Uché Blackstock, LEGACY: A Black Physician Reckons with Racism in Medicine

Zibby welcomes doctor and New York Times bestselling author Uché Blackstock to discuss LEGACY: A Black Physician Reckons with Racism in Medicine, a searing indictment of our healthcare system, a generational family memoir, and an urgent call to action. Uché shares stories of her upbringing, her mother’s influence, and her experiences as a Black woman navigating the medical field. She and Zibby delve into the topics of culturally responsive care, racial health disparities, and the impact of historical decisions on the representation of Black physicians. Uché’s advocacy shines through as she offers actionable steps for improving healthcare equity and reflects on her journey in writing this book.

Transcript:

Zibby Owens: Welcome, Uché. Thank you so much for coming on "Moms Don't Have Time to Read Books" to discuss Legacy: A Black Physician Reckons with Racism in Medicine.

Uché Blackstock: Thank you so much for having me on, Zibby.

Zibby: I really loved your story and your personal story and really, this love letter to your mom and the legacy that she left and your relationship with her and how she informed the lives of you and your sister. It was such a wonderful, even, framing device of a book to have your mom there. Maybe just tell listeners a little bit about the story and her. I want to talk about your own health issue that you write about and just so much more.

Uché: I know, there's so much to talk about. Actually, when I thought about writing the book, it really was an opportunity to give my mom -- she always had a voice, but to share that voice with others, people who didn't know her or didn't have the fortune to interact with her. She just had such a different upbringing than I did. She had a really challenging upbringing. Single mom, born on public assistance. They moved a lot, changed schools. It was really rough. Despite all of that, she was the first person in her family to go to college. She went to Brooklyn College and then had a chemistry professor who saw all the potential in her and was like, "You need to apply to medical school." She applied to medical school and got into all her med schools and ended up at Harvard Medical School. She obviously felt like a fish out of water there. There was one kid whose parent had won the Noble Prize for embryology. Another, a relative of Jackie Onassis. She found her friends there. She made it through. What was really most important, she came back to the same community she grew up in to practice, to take care of her friends and neighbors. She was super purpose driven. The work was more than just work. It was really, how do I show care? How do I work in service to my community? She made such a tremendous impact on my sister and me as a result.

Zibby: You talked about how there's almost a new name for the type of medicine she practiced because she took into consideration, really, the whole person and all of the environmental factors and everything about them, not just the one tiny complaint of the skinned knee or whatever it might be.

Uché: Exactly. I feel like so much of what we learn in medical school, it's about the patient-physician relationship and just what happens between the two of us as opposed to, when you're in the exam room or a clinic room with your patient, you really are in the room with all their family, their friends, their employer. All of that, we know now, it impacts how healthy people are. I feel like my mom really got to know her patients on a very intimate level so that she could provide the best care possible to them. Yes, now it's called culturally responsive care and structurally competent care. I feel like my mom was practicing that in the eighties and nineties before there were these sexy terms for it.

Zibby: You paint such a picture of you and your sister doing your homework there at the desks. Of course, then the two of you go on to Harvard Medical School yourselves and both become doctors in different neighborhoods, which is amazing. I have twins. I'm like, oh, my gosh, what's going to happen with them?

Uché: I always joke that we were my mother's little projects. I think it's because of her upbringing. I think because she grew up in poverty, she wanted to give us so much, and so exposed us to everything. Everything was a learning experience, like going to the Brooklyn Botanic Gardens, like looking at the different flowers, going to museums, introducing us to artists that most people don't know about until they're adults, but when we were young, taking us traveling. I feel like we were her little projects. Saturday mornings would be full of activities, gymnastics, modern dance, reading comprehension, because she really had this drive. I want these girls to have a totally different life than I had. Actually, when we went off to college at eighteen, she was like, "You know what? I'm really tired." She said this even before she got diagnosed. Maybe that was part of the leukemia, and that's why she was tired. She said, "I'm really tired. I put so much into you girls." We didn't do too shabby. Actually, conversations I had with her when she was sick, she told me -- I asked her, "What are things I should know?" when I knew that she wasn't going to live much longer. She was like, "Even when you have your kids, I want you to still take care of yourself." That has always stayed with me.

Zibby: I was so struck by that scene in the book too. I'm like, wow, that is the parting advice from a forty-seven-year-old mom. I'm forty-seven now. Sometimes I read it, I'm like, oh, forty-seven, that was old. Then I'm like, but wait, I'm forty-seven. That's not old at all. It's so young. I'm so sorry. I'm so sorry that you lost her. It just sounded terrible, how quick, just the whole thing. I'm so sorry. Obviously, there's no good way. That that was the parting advice -- I'm not sure what my parting advice would be to my kids. I don't think it would be that, but maybe it should be. Maybe I'm going to learn from your mom.

Uché: I think she maybe had some time to look back and was like, maybe I should have -- she was so present for us, so present for her patients, so present for everyone in her life. It's okay to keep a little bit for yourself. I think that's kind of what she was trying to tell us. Interestingly, we were only nineteen, and at the time, I didn't feel like a little girl. I was a young woman. In retrospect now at forty-six, I look back, and I'm like, we were just babies. We literally were just babies. I even thought once I had my own kids that the pain of losing her would lessen, but actually, no. It got even more because I said, wow, my kids could've had this whole other grandparent here who would love on them and be sweet to them and also help support me as a parent. You always need mothering. That's the other thing. It doesn't matter how old you are. You always need mothering. You need someone who is going to see you for who you are, who you can be vulnerable with, and who literally is looking out for you and only you.

Zibby: It's true. What you say is just so poignant because it is the people that you lose, but you lose the love they had for you that's in the world. Where does that go? How do you get that feeling? When I lost my grandmother -- she had that unique love, just that special thing. Where did all those rays of -- where do they go? It sounds silly.

Uché: No, no, no.

Zibby: You also wrote in detail about a time when you were misdiagnosed, which sounded horrific. Your appendix ended up bursting, getting infected. You were misdiagnosed. The thesis of the book is that there is a lot of racism in medicine. How do we reduce that? All of that. Part of every story told takes that view, but also, how could it not have been missed? Was it that? Was it not that? Looking back on the whole thing, what do you make of it now?

Uché: At the time, I didn't really understand what was going on. I just knew that it was really frustrating that no one knew what was going on. I was feeling sicker and sicker. Also, I was being questioned about things multiple times. My pain was being [indiscernible] like I was not in that much pain. Then I kind of was just like, okay. Then my twin sister thought -- she was like, "I think you have appendicitis." She was in med school with me, but we didn't feel comfortable enough to tell the doctors that. Even as medical students, we didn't feel comfortable. It really was looking back after the fact that I was like, could it have been because I was a young Black woman? It could not have been, but we know there's a lot of data out there that shows for women, for Black people, often in health-care settings you're not listened to as much. Your pain is minimized. There's a lot of gaslighting that happens. It just made me, later on as a practicing physician, reflect on that experience. Actually, at the time, what it did for me was it just made me more understanding of my patients. One thing is listening, listening, listening to my patients because I wish those doctors had listened to me.

Zibby: When you talked about your experience in the pandemic -- you had that one scene where you're wearing all the PPE and everything. You had a young Black girl as your patient. She said to you, "Can I ask you something? Are you Black?" You're like, "Yes, I am." You could see her relax. Tell me about that moment and the fact that there are so few Blacks doctors in the world, percentagewise. You give all the statistics and everything. It's really insane. It's really surprising.

Uché: In that moment, I was glad that I could be the doctor she needed. At the same time, it made me feel sad because it made me realize that she had had these experiences before where she didn't feel listened to. The fact that she would be like, oh, thank god -- ideally, we want to have health professionals and physicians that can take care of everybody and give everyone the best care possible. We want all patients to feel seen, heard, and appreciated when they go to see a doctor. One thing I talk about in the book is this report called the Flexner Report that came out in 1910 that was commissioned by the American Medical Association and Carnegie Foundation. That actually led to the closure of five out of seven of the historically Black medical schools. There was a study that came out in 2020 that showed those schools would've trained between 25,000 and 35,000 Black physicians. For me, a lot of the book is using my story and my mother's story, bringing in history to help explain how we got to where we are today in 2024 where we have such a small percentage of Black physicians, where we have these racial health inequities. They didn't just come out of nowhere. There are policy decisions and practices that actually have created this environment we're in now.

Zibby: What now? What are our next steps? Say people finish reading the book. They're totally inspired for so many reasons. They're your cheerleader from now on. What now? What can we do?

Uché: In the last chapter, I have a call to action because I knew that people would be like, okay, so what now? I think for physicians in medical school, really to think about how we're teaching our students to care for patients and really to listen to them very, very well, to think about what's in the curriculum, and then also recognize that being a great doctor is continuing medical education. You're always going to be learning something. That's what I actually love about being a doctor. Also, addressing some of these issues as people go on in their career. Also, the other thing is holding hospitals accountable, making sure that they're tracking metrics. Make sure that every patient is getting the best care possible. If they see any discrepancy in, for example, who's being prescribed pain medications, who's not, that they are keeping track of that and that they can intervene as needed. Another thing I talk about is, sometimes the problem seems so big that there's a lot of things happening on a hyperlocal and local level. I talk about, there's a birthing center in Minneapolis called the Roots Birthing Center that's owned by a Black midwife. She created the birthing center specifically to care for Black birthing people just to make sure that they're honoring their dignity and respect. They've actually shown that they've had great health outcomes. There are things that we can invest in. We can maybe volunteer there or donate there or see what's happening in our communities where we can help to advance health equity.

Zibby: I love that. Your mom made you do all these activities as kids. What in all of that do you still do or are you glad that you possess the skills for?

Uché: You know what? I have to think that all of those classes, all of those practices somehow created the person I am today where I'm super purpose driven, very passionate. I don't play the violin anymore. I definitely don't do gymnastics. I think all of that was my mother's love showing up in different ways. I always say when people meet me, they meet her, even though she's no longer physically here. My sister and I are the manifestation of the kind of the mother she was, the love that she gave us, the experiences that she gave us.

Zibby: I am so sorry that you don't have her. It's totally not fair. I'm sure she would be so proud of you. Tell me about deciding to write this book and how long that took and what that was like.

Uché: I had this whole experience when I was in academic medicine. I wasn't happy there. I felt very silenced and muzzled, so I left to start my company. I was working part time in urgent care. Then the pandemic happened in 2020. I all of a sudden got this increased platform. My agent heard me on a local radio show. She's like, "I've been seeing your tweets. I've been hearing about you as a health communicator. I read about you. I read about your mom. I read about the advocacy you do. I think you should write a book. I feel like there's a book out there, and you're the only person to write this book." It was so amazing. We worked on the proposal together. Really, I thought it would be a great opportunity, again, to share my mother's story, to share my experiences, but to use that storytelling as a way of talking about this really difficult topic, to sharing some of the history, social commentary. I worked for a year and a half on the book. It's exhausting. Because it's a memoir, part memoir, part advocacy, history, it was emotionally, psychologically draining, I have to admit. Right before it came out, I was feeling incredibly vulnerable also because I'm sharing my family's story. I actually had my twin sister -- she read all through it and gave me feedback and everything. I wanted to make sure that she also was pleased or satisfied with how we were presenting our family. I feel like it's such an honor to be an author. I feel like this is my gift to the world, sharing about my experiences, my mom's, sharing this history, sharing how people can make a difference all in one book.

Zibby: Amazing. Wow. A year and a half is not bad, by the way, to write a whole memoir. It's pretty good.

Uché: Oh, yeah?

Zibby: Oh, yeah. Sometimes it's seven years, eight years, thirteen years. You never know.

Uché: You know, I'm a mom. I'm a doctor. I'm a business owner. I feel like I'm really efficient. I'm super efficient. If you give me a task to do, I'm going to do it.

Zibby: Next time I have something to do, I'm calling you, Uché.

Uché: I'm sure you're the same.

Zibby: I know. I am pretty efficient, I have to say. You just do it. You don't even have a choice. You just throw it in the mix, and it gets done. We're like Cuisinarts. You just keep putting it in. It's going to work just as fast. [laughs]

Uché: Exactly. What I was going to share is that I really enjoyed recording the audiobook. I didn't think I was going to enjoy it as much as I did. It was really wonderful. I almost would tell people, listen to the audiobook over reading the book, just because it's me talking about my experiences. It made me fall in love with the book again.

Zibby: That's so nice. Are you doing a big marketing outreach at hospitals and hospital gift shops and all of that?

Uché: Yeah, with a lot of large hospitals and health organizations. I wrote the book for a broad audience. Definitely, we're doing the health focus and hospital focus, but I would love for anyone to read the book because I think there's something in it for everyone.

Zibby: I just meant from a marketing perspective. Of course, this is a book for everybody. I was just thinking to reach some of the other doctors and administrators. Everybody should be aware of some of the things in there that they might not have known.

Uché: I'm getting a lot of requests, definitely, to come and speak about the book to health-related organizations. I'm really happy about that.

Zibby: That's great. What is still on your wish list of life?

Uché: My bucket life?

Zibby: Yeah, your bucket list, your wish life of life, or the things you want to achieve. You wrote the book. You did this. You did that. What else is out there?

Uché: I would love to get to the point where I could have a philanthropy and actually help support some of these small community-based organizations that are doing such beautiful, wonderful work but kind of are unknown and unseen. I would love to get to a point where I can actually help them thrive. That would be amazing.

Zibby: Wow. It's a good message for the world, even in the wish list, so there you go. Amazing. Would you ever write another book?

Uché: Oh, yeah, I definitely want to. I'm not sure what it would be. I was thinking maybe a children's book with my sister, two twins that have a mom who's a doctor, so a children's book. Our mom is a big inspiration to us. That's something. Then I'll see what happens after this book is out for a while and see what kind of feedback there is and see if there's room for another book. Right now, I'm just enjoying having it out.

Zibby: As you should. Congratulations. Thank you for sharing your story and your experiences. There's really no better way to inspire change than to share from the most person-to-person, deeply personal, experiential -- it's one thing to get facts and figures, but it's another to be like, listen, here's what happened to me. Let me tell you this. Let me tell you that. There's a lot of impact. Thank you.

Uché: Thank you so much for having me.

Zibby: It's my pleasure. Good luck. Take care. Buh-bye.

Uché: Bye-bye.

LEGACY: A Black Physician Reckons with Racism in Medicine by Uché Blackstock

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