HITLAG Book Club Book Report: “Legacy” by Uché Blackstock, MD

Recently, the HITLAG book club got together to discuss “Legacy” an absolute must-read. Blackstock takes readers through a concise yet comprehensive history of racism in medicine in the U.S., with a centering of Black experiences. Dr. Blackstock is an ER doc, and our group loved her first-hand stories woven through current statistics on inequity in medicine.

That’s enough set up; let’s get to the takeways:

1. Read this book. Yes, we’re about to summarize our group’s favorite themes, but the book is only 250 pages. If you don’t want to read, listen to the many podcasts and video interviews that Dr. Blackstock has given. Better yet, hire her company.
2. The Flexner Report. If you didn’t know about The Flexner Report, you are not alone, but we’ve really got to make sure everyone knows about this one. In 1910, a guy named Flexner attempted to standardize and score medical school curriculum. However, he weaponized his scoring system to denounce Black medical institutions; by the time he was done, only Howard and Meharry were still standing out of 7 historically Black medical schools. A generation of Black clinicians were forced out of practice.
3. Black maternal health. Nothing’s less controversial than moms and babies, right? Apparently not. The 1910 the Flexner Report and the 1923 Sheppard-Tower Act attacked the credibility of Black birth workers and continued the long history of Black birthing people being denied basic human rights in the United States. Even today, Black women are 3x more likely to die due to childbirth and 2x as likely to have a child who dies before the age of one versus white peers. It is both par-for-the-course and mindboggling that inequities like this exist in 2024. Important work is being done by the Black Maternal Health Caucus. Support this organization and support Black birth.
4. Medical trauma is still happening. Often times when the media talks about the ‘distrust’ of people of color regarding the medical system, the journalists will bring in historical instances like the Tuskegee syphilis study. One thing Blackstock makes so eloquently clear is that people of color don’t have to rely on these historical examples to explain their experience of the medical system. Injustices are happening right now, today, every day. In one of the most powerful sections of the book, Dr. Blackstock describes being an emergency room doctor at two hospitals in NYC: Tisch and Bellevue. Tisch’s patient population is about 9% Black while Bellevue’s is about 26% Black. The differences in resourcing are stark, with patients at Tisch receiving glaringly superior care. Blackstock writes: “…I came to view [the ER] as the place where the United States’ social problems come home to roost.” (p.111)
5. Intersectionality + white feminism. Blackstock pulls no punches when she describes her experience coexisting with white feminism when most of her white colleagues abandoned her for being “too political” amidst a hostile environment against DEI work at NYU.  It’s important to our community at HITLAG to always question our own perspective, make space for each other person’s perspective, and advocate for the most inclusive solutions. Equity isn’t optional.
6. Unpaid labor for Black medical professionals. The unpaid labor of educating, mentoring, and advocating isn’t limited to the medical field, but Blackstock does a great job of describing the toll it takes in academic medicine. The burden of dismantling racism can’t be on people of color; it has to be on the institutions that keep and renew inequitable practices. 

Yep, we spent an hour talking about this book and could have spent a week. The important thing, as always, is for each of us in the HITLAG bookclub to walk the walk from our various corners of the healthcare puzzle. Equity only happens intentionally, so let’s keep going!