Honoring Black History Month: Q&A With Dr. Adriane Birt
Columbia Psychiatry’s Adriane Birt, MD, Assistant Clinical Professor of Psychiatry, describes her work directing a crisis team, how race, gender and family history led her to study medicine, and shares her view that our “department exists within a society that’s now grappling with how racism remains interwoven into its structure, many years after the Civil Rights Movement. There’s no reason we should exempt ourselves from joining that dialog. It’s crucial to create special opportunities and settings for discussions, but as we become more diverse, these conversations will hopefully begin to happen spontaneously and naturally during the routine course of our efforts in all areas, ranging from patient care to departmental planning and policy. ”
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Communications: Tell us about your current work.
Adriane Birt, MD: I direct a psychiatric crisis outreach service. We’re a small team that provides urgent home visits to patients in the hospital’s community -- Washington Heights and Inwood – as well as a part of the Bronx that includes Riverdale. When they’re referred to us, our patients are in an emotional crisis but can’t access care on their own. Our job is to assess the nature and severity of the crisis, then determine which immediate interventions are needed. The safety of the patient is the first and most important judgment we have to make. For about 10% of our patients, we need to organize the process of getting them transported to an emergency room for further evalutation and probable admission to an inpatient unit. The recent nationwide focus on the management of the mentally ill during community emergencies has made the importance of this function more clear than ever. But our primary goal is to keep the patient safely in the home if possible. So for the majority, we work to either get them re-engaged in their existing outpatient care or link them to a new treatment provider and to any needed support services.
I’m also one of the Chairs for Quality and Patient Safety in Psychiatry for NYP. In that role, I’m part of a quality team that has repsonsiblities like: reviewing incidents – suicide attempts or patient assaults, for example – that occur on the inpatient unit, in the psychiatric emergency department, on the consult-liaison service and in the outpatient department; developing corrective actions when quality lapses occur in system processes; participating in quality improvement initiatives implemented throughout Behavioral Health in the NYP Enterprise of hospitals; and revising policies that help govern how the hospital’s psychiatry services deliver clinical care.
Communications: Why did you choose medicine? Did culture (or race) play a factor in your decision?
AB: Race, gender and family history all impacted my decision to go into medicine. My father was a physician, a urologist, who unfortunately died when I was young, age 16. When the time came for post-grad studies, I debated endlessly with myself but did what I think was inevitable and chose medicine largely as a way to honor him. But before that point, in high school actually, I began to feel I had a responsibility to consider a science career, as a woman and especially as an African American woman. It was the late seventies and I felt part of the early stages of an opening up of non-traditional careers for women and wider educational opportunities for African Americans. My parents and grandparents had all moved into places in the world their fathers and their mothers hadn’t had access to. So, my choices about education and career felt like part of a continuum of change in both my family and in society, as much as they were personal aspirations.
Communications: What does Black History Month evoke for you?
AB: Like everyone, I see Black History Month as a time to be reminded of the fundamental role of black people in the development of all areas of American culture. It’s also a cue for me to acknowledge the uncelebrated African Americans that surround us all day-to-day. The fact alone of our existence in the life of the country in many capacities makes a statement about endurance that I find hopeful. And for everyone, it’s an opportunity to look beyond personal experience, from the perspective of someone different, which is a difficult skill for most of us to practice but so important to forming a respect for human rights.
Communicatios: Should we in our department initiate discussions about racism and try to pinpoint how racism plays out in our research and clinical practices? And if yes, what are venues for these discussions?
AB: I think discussions about racism can and should happen anywhere, including in our department. As psychiatrically-trained faculty and staff, we’re particularly mindful that beliefs and assumptions out of the reach of our immediate awareness influence our behavior. On one level, discussions about race and racism should be a part of the general process for the individual of identifying the implicit beliefs that shape decisions, including decisions about how work gets carried out — work like treating a patient, creating a research protocol, evaluating a trainee or organizing recruitment efforts. But beyond getting a better grasp of individual assumptions in order to take more informed actions, we should talk about race because we don’t conduct the activities of the department in a bubble. The department exists within a society that’s now grappling with how racism remains interwoven into its structure, many years after the Civil Rights Movement. There’s no reason we should exempt ourselves from joining that dialog. It’s crucial to create special opportunities and settings for discussions, but as we become more diverse, these conversations will hopefully begin to happen spontaneously and naturally during the routine course of our efforts in all areas, ranging from patient care to departmental planning and policy.