The Forward Movement: Color Blind, or Blind to the Truth?

A productive discussion on the Black experience in orthopaedic surgery requires a contextual understanding of the complex interplay between historic and social factors that have led to our current reality. For this discourse to be productive, uncomfortable truths about American anti-Black racism need to be confronted. In previous columns, I have sought to provide necessary context to facilitate this discourse within our field. It is also prudent to address aspects of the conversation that are decidedly unproductive. One such element is the notion that we in medicine and orthopaedics should aspire to becoming “color blind.”

The premise of “color-blindness” suggests that if we ignore the existence of racial differences, our field will somehow be elevated to a place in which all patients are treated equally, racial health disparities cease to exist, and entry into our field will be based purely on merit. Proponents of color-blindness suggest that talking about race is the central problem; therefore, if we stop talking about it, the problem will go away. It will not. Believers in color-blindness will frequently misquote the Reverend Dr. Martin Luther King Jr., suggesting that the pre-eminent civil rights leader would endorse ignoring the effect of race on society. He would not. When confronted with the truth of systemic racism and its effects on Black populational health, supporters of color-blindness will proudly state how they “treat all patients the same,” as if to suggest that their individual application of the Hippocratic oath was enough to erase 400 years of injustice. It is not.

By way of analogy, I will ask the orthopaedic reader this: After performing fixation of a fracture, why do we obtain postprocedural radiographs? The obvious answer is to monitor for appropriate healing and alignment and detect early evidence of complications, such as nonunion or malunion. In the unfortunate event that a patient does develop a nonunion, would it be effective to simply stop taking radiographs? Doing so would certainly allow the surgeon to avoid confronting the complication. But failing to obtain radiographs, remaining “blind” to the problem, would not change the patient’s experience. The patient would continue to experience the pain and loss of mobility resulting from the complication. And the longer the complication persists unaddressed, the larger the impact on the patient. Turning a blind eye to the problem is not appropriate for the treatment of an individual patient, so how could it possibly be appropriate for addressing the public health crisis that is anti-Black racism?

Overlooking the role that race plays in orthopaedic care is not just ineffective, it is irresponsible. Doing so undermines the experiences of Black patients receiving orthopaedic care because of systemic boundaries to access. It undermines the experience of Black orthopaedic surgeons who are challenged daily by micro-aggressions, which in fact have macro-consequences on mental and physical well-being. We should not aspire to becoming color-blind, but rather to creating a generation of professionals who understand the nuances of racial disparities. This must take place early and often in orthopaedic education.

I propose that we change our concept of orthopaedic training and integrate education on racial disparities into every curriculum, from entry to graduation. Some will argue that this will take time away from the technical aspects of training, to which I will respond: Is our goal to train physicians who effectively improve the care of patients with musculoskeletal problems, or is it to train carpenters of bone? Treating patients properly requires empathy as well as technical mastery, and both can—and must—be taught and learned. The social contexts of our patients’ experiences affect their outcomes just as much as correctly placing their screws or meticulously closing their hip capsules. And for a large portion of the American population, this social context is informed by race. When orthopaedic residents learn where to place anterior cruciate ligament tunnels, they need to learn about how Black patients with ACL tears are at higher risk for misdiagnosis [3]. When residents learn how to fix hip fractures, they need to learn about how redlining and housing discrimination has contributed to delayed care for many Black patients with hip fractures [2]. When residents learn how to properly balance a total knee arthroplasty, they need to learn how racist attitudes about Black pain perception may play a role in decreased utilization of arthroplasty in Black patients [1, 4].

We must aspire to fully integrate racial disparity knowledge into orthopaedic education as a component of training that is just as important as psychomotor skills, and not merely as an afterthought. Getting there requires us to confront the harsh truths about inequality and not turn a blind eye to them.