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Physician coach Seema Pattni discusses her article, “Why racism in health care is still an emergency.” Seema reflects on a painful encounter with an eight-year-old Black patient who wished to be white, illustrating the devastating impact of systemic racism. She outlines the profound racial disparities in health outcomes from birth to death, and highlights the lack of urgency within medical education and leadership to address these issues. Seema also calls out the exclusion of ethnic minorities from positions of power and the continued presence of toxic teaching methods in medical training. Her conversation offers both a reality check and a plea for institutional reform, authentic representation, and a more humane clinical culture.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Seema Pattni. She’s a physician coach. Today’s KevinMD article is “Why racism in health care is still an emergency.” Seema, welcome to the show.
Seema Pattni: Thank you so much for having me, Kevin. It’s really great to be here, all.
Kevin Pho: Well, thank you so much for writing and for joining me. So tell us a little bit about yourself briefly, and then talk about the KevinMD article that you contributed.
Seema Pattni: Sure. Brilliant. Thank you. So I’m Seema. First and foremost, I’m a mum. I’m also a physician. I’ve worked all around the world. I’ve worked as a family doctor. I’ve worked in hospitals, and I pivoted more recently into working as a coach for physicians, and writing and speaking. That kind of comes around that, and I did this because, through my personal journey as a physician and through seeing my colleagues, my friends, everyone around us, I could just see there’s such an acute need for this. I realized that there are so many of us who feel worn out, burnt out, unrefreshed, and actually just going through the motions—not really reflecting on what we really want, what’s important to us.
So I set up and moved into that. As part of it, I focus a lot on the most powerful experiences that I’ve had as a physician, including the patients I’ve met, and the things that stood out to me about them, because, you know, it is a privilege—people tell you the things that are closest to them when you’re working with them as their doctor. And I guess a lot of that grew into the article that I submitted to you.
Kevin Pho: Alright, and before we talk about that article, I understand that you are in the United Kingdom, in London. You talk a lot about burnout here stateside, but I’m going to assume, since you’re a physician coach in the United Kingdom, that burnout and some of the stressors that affect the medical profession are also pretty prevalent there, right?
Seema Pattni: It is, absolutely. I think sometimes it’s a bit tricky using the word burnout, because it can feel overused. But it’s really critical that we understand the traumas of being a physician. That doesn’t take away from the rewards of it, but they’re in parallel here. We see so much, we file it away, but there’s not enough support for us. And yes, burnout is prevalent here, and it’s leading to really extreme things, right? The suicide rate—to take the most extreme version of burnout—is 24 percent higher than the national average in the U.K. I’ve read that it’s not dissimilar in the U.S., in India, et cetera, but it is phenomenal. We are losing a physician to suicide every three weeks. I don’t know what it’s going to take—how many lives need to be lost for this to be looked at directly, for things to change.
So yes, that’s obviously one end of the spectrum. There are a lot of stages before that, and it’s multifactorial, I accept that, but there is something severely wrong when that’s happening. We can’t just say, “Oh, but that’s part of the territory,” right? Mm-hmm. That’s not right. Or “be more resilient.” I find that narrative very toxic because we are resilient. Doctors have carried the health care system on their shoulders for decades, and that’s why it’s surviving—on our goodwill, on our dedication. But you know, something really big needs to change. That’s why I try to break it down into all the different issues that we’re facing and look at those in detail—things like discrimination, not just the patient’s experience but that which we experience ourselves: sexism, racism, issues we face when female doctors are pregnant. All of this builds up, and it all contributes to this crisis. So yes, it’s massive in the U.K., and I think it’s a global phenomenon.
Kevin Pho: One of the things that you said earlier was that the stories clinicians see really have a deep and profound impact on them as well. You shared one particularly poignant story, of course, in your KevinMD article. Now, for those who didn’t get a chance to read it, tell us about it.
Seema Pattni: So this is about a boy I met when I was working in pediatrics. He was in with an asthma attack. He was about eight years old. I was just making conversation, and I look back and think, “What was the point of that question?” But I asked him what he wanted to be when he was older, and nothing would’ve ever prepared me for him saying he wanted to be white. And when he said that, I just—I didn’t know how to respond. There was so much going through my head. It’s only now, years later, that I reflect on that in the article. I think there’s so much here that we need to explore and address: Why is an eight-year-old saying this to us? What is the thinking behind it? But actually, I can now take it further than that and look at the data behind it, the evidence behind it, and look at the inequalities faced by people who aren’t white. None of it is acceptable, but why is it still here now? It’s embedded in centuries of societal structure and hierarchy. We all know that; we all know what I’m talking about. But it’s about how do we start to dismantle that in health care? Because if we don’t, it’s just going to carry on and get worse. Right. And I think, politically, this is especially important in the U.S. and, again, in the U.K., in Europe, the wider world. But from what I’m reading and seeing, it’s even more critical than ever before in the U.S.
Kevin Pho: So when that eight-year-old patient said that he wanted to be white, tell us some of the thoughts that were going through your mind during that encounter.
Seema Pattni: I mean, firstly, I was really sad, because he’s really young. He’s not super young, but he’s so young, and he’s already seeing his identity as a negative thing. How must that feel, to grow up with that thought? It is true—because I wrote in the article—I wonder what he thinks now, what he’s doing now, and how that has shaped him as he’s grown up with that awareness. Actually, he’s not wrong in terms of acknowledging the disadvantages he’s at. It’s a brutal realization for an eight-year-old, but he’s not wrong either, and that made me even more sad and angry. So I think sadness and anger, but also a drive to change it, are the things that surfaced right away.
Kevin Pho: So before we talk about the drive, the changes, some of the potential solutions, talk to us about the scope. Because after this encounter, it inspired you to dig into some of the data regarding the disparities that a lot of our patients face. Tell us about some of those data that really highlight these disparities.
Seema Pattni: The numbers are in the article, but essentially, people from ethnic minorities face inequality, particularly in maternal health care and in women’s health care. The outcomes are poorer, which unfortunately means more maternal death. It means neonatal outcomes can be worse. This isn’t unique to the U.K.; it’s global. It also applies across the board—we start right at birth, but it follows you all the way through your life. It’s like it almost holds your hand through your life journey. So things like asthma outcomes are worse, and that’s what this little boy was in for. Mental health crises can be more severe. It’s not all down to genetics; it’s not all down to the families we’re growing up in. It’s also how we’re treated, how it’s recognized, and how we’re educated about it as physicians.
There’s a real lack of this being processed as a medical student. I didn’t have it in my medical education—that was a couple of decades ago—but when I speak to students of today, it’s minimal. I understand there’s a lot medical schools have to fit in. You don’t want to be examining every single aspect either. But if we don’t have these issues integrated into the curriculum, then they’re never going to go away. The biases will continue, and the problems will continue. All these barriers have to be tackled right from the foundation—there’s no point coming up with surface-level ideas to treat it.
One of the things I mention in my article is underrepresentation of ethnic minorities in leadership roles, and sometimes that prevents systemic change.
Kevin Pho: Talk more about that facet.
Seema Pattni: Certainly, in the U.K. we have the NHS, and at the executive tier—often referred to as snowy white peaks—that’s literally how it looks. You can get to a certain level, and there are thousands, hundreds of physicians from every walk of life. But as you climb higher, that shrinks. I’d find it hard to believe it’s because none of us are good enough. We are. In fact, many are overqualified. There’s that old adage that you have to work twice as hard if you come from a certain background. That’s severely lacking. But there’s no point having representation for the sake of it, just to look good on a poster—it needs to be meaningful. The people in those positions need to genuinely believe in the cause as well. There are plenty of examples, certainly here, of people in powerful positions who don’t actually care about what we think they should be caring about. So it’s meaningful representation, and those individuals need the capacity to make change rather than being constantly up against brick walls. That’s why you need more diversity; otherwise, it’s still going to get pushed aside in terms of priorities, because people need to be receptive to it. There’s no point in us being a minority if the proportion of leadership doesn’t reflect the workforce overall. Even if it’s getting better, it still doesn’t represent how many of us are in the broader workforce of health care professionals. It’s still disproportionate.
Kevin Pho: You mentioned earlier that we need better ways to train in medical school and medical education—beyond superficial changes. So in your ideal world, what would you like to see instituted to help address racial biases in medical education beyond those superficial changes?
Seema Pattni: What I’m seeing at the moment is a few unassessed modules that are poorly attended with little engagement. I’d like to see every lecture, every module, every talk include a discussion of how this fits into the real world. If we’re talking about cardiology, where are the inequalities in terms of different ethnicities, in terms of whether you’re female or male, in terms of social background? Let’s go through anatomy and physiology, yes, but let’s also integrate these issues. It doesn’t need to be a separate, optional module—it should be normalized as part of lecture structure. That’s what I’d suggest. All these add-ons become just that—add-ons, not essentials. Yet this is how important it is, and that’s how prevalent it is.
It is getting better, but it’s being steered by independent organizations, not necessarily by medical education itself. We need representation from patients with lived experience as well. Dermatology textbooks, for instance—how many of them show a range of skin types? Yes, it’s improving, but it’s being pioneered by students, which is great because that’s often where activism begins. But now it’s time for it to be fully pushed through.
Kevin Pho: Now, after having this discussion, writing on KevinMD, and doing a lot of research since that encounter, if you were to replay that encounter with that eight-year-old boy—knowing what you know now—would you say or do anything differently?
Seema Pattni: That’s a really tough question. It’s hard because he was only eight. I definitely wouldn’t just move on to the next point, which is unfortunately what I did then. I think I would acknowledge him and probably ask him why he thinks that, what led him to that, and what he feels might be different if he were white. I would want to validate him somehow. I’m not sure exactly how, if I’m being honest, but I’d want him to feel heard.
Kevin Pho: We’re talking to Sima Pattni. She’s a physician coach. Today’s KevinMD article is “Why racism in health care is still an emergency.” Seema, let’s end with some take-home messages you want to leave with the KevinMD audience.
Seema Pattni: Over the years, I’ve learned that medicine isn’t exempt from all the flaws in society. The medical world is sometimes put on a pedestal; people think everyone’s perfect, but it suffers the same systemic barriers we see elsewhere. That doesn’t mean we can’t overcome them; it doesn’t mean there’s no other way. You can find support, although it’s not necessarily mainstream or readily available, but there are people out there who can support each other. Sometimes you go through medicine feeling like it’s all on you, that everything’s wrong with you, and that’s not always the case. Of course, we all have areas where we can improve, but a lot of the time we don’t realize how much of it is systemic barriers.
I want people to know there is support and there are people who will root for you through all of this. Also, keep hope because it will drive what you do, no matter how long you practice medicine. Remember that the experiences we have with patients as physicians really do give you so much insight into life—into how other people experience things. There’s a real humility in that, which I definitely find a privilege.
Kevin Pho: Sima, thank you so much for sharing your story, time, and perspective, and thanks again for coming on the show.
Seema Pattni: Thank you for having me.