This article is part of a weeklong series looking back at the first year of Donald Trump's presidency.
One of the questions doctors are taught to ask to assess whether a patient is alert and oriented to their surroundings is, “Who is the President of the United States?”
When I would ask this question to confused patients in medical school, I would get a variety of answers, ranging from actual presidents like Barack Obama or Jimmy Carter to fictional characters like Captain Ahab. More often, I would get no answer at all, as patients strained their memories in search of an elusive name.
But in 2017, as a resident, I’ve noticed the answers have changed. No matter how I ask the question, or how confused a patient is, the answer is almost always the same: Trump. That even the most delirious of patients is able to correctly identify their President speaks to the influence Mr. Trump has had on American society.
President Trump will end the year with just one signature legislative accomplishment, a tax cut whose benefits will primarily flow to the wealthy. But that doesn’t mean that he sat still In 2017. From dismantling environmental regulations to revolutionizing the way we engage with our president, he transformed America in ways that will reverberate for decades.
But when I look back at the changes wrought by the dizzying first year of Trump’s presidency, the racial divisions he stoked stand out. From his deplorable response to the events at Charlottesville to his inflammatory use of Twitter, Trump’s actions and words helped fan the flames of bigotry. Taken as a whole, they have not helped to make America great again. Rather, they have made it ok for America to be racist again. After all, If the President can say that, why can’t I?
You don’t have to look far to see how Trump’s behavior has affected America. The country is now polarized on the topic of race to an extent not seen in modern American history. Increasing numbers of Americans say that race relations are worsening. Hate crimes, particularly against Muslims, have surged. And white nationalists are increasingly becoming normalized.
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Working in healthcare, I am particularly worried by these developments. The entire field is predicated on the patient-provider relationship, one of the most complex and vulnerable relationships in society. The practice of medicine is fundamentally asymmetric: Patients are almost wholly reliant on the knowledge and guidance of their physicians when selecting optimal courses of treatment. For this arrangement to succeed, trust is paramount. Anything, like racism, that causes patients to suspect that their physicians are not acting in good faith undermines this crucial bond and impedes the delivery of high-quality care.
Sadly, the American healthcare system has a long legacy of racism, which has helped foster mistrust in minority communities. A 2000 study found that African Americans were more likely than white patients to perceive racism in their care and distrust their medical providers, a finding that has been repeated.
Moreover, physicians are not immune to implicit bias, and some may allow race to play a role in decision-making. The result is an environment in which patients from minority groups are disproportionately affected. African American patients are less likely than white patients to receive treatment for pain. And a 2010 study found that African American, Asian American, and Hispanic patients were far more likely than white patients to report experiencing discrimination in the healthcare system.
Discrimination discourages patients from getting the medical care they need. In 2001, an investigator interviewed 51 African Americans about their experiences with the healthcare system in King County, Washington. They reported an average of 1.5 discriminatory experiences at healthcare facilities over the previous decade. Over a quarter of these incidents made them more likely to avoid the offending provider, and in nearly a sixth of cases, these patients stopped receiving specific medical services.
Additionally, a growing body of literature has found that discrimination impacts health outcomes. A 2015 meta-analysis that reviewed the results of 293 studies found that racism was linked to poorer mental health, including higher rates of anxiety, depression, stress, and suicidal ideation. Patients who perceive high levels of discrimination are more likely to report being in poor physical health, and are at higher risk of developing chronic conditions like high blood pressure, obesity, and substance abuse. These factors may help explain why patients are more likely to select physicians of their own race when given a choice.
That race plays such an outsized role in healthcare makes the President's actions in 2017 particularly disturbing. By fostering conditions in which bigotry and racism can flourish, the President has helped inject an additional measure of uncertainty into the fragile relationships that exists between patients and providers. As a result, millions of patients are at risk of not receiving necessary medical care, and of poorer mental and physical health outcomes. Since the health effects of discrimination may take many years to manifest, his actions have ensured that discrimination today will continue to be a problem well into the future.
President Trump’s actions in 2017 are a threat to the health of patients across America. I can only hope that 2018 will be better.
Kunal Sindhu is a resident physician in New York City. Follow him on Twitter @sindhu_kunal.