Black History Month:

Human beings are imperfect creatures, prone to selfish, self-destructive, self-centered behavior. We are imperfect, yet we expect to achieve perfection. This is illogical and irrational, for the imperfect can never make itself perfect. We can, however, progress toward becoming better. The delusion is to think we either know what perfection is, or that we can achieve it. The destination may be “perfection,” but the actuality is only consistent improvement on the path to continually becoming better. Sounds like the practice of medicine. Sounds like the study of history.

What follows is a small fraction of the context in which STFM is working to transform health care through education to become the indispensable academic home for medical educators.

History uses the past to better understand the present to inform the future by recognizing: (1) the good, to do more of it, enhance it, and expand on it; and (2) the bad, to learn from it, how not to repeat it, and how to do more of what is good going forward. The purpose of history sounds like the purpose of high-quality feedback. Too often an inversion happens and the present is used to inform the past, and time is spent reinterpreting, re-presenting, and even reforming the past through the lens of the present.

The United States Constitution, Article 1, Section 2, Clause 3 reads:

Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons.1

This three-fifths compromise was an accounting maneuver, later modified by Amendment XIV, Section 2, to determine how slaves would be counted when determining a state’s total population for apportioning legislative representation and taxing purposes.2 Ironically, antislavery leaders wanted slaves to not be counted at all, to limit slave states’ apportionment of representatives, and proslavery leaders wanted slaves to be counted to increase their apportionment of the representatives. Black people have been a political football with an enigmatic role in culture since the nation’s founding. This extended into medicine.

When few medical schools would admit black students, whites founded black medical colleges, the earliest two at Howard University (1868) and Meharry (1876). Opportunities for specialty training and hospital privileges remained extremely difficult to access. This led to black physicians and health professionals necessarily forming an analogous, separate, segregated medical infrastructure, from teaching hospitals to medical societies.3

The National Medical Association (NMA) was established by black doctors and health professionals out of urgent necessity after the American Medical Association repeatedly denied membership to black doctors.4 The NMA “promotes the collective interests of physicians and patients of African descent” with a mission to “advance the art and science of medicine for people of African descent through education, advocacy, and health policy to promote health and wellness, eliminate health disparities, and sustain physician viability.”5

Charles Godwin Woodson, the father of black history and founder of The Journal of Negro History (now The Journal of African American History) called for the second week of February to be Negro History Week because it contained the birthdates of both Abraham Lincoln (February 12) and Frederick Douglass (February 14).6 Per Woodson:

We should emphasize not Negro History, but the Negro in history. What we need is not a history of selected races or nations, but the history of the world void of national bias, race hate, and religious prejudice. There should be no indulgence in undue eulogy of the Negro. The case of the Negro is well taken care of when it is shown how he has influenced the development of civilization.7

The Student National Medical Association (SNMA), founded as a subdivision of the NMA, was an outreach to and support for black medical students. By 1971 it had become its own independent corporation, SNMA, Inc,8 now with a mission to “support current and future underrepresented minority medical students, addressing the needs of underserved communities, and increasing the number of clinically excellent, culturally competent and socially conscious physicians.”9

In its 51st year (2017-2018), STFM is intentionally increasing emphasis on health equity and social determinants of health and will explore partnerships outside family medicine to advance our health equity goals.10 Organizations like NMA, SNMA, and Society of General Internal Medicine are examples of potential partners.

The 1964 Civil Rights Act (CRA) undid the 1895 Plessey vs Ferguson Supreme Court ruling which legalized racial segregation so long as it was “separate but equal.” One result was Grady Memorial Hospital in Atlanta where a black side and a white side (the “Gradys”) were separated and connected by a hallway. CRA outlawed discrimination based on race, color, religion, sex, or national origin, and required equal access to public places and employment, and enforced desegregation of schools and the right to vote.11

Today, those seeking simple answers to complex problems bemoan the challenges of enrolling black people (especially African Americans) into their research projects, often oversimplifying the problem by referring only to the legacy of the horrendous, tragic Tuskegee Study of Untreated Syphilis in the Negro Male. Many black people are consciously or subconsciously leery of being research subjects because of the totality of what they have historically been subjected to across the US health care system.How much medical training continues to disproportionately occur on those who are poor or black?

The Rev Dr Martin Luther King, Jr was murdered in Memphis, Tennessee years after the passage of the CRA. He was in Memphis to address black sanitation workers being paid less and differently than their white counterparts.12

The 38th President of the United States, Gerald R. Ford designated February as Black History Month. Every subsequent president has followed suit.13

Barack Obama was elected 44th president of the United States, the first black man to hold that office. The first African American to be president. Or, as some of the racially mixed have jested with pride and affirmation, the first “Halfrican-American” president, since his father is black and his mother is white. The United States became the first nation of significant size or presence in which someone from its racial minority (13% of Americans identify as black or African American; even less, 3%, identify as multiracial14) was elected to its highest leadership position.

History. Progress, never perfection. There are still many lessons to be learned, errors not to be repeated, and improvements to be expanded upon going forward.