr Marie Ramas: This is an evolving subject, especially over the past five years in the practice of medicine. Previously there was really no formal discussion of race and racism and its effects in medicine. But over the past five years, ACGME, which is a national accreditation body for residences and medical schools, as well as other houses and regulatory bodies within the structure of medicine, have formalized training requirements in order to better understand our patients within their social environment. and historical context.

Now there are residency program requirements to do implicit bias training. For example, understanding what cultural awareness and how it would apply to our patient care. And then also, what I think has been discovered more recently is to understand the historical manifestations of the practices that we have in medicine as well.

Peter Biello: With this new law, how would these things change? would they change?

Dr Marie Ramas: This law is particularly aimed at public establishments which receive funding. But the danger behind this is that with our private entities and our academic bodies in the state of New Hampshire, there are usually alliances and relationships with state funded opportunities and grants. And so there is a gray area to [how] funding affects our medical and nursing education. And so it is difficult because now there is a fear among faculty to even talk about the concepts of race and racism and its effects on the students, interns and patients we serve.

Peter Biello: It seems what you are saying is the same fear that some public school teachers have expressed regarding this law and their ability to speak freely about racism and sexism and the way they work in our society, those same ones. fears are present among those who are teaching people preparing to work in the medical field.

Dr Marie Ramas: Absoutely. And I would be even stronger. It’s not just a fear, it’s a threat. And again, these types of legislation specifically threaten the progress that has been made to help us understand our patients and not harm our patients and our community.

Peter Biello: I want to ask you a question about a specific example. Studies have shown that many doctors believe black patients feel less pain than white patients. Now that this law is in force, how could it play on this misconception?

Dr Marie Ramas: I think that’s where the problem lies. Racism has, for example, been declared a public health emergency by both [Centers for Disease Control and Prevention] and several medical corps over the past year to two years. There is scientific evidence and evidence that shows the effects of racism and structural racism and how it affects the downstream consequences on the health experience of patients. Pain is one of them. And so, when we talk about science, we have to use our best judgment.

The wording of the law at this point is very vague and it is left to the vices of subjectivity. But as a physician-researcher, I have to work within the framework of evidence-based practice. Thus, I will be interested to see, as we work in this new climate, how the state will both justify and reconcile the subjective components of law with the objective practices within our institutions.

Peter Biello: What advice would you give to people who teach future healthcare professionals and try to teach them how racism and sexism exist in the medical field?

Dr Marie Ramas: I think this is the time for our trainers and our institutions to come together and really decide what is important, both for our trainees to make sure that they are well prepared and that they are able to To graduate with the information that our accreditation bodies have demanded of us, we have to make sure that we are doing what we can to prepare our students, and that is going to take a joint effort.

Peter Biello: Dr. Marie Ramas is the Medical Director of the Gatehouse Treatment Center in Nashua and the President-Elect of the New Hampshire Academy of Family Physicians. Thank you very much for speaking with me.

Dr Marie Ramas: My pleasure, Pierre. Thank you.

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