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Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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The prescription America needs right now is more than a vaccine

The author issues a call to action for health care systems to recognize the harmful effects of implicit bias on patient care through the lens of her husband’s experience at a state-verified Level II trauma center in the Chicago, IL, area.

Jamie Coleman, MD, FACS

March 4, 2021

I’ve given half my life to medicine, and medicine wouldn’t give my husband a chest X ray.

Some kids stole a truck New Year’s Eve. And they almost stole my husband’s life alongside it.

That night, I received a FaceTime call from my husband. When I answered the call, I wasn’t met with his usual smiling face. Instead, I saw my husband’s car on its side, wheels spinning in the air and illuminated by flashing lights. I took a deep breath and began calling my husband’s name. When he didn’t respond, I began to loudly introduce myself, just to get someone to talk to me. “My name is Jamie Coleman. I am the wife of the owner of this cell phone. I am a trauma surgeon. Someone please tell me what happened.”

Minutes that felt like hours passed before I finally heard his voice. He sounded coherent. I took another deep breath. Glasgow Coma Scale score: 15. Airway intact. Over the next few minutes, I saw him being loaded into an ambulance and taken to a local hospital—in a state 1,000 miles away from me. Again, the phone was on, but no one was speaking directly to me. I was a powerless auditory witness to everything that was happening. I could hear the prehospital personnel discussing which hospital they should choose, and I was trying to get their attention, asking repeatedly for him to be taken to a Level I trauma center. The phone disconnected.

Approximately 35 minutes later, my phone rang, and I eagerly awaited the voice of the person evaluating and treating my husband. I was incredibly grateful for the call and was prepared to hear my husband’s status, as well as the intended work-up after I overheard his car had rolled over multiple times at highway speed. I was unprepared for the ensuing conversation. Although the enthusiastic voice did update me regarding my husband’s condition, it also informed me they were beginning my husband’s discharge paperwork.

Naively, my first thought was, “Wow, this emergency department is incredibly efficient.” In a surprised and impressed voice, I then asked, “Oh, okay, wow, so his workup was negative?” Then a pause— the first sign that my husband’s treating physician and I were not on the same page, or even in the same book. The physician responded that it was their belief my husband didn’t need a workup, and they were trying to “spare him the radiation.”

Again, I made another incorrect assumption. I thought the physician was just telling me they didn’t do computed tomography (CT) scans. I then replied with, “Oh, okay, so his chest X ray and focused assessment with sonography in trauma (FAST) exam were negative?” Longer pause. Less bright and less enthusiastic, the voice then told me that they had “pushed on his chest and examined his abdomen,” and my husband said he was fine, so they didn’t perform a chest X ray or a FAST exam.

It turns out, they didn’t even place an IV, give him fluids, or check any labs. They did a visual examination of my husband, pressed on his extremities, and began filing the discharge paperwork. All because my husband told the physician he was “fine.” This is the same man who I personally and painfully witnessed sustain concussions and stay on the football field. But because he told them he was “fine,” the treating physician decided, in fact, not to treat him.

Now it was my turn to pause, my mind reeling, unsure of how basic Advanced Trauma Life Support® (ATLS®) treatment was skipped, unsure how any physician could think it was okay to not perform an adequate workup. I then explained again that my husband was on his way to the airport when the accident occurred, that he would be leaving the hospital in a taxi, and either headed to the airport for a two-hour flight, or headed to a hotel to spend the night. Could they please at least do a chest X ray and a FAST exam? Knowing this was an inadequate workup for a blunt aortic injury, or even a subcapsular splenic hematoma, I was trying to buy some time—some time to try and take myself out of the role as my husband’s wife, and fully into my role as a trauma surgeon.

Try as I might, I couldn’t separate myself. I called a partner, who promptly and emphatically confirmed my concerns, instructing me not to let him leave that hospital without the proper workup and to have him transferred to a Level I trauma center if that hospital was unwilling to provide a standard level of care. I waited for the call and was glad to hear his chest X ray and FAST exam were negative.

I then just came out and said it: “I appreciate your opinion, and I acknowledge you don’t think it is necessary. And, as you know, a portable chest X ray doesn’t effectively rule out a blunt aortic injury. Even a Grade I or Grade II spleen would change what I would do next. Please, can you please, order my husband a CT scan of the chest, abdomen, and pelvis?” Thankfully, with some encouragement, the physician acquiesced.

I learned the details later that night. Going an estimated 80 miles an hour, the driver of the stolen vehicle hit a total of six cars, eventually flipping their car into my husband’s. His car then flipped over two lanes of traffic on the interstate, over the guardrail, and onto the adjacent service road, eventually landing on the driver’s side.

The driver’s seat broken, windows smashed, and airbags deployed, my husband lay inside the broken vehicle. He was conscious, and with the help of bystanders, was able to be extricated through the broken sunroof of the car and taken by ambulance to a Level II trauma center. Within minutes of his arrival, and without a basic trauma evaluation, that state-verified Level II trauma center arranged to discharge my husband. No IVs had been placed. No labs were drawn. No chest X ray was performed. No FAST exam was completed. ATLS protocols were not followed; standards of care were not applied. He was given a cursory physical exam, had his blood pressure checked, and was ready to be pushed out the door.

I am a trauma surgeon. I was fortunate enough to have trained at three of the busiest trauma centers in the country and am proud to have continued my career in urban Level I hospitals. I started dating my husband in my senior year of college and the first time he told me he loved me was the day I opened my acceptance letter to medical school. More than 20 years of my life have been devoted to my husband and to medicine. And yet, that devotion gave my husband nothing when he needed it most.

My feelings since this incident have been an odd mixture of gratitude and betrayal. Gratitude because my husband is alive and well with only minor injuries. Betrayal from a system to which I have devoted so much of my life. And betrayal from a system to which my husband has sacrificed so much of his life for my training and my work. My husband should not have to be married to a trauma surgeon to get the basic care outlined in ATLS. A husband should not need his spouse to request a chest X ray or FAST exam, but that is what happened. Because no matter how many hours, days, and years I have given to my medical career, my professional credentials do not offer any protection for my husband’s Blackness.

I wish I could say my situation was unique—that it was a one-off. That surely this situation had nothing to do with the color of my husband’s skin. But I can’t say that because it isn’t true. Systemic racism in medicine is just that—it is systemic. Papers have been written, data have been presented, courses are often mandated. And yet the fact remains: the hospital is not the same for my spouse as it is for yours, if yours is white.

I’ve been asked too many times to count, “Are you sure this wasn’t just incompetence?” “How do you know race was an issue?” “Where’s the proof?” The proof is in the data. Although medical errors and “incompetence” occur across genders, races, and ethnicities, when incompetence is not found or experienced equally, when incompetence is found more often in people of a certain race, then we’re not talking about professional incompetence—we’re talking about racism. Study after study has shown that independent of socioeconomic status, insurance status, and controlling for severity of injury, Black patients who have sustained trauma have different outcomes than patients who are white. Specifically, this means my husband can have the same exact injuries as your spouse, the same job, the same income level, and even the same insurance company, but my spouse is going to be discharged sooner than your spouse, prescribed fewer pain pills, and is even more likely to die and never come home again than your spouse, if your spouse is white.

Despite the reassurances of so many physicians who claim only to see bones, disease, their patients’ insides, and pay no attention to a patient’s “outsides,” it is clear that our insides do react to our patients’ outsides. Across the spectrum of medicine, whether it is patients with the coronavirus, diabetes, pregnancy, trauma, or even cancer, the data show people of color in the U.S. do not receive the same health care as white patients.

This situation is the definition of implicit bias and why it is so deadly. It is when our subconscious mind causes us to act in ways that go against our conscious beliefs, and our conscience doesn’t even recognize that this is happening. Implicit bias isn’t loud. It doesn’t draw attention. It doesn’t raise eyebrows. It is a silent, odorless, invisible vapor that exists in and surrounds all of us.

Talking about race with anyone is hard. Talking to yourself about race is even harder. No vaccine can fix this pandemic, this disease that has continued to plague our health care system, our patients of color, and their families in the U.S. The prescription American medicine needs right now is one large and continuous infusion of acceptance, introspection, and action—acceptance that implicit bias exists, and acceptance that our implicit bias harms our patients. Introspection allows us to realize that we sometimes act in accordance with our implicit biases rather than our conscious mind.

And we need to address it head-on, over and over again. Actions speak louder than words. We need to pause whenever a patient of color is in front of us—to stop, to think, to reexamine our beliefs, to change. Lives depend on it, including my husband’s.


The opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the American College of Surgeons or The Joint Commission.