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N.H. Doctor: Restrictions On Teaching About Racism And Sexism 'A Threat' To Education And Patient Care

A new state law passed in the state budget also applied to publicly funded medical institutions that provide training for health care professionals and care for patients.

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

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

Peter Biello: This is All Things Considered on NHPR. I'm Peter Biello. Following the passage of the new budget, the state recently issued guidance on how topics like racism and sexism can be talked about in publicly funded institutions — that includes medical clinics and schools that receive state money. Dr. Marie Ramas is the medical director of Gatehouse Treatment Center in Nashua and president-elect of the New Hampshire Academy of Family Physicians. She's with me to talk about how these new restrictions could impact medical care in the Granite State.

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

Dr. Marie Ramas: Thank you for having me.

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

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

Now, there's requirements from residency programs to do trainings on implicit bias. For instance, understanding what cultural awareness and how that would apply to our patient care. And then also, which I think is more recently has been discovered, is understanding the historical manifestations of the practices that we have within medicine as well.

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

Dr. Marie Ramas: This law is particularly for public institutions that receive funding. But the danger behind that is that with our private entities and teaching bodies within the state of New Hampshire, there are typically alliances and relationships with state- and grant-funded opportunities. And so there's a gray area to [how] funding affects our medical and nursing education. And so it's difficult because now there's fear within teaching bodies of even speaking about concepts of race and racism and its effects on students, trainees and the patients that we serve.

Peter Biello: It seems like what you're saying is that the same fear that some public school teachers have expressed regarding this law and their ability to talk freely about racism and sexism and how it operates in our society, those same fears are present in those who are teaching people preparing to work in the medical field.

Dr. Marie Ramas: Definitely. And I would be even stronger. It's not just a fear, it's a threat. And again, these types of legislation are specifically in threat of the progress that has been made in helping us understand our patients and do no harm to our patients and our community.

Peter Biello: I want to ask you about a specific example. Studies have shown that many doctors believe Black patients experience pain at a lower level than white patients. Now that this law is in effect, how might it play into this false idea?

Dr. Marie Ramas: I think this is where the trouble lies. Racism has been, for instance, declared as a public health emergency by both the [Centers for Disease Control and Prevention] and multiple medical bodies within the last year to two years. There is evidence and scientific evidence that shows the effects of racism and structural racism and how it affects downstream consequences to patients' health experience. Pain is one of them. And so when we're talking about science, we have to use our best judgment.

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

Peter Biello: What advice would you give those folks who are teaching future medical professionals and trying to teach them about 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 to really decide what is of importance, for both our trainees to make sure that they are well prepared and that they are able to graduate with the information that our accrediting bodies have required of us, we need to make sure that we're doing what we can to prepare our students, and that's going to take a joint effort.

Peter Biello: Dr. Marie Ramas is the medical director of Gatehouse Treatment Center in Nashua and president-elect of the New Hampshire Academy of Family Physicians. Thank you very much for speaking with me.

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

Julia Furukawa is the host of All Things Considered at NHPR. She joined the NHPR team in 2021 as a fellow producing ATC after working as a reporter and editor for The Paris News in Texas and a freelancer for KNKX Public Radio in Seattle.
Peter Biello is the host of All Things Considered and Writers on a New England Stage at New Hampshire Public Radio. He has served as a producer/announcer/host of Weekend Edition Saturday at Vermont Public Radio and as a reporter/host of Morning Edition at WHQR in Wilmington, North Carolina.

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