- Jennifer Middleton, MD, MPH
In AFP's first editorial of 2021, "Systemic Racism and Health Disparities: A Statement from Editors of Family Medicine Journals," the editors of several Family Medicine journals "commit to actively examine the effects of racism on society and health and to take action to eliminate structural racism in our editorial processes." AFP committed last year to "recruit editors and editorial board members from groups underrepresented in medicine," and please join us in welcoming AFP's new medical editor for Diversity, Equity, and Inclusion, Renee Crichlow, MD, FAAFP. Dr. Crichlow is the Director of Advocacy and Policy at the University of Minnesota School of Medicine where she holds the Mac Baird Endowed Chair in Family Medicine Advocacy and Policy. Here are some highlights from a recent interview!
1. Tell us a little about yourself and your background.
I grew up in the South, and I have lived on both coasts, the Mountain West, and the Midwest. I have seen communities and medical practice in many regions and I have come to realize that, first and foremost, I am a Family Medicine zealot. This country needs us. I have always practiced and taught full-spectrum care with Obstetrics having lived and worked in both rural and urban communities. I have known these communities as both a physician and a patient. When I gave birth to my son, I lived in a town of fewer than three thousand people and the hospital two blocks from our house had stopped doing deliveries a few years prior. I know personally what it means for a patient to drive sixty miles from home to have a safe delivery. I have done two fellowships, one at UCSF/UCDavis as a clinical research, faculty development fellow and the second through a Department of Health and Human Services Primary Care Health Policy Fellowship. As such, I believe that Family Medicine physicians working with their patients in the exam room is necessary for the health of our patients, and Family Medicine physicians working with health systems, stakeholders, and policymakers to develop evidence-based decisions is necessary for the health of our communities and the survival of our specialty.
2. What are your goals for this new position at AFP?
We aim to provide systemic support, including advising for authors and editors as we all engage with becoming an anti-racist, inclusive, and equitable specialty in our efforts to both care for and represent all of the communities we serve.
3. What advice might you share regarding specific actions each of us can take toward a more inclusive and equitable world?
First, do no harm, primum non nocere.
Second, ask yourself if you really care about anti-racism and inclusion and their impact on health equity. You may be comfortable with the current health inequities and prefer to attribute their causes to poor personal and individual choices. If not, you may care that the structures of current systems facilitate and perpetuate the status quo, a status quo that is inequitable to many of the patients and communities we serve. Third, consider this work more with a mindset of transformation than a change. The idea of change can seem very polarizing, e.g. light switch turns on the light, the light switch shuts off the light. That is categorical change and that type of change is not possible when dealing with anti-racism, inclusion, and equity, because the work that needs to be done has no predictable path; at its best, this process is co-creative where, working together, we all engage in transforming our systems to facilitate more inclusive and equitable outcomes.
4. Is there anything else you'd like AFP readers to know about you?
We are Family Medicine physicians. We deal with growth and change every day. I believe we are our best when we are helping each other grow through the challenges and choices of life, and these are indeed challenging times. Right now, our whole society is undergoing growth and change at an unprecedented pace. As with all growth, there will be some discomfort. We are Family Medicine physicians, trained to care for the full life cycle of our patients. We are not afraid of growth. I understand that, often, what people really fear is not change but loss. We understand that people may be concerned with changes where they will lose systems and structures that were familiar and dependable. But we know that the current systems and structures are inequitable for many and expensive and inefficient for all. I believe that addressing healthcare information and education using the lens of health equity and inclusion can contribute to systemic transformation. It provides a path for functional excellence, evidence-based structural revision, and systemic transformation.
Caring for all of our patients in an equitable and effective health system is a reasonable goal. We are Family Medicine. We can do this.