Combating Systemic Failures

How my experience as a physical therapist is helping me tackle racial inequality

By Amy Williams, PT, DPT

I’ve never been much of a writer. I often have great difficulty finding the right words to say in normal circumstances, but sadly, our country is anything but normal right now.

Surprisingly, I’m finding it hard to not let the words come spilling out. I don’t pretend to have all the right words or right suggestions, but as our country is in crisis, I’d like to share some of my personal reflections as a white American woman and physical therapist.

I am a physical therapist. I am also a white American woman. I never dreamt of being anything other than a physical therapist. When I decided to go to physical therapy school, I knew I needed to get good grades, pay tuition, and show up. If I could keep up and pass my classes, I’d likely be able to get a job almost anywhere.

Next summer, I will marry a black American man. He also went to graduate school. In fact, he went to our country’s highest-ranking and most prestigious school in the country for his chosen profession. He knew he needed to get good grades, pay tuition, and show up, but he also knew he needed to cut his dreadlocked hair so as not to make his admissions interviewer uncomfortable if he wanted to get accepted. This consideration was only one of the many ways our graduate school and professional lives have diverged based on the colors of our skin.

With our wedding planned for next summer, from that day forward, I will have a black husband, a black mother-in-law, and a black sister-in-law. I will also have a black brother-in-law, and a black niece. One of my brothers is married to a black woman, and they have three daughters, so I already spoil my three black nieces.

Despite all of these relationships with beautiful black people, I am not exempt from taking responsibility for the racial issues our country faces right now; even though sometimes I’m guilty of thinking that they do exonerate me. It’s a sentiment that I hear echoed from my non-black friends often. Have you ever heard someone say, “I have black friends, so this isn’t a problem with me,” or “I played football with black teammates that were also my good friends, so this isn’t a problem with me,” 0r perhaps, “I did a mission trip in Sudan once and met many beautiful black people there, so this clearly isn’t a problem with me. It’s other people that are the problem.”?

The reason it’s a problem if I exempt myself from taking responsibility for racial issues based solely on my relationships with black people is that it falls tremendously and devastatingly short of solving any of the actual issues at play. Racial inequality is a systemic problem. Racial discrimination is pervasive in our systems of education, employment, legislation, and law enforcement.

‘Systemic’ is not an unfamiliar term to me as a medical professional. Medically it’s defined as something affecting the entire body, not just a single organ or body part. I know that it is much more difficult to treat a patient with multiple issues. Sometimes I can’t decide where to start; even if I do start treating one area, I might think to myself, “Is it really going to help?” because the problem seems too big.

One popular phrase circulating on social media is, “I know I will never completely understand, but know that I stand.” I certainly don’t know what it feels like to get pulled over while being black or what it feels like to have the police called on me while I’m running in my own neighborhood — a neighborhood I’ve lived in for 12 years. I will also never know how it feels to be turned away from buying dessert in my elementary school cafeteria because it was assumed I was restricted to the free and reduced lunch options strictly because of the color of my skin. However, through my reflection, I’ve been reminding myself that I do understand issues presented by a problematic system.

Allow me to present a scenario, which might sound familiar.

A 55-year-old male presents to your clinic with complaints of chronic low back pain. The pain has been ongoing for 10 years. His aggravating factors are sitting, standing, walking, sleeping, dressing, bending, lifting, and twisting. His easing factors are a combination of bed rest, Norco, and Gabapentin. He says that when his pain first started, he went to Doctor A who ordered an x-ray. The x-ray showed degenerative disc disease. He was then sent to Doctor B who ordered an MRI. The MRI showed neuroforaminal narrowing impinging on the left L5/S1 nerve root. The patient was told he “probably shouldn’t bend or lift or twist because that might damage his spine.” Doctor B then added a prescription medication to manage the pain as well.” This patient avoided those positions, and he took the prescribed medication. Unfortunately, the pain persisted. He decided to visit Doctor C who, upon noticing it had been several years since his pain began, wanted to do another x-ray. Doctor C went on to state that the degeneration had progressed since the last image and proceeded to offer a spinal adjustment to “realign his spine.”

Instead of helping his pain, this treatment made it worse. Consequently, he went to yet another doctor, and this one suggested physical therapy. He made an appointment, but when he arrived, his physical therapist was treating two other patients at the same time and gave him a variety of exercises that didn’t really help. This physical therapist didn’t really listen to the problems the patient was describing. He shares that he never really got any better, which is why he stopped going. Finally, he tells you that he visited one more doctor, and she said “How about you try physical therapy one more time. See if this physical therapist can help.”

Does this scenario sound familiar? Does it ever feel as if you’re starting from a deficit with a patient? Does it feel as if you’re entering the race at a much later phase and as if the odds are stacked against you? Does it feel as if a large part of the reason you’re starting from a deficit is because of a medical system that you are a part of?

When I think about this patient scenario, I realize that while there are overwhelming systemic contributions to this patient’s pain, I know exactly what to do to help.

I apply to an orthopedic residency program. I take continuing education courses. I go to professional conferences. I look up research articles. I reach out to mentors and colleagues and have meaningful conversations, all while having an understanding that I am part of a bigger system that sometimes is working against me — a system that I sometimes contribute to in a negative way as well.

This patient scenario is not unlike systemic racism in our country right now. While it often feels overwhelming and insurmountable, I remind myself that I actually know exactly what to do.

I read articles. I donate money. I listen to my partner and his family tell their stories. But I don’t ask them to teach me how to be a better white person; that’s not their job. That’s my job. I make sure I’m registered to vote. I research the candidates, and I go vote. I make sure to vote not only during the presidential election (although that is a big one) but also in the many local elections for officials that can make a meaningful difference.

I also try not to label good things as “white” and bad things as “black.” Have you ever noticed that? Blackmail, blacklist, and black market. My partner notices those things, and now I cannot unsee them.

I also sign petitions and write emails to elected officials. I watch documentaries and interviews even when they make me uncomfortable. I asked my employer to sponsor a scholarship specifically for black Americans wishing to enter into physical therapy school because I know there is a lack of diversity in our profession. That’s a problem. It’s a difficult, multifactorial problem, but hopefully, our support will be a small step in the right direction.

I’m doing these things now; I’ll do them in two weeks, and I’ll do them in two years. All the while, I relate my efforts to tissue change within the human body. These societal changes — just like human tissue — take time. Alas, we can’t expect change without effort. I often share a quote with my patients, and I pray it holds true here, too:

“Success is the sum of small efforts repeated day in and day out.”
—Robert Collier

Amy Williams, PT, DPT is a Board Certified Orthopedic Clinical Specialist with degrees from Belmont University in Nashville, Tennessee. She currently works with Agile Physical Therapy in Northern California.