Nearly six months ago, while studying for USMLE Step 1, I visited one of my go-to online forums during a study break: a discussion board dedicated to Black doctors and trainees. I learned about a recent publication in the Journal of Neurology that caused significant outrage not only within this forum, but also in the medical community online at large. Much like the rest of the readers, I was deeply troubled and did not understand the purpose of the article, entitled “Lucky and the Root Doctor,” which was published on Feburary 12 and has since been retracted by the journal.
It was the story of an ill, elderly and superstitious Black man named Reggie. He was seeking treatment from a neurologist for his worsening polymyositis while also consulting a “root doctor.” The story was published in the Journal of Neurology by the neurologist himself — a now-retired White male physician from Georgia. The essay drew immediate and significant criticism from physicians and medical trainees who pointed out that it was littered with condescension and racism towards Reggie as well as poor, Southern Black people at large.
The monicker “Lucky” in the title refers to a few things, including Reggie’s sexual function, as told in the story. The physician does not believe Reggie to be lucky, and in fact recounts, “So a man who was blinded and suffered terrible facial disfigurement […] considers himself lucky. Reggie was like Amy Tan’s mother, who believed in curses, karma, good luck, bad luck, feng shui, whatever, then chose what worked for her.” He ultimately chooses to nickname Reggie “Lucky,” reducing him to his sexual function and folkloric beliefs, which sets the tone for the rest of the story.
It begins with a harrowing description of Reggie’s wife, mocking her appearance and fat-shaming her: “…a roly-poly woman […] His wife’s abundant rolls of fat jiggled as she giggled.”
Then, the author uses his experience in the South to attribute the southern Black community’s ailments to personal decisions and home remedies: “Having been born, raised, and educated in the deep South […] I was passingly familiar with some of the medical risks of living poor and Black in the American South, such as anemia caused by eating clay.” He seems to disregard that Southern states are home to the majority of Black people in the United States and home to some of the most draconian disenfranchisement laws and policies, from mass incarceration to voter suppression.
He further argues that growing up in the South and treating Black people makes him well-versed in Black lingo and thus familiar with the culture. To support this argument, he deploys stereotypes: “I once shared a table at a fried chicken fast food establishment with a nice African-American lady. […] I knew the various ways lead could get into moonshine.” This claim of proximity to Black people, however, is a well-known ploy often used to deny the presence of a single racist bone in one’s body.
Two days after its publication, succumbing to the pressure of social media criticism, the article was retracted. Six and 11 days later, respectively, the editor-in-chief of the journal and the president of the American Academy of Neurology announced sweeping changes, including the retraction of the offensive article, structural changes to the journal and the need to address matters of diversity and inclusion — or lack thereof — within the field of neurology. The most salient changes were the resignation of the humanities editor, the suspension of the humanities section, significant changes to the editorial process, and the creation of a deputy editor for diversity, inclusion and disparities. Still, I felt that the journal’s handling of the story by simply retracting it and suspending the humanities section was inappropriate.
Although well-intentioned, suspending the humanities section en-bloc was the less responsible choice. Instead, keeping the humanities section open after this fiasco of a peer-reviewed essay would have allowed for dissenting opinions in the same forum. More importantly, it would have allowed others to seize the important learning opportunity that was wasted in “Lucky and the Root Doctor”: the importance for physicians to reconcile differences in values vis-à-vis their patients in order to reach shared goals in the patients’ health. The story of Reggie should have been an opportunity to create a forum for critical conversations around structural competency and cultural humility.
The core element in this story is the interaction between the patient’s superstitious beliefs and the role of Western medicine in his care. In the United States, folkloric beliefs are held among individuals of various backgrounds, especially when struck by life-altering diagnoses such as cancer. In fact, alternative medicine is adopted by an average of 31.4% of cancer patients in the United States. A study published in the Journal of the National Cancer Institute in 2018 showed, however, that this practice decreases survival.
The adoption of alternative medicine without beneficial evidence is an issue that requires attention. The issue is not only one of science, however; it is as much about communication and building therapeutic relationships with patients in order to earn their trust and ultimately optimize their treatment. For Black patients, as well as other minorities, this issue is particularly salient, given the evidence that suggests increased distrust in the health care system for various reasons. This includes a long history of paternalism, abuse and mistreatment from the medical field, and even the fear of the state’s involvement (and thus state-violence) such as, but not limited to, immigration enforcement or child protective services.
In the published story, Reggie’s neurologist “wasn’t much worried about serious competition from [the] root doctor” and was nonchalant about him seeking alternative treatments: “Well, if you want to go see the root doctor, I guess it’s OK with me.” Reggie, on the other hand, was rather worried and conflicted, explaining, “You don’t understand. Root doctors cost a lot of money. You got to save up a long time to see ’em. I don’t have enough money to pay your bills, buy all this medicine, and save up for the root doctor too. I got to do one or the other.” Rather than engaging with Reggie by building rapport in order to optimize his treatment, the author of “Lucky and the Root Doctor” unfortunately makes a mockery of it all.
This essay’s acceptance into a peer-reviewed publication demonstrates ignorance of cultural and structural influences on health behaviors in the medical field. At the same time, the abrupt suspension of the humanities section as a response underscores the perceived dispensability of medical humanities overall. Often perceived as an avenue for humor and entertainment, medical humanities, however, are an integral discipline that contributes to informing how medicine is taught and practiced. They create an avenue for interdisciplinary research that ultimately can be the key to solving complex socio-medical problems.
I suspect that in the case of Reggie, a physician more aware of the importance of cultural beliefs as well as their impact on patient-physician trust and medication adherence would likely not have written such a piece, let alone published it in an academic forum. Thus, publishing the story was a mistake, but suspending the humanities section was tantamount. The medical humanities are not an accessory to our profession. In fact, they are indispensable: they can and have shaped how we practice medicine as well as ask and answer research questions. But only if we continue to allow them.
Author’s note: I would like to thank Drs. Anna Reisman and Benjamin Oldfield for their guidance in the conception of this essay, as well as their feedback as I wrote it.
Attending Howard University gave Max a foundation for and continues to inform how he approaches issues related to injustice. Now in medical school, he has made it one of his focal interests to learn about and contribute to progress towards health equity, nationally and globally. Through this column, he will share stories on his experience as a Black man in medicine, and insights on topics of race, class, health equity, and medical education.
Columnist
Yale School of Medicine
Max is a third-year medical student at the Yale School of Medicine, with a background in civil and environmental engineering, and bioengineering.
White Coat and a Hoodie
Attending Howard University gave Max a foundation for and continues to inform how he approaches issues related to injustice. Now in medical school, he has made it one of his focal interests to learn about and contribute to progress towards health equity, nationally and globally. Through this column, he will share stories on his experience as a Black man in medicine, and insights on topics of race, class, health equity, and medical education.