No more silence: Confronting racism in medicine
As part of a new generation of healthcare workers tasked to provide care for everyone, regardless of race, gender, insurance status, or disability, medical professionals have a duty to support all forms of equality in health care. And yet, there is no shortage of stories of blatant racism in the healthcare setting from the point of view of black healthcare workers.
Dr. Jennifer Okwerekwu, during her internal medicine rotation, was referred to as “colored girl” three times in front of her attending, who said nothing. Dr. Tamika Cross, having responded to a call for a doctor on her flight, was greeted with demands for her medical credentials and questions of if she was an actual physician. When asked if she was angry, Dr. Cross responded, “I experience so many things almost every day of my life that if I were to be angry at this situation, I would be angry all day, every day.” There is no doubt that women and other minorities have similar stories.
To read these stories is to feel the exhaustion of the writer, to witness each racial comment chip away at the foundation of being a medical professional and a black American. The burden of having to endure humiliation, to swallow the anger and pain, and to continue on with the day constitutes one of many significant reasons why black physicians are leaving academic medicine.
As a medical community, we are in agreement that these prejudices have no place in our world, much less our hospitals. We believe that when we hear a racist comment, be it from a patient or a healthcare worker, we will intervene and condemn it, emphatically contending that such speech will not be tolerated. But this rarely happens.
Many medical professionals have been in a situation where, confronted with an offensive comment, they felt paralyzed. The desire to interject is shamefully caged in the confines of what we have learned – that we must treat all patients, even the ones who treat us poorly.
There are no guidelines on how to respond to an offensive comment, no set of standards that we can refer to. The general consensus revolves around the guiding principle that we must rise above offensive comments to provide essential care. Medical professionals can express disagreement with offensive statements, preferably in a calm, inoffensive tone to allow the patient to remain comfortable.
If a patient, through offensive statements, requests to be seen by another doctor of a different race, gender, or religion, there are few options: switch the patient care to another provider, deny the request and attempt to demonstrate the competence of the current provider, or offer the patient transfer to another hospital.
However, these options offer little in addressing the offensive remarks and the psychological damage they wreak on the recipient. To acquiesce these requests in silence not only allows for these deplorable views to live freely, but also invalidates the promise the medical profession has made to fight racism.
Why must the care of a patient come at the cost of allowing racism against our black colleagues? Why must this play out in minority medical students citing experiences of racial prejudice and feelings of isolation as causes that make them more likely to have burnout and depressive symptoms?
Can a person feel human if they are taught to look the other way at racist comments, to be bigger than the manifestations of structural injustice that have oppressed them for centuries? Can we truly declare that we support our colleagues if we are complicit in this silence?
Enacting real change requires both a top-down and bottom-up approach.
First, hospitals and medical schools need to make policy statements mandating no tolerance for racist comments from anyone in the hospital. Structural support would go a long way towards alleviating the burden of silence in the face of wrongdoing. Dr. Okwerekwu commented on this silence, how she did not “want to jeopardize my grades and evaluations by calling attention to intolerance, so I stayed silent instead of voicing the values I believed in.” This is an opportunity to empower doctors and students alike with policies condemning racist comments without fear of repercussion.
Second, medical schools need to create educational guidelines on how to effectively intervene, providing not only examples, but also opportunities to practice these interventions, workshops to practice overcoming feelings of discomfort and confronting offensive comments. Knowledge of our prejudice and good intentions are not enough to ensure implementation. Like all else in medicine, this requires consistent practice.
Training would empower health professionals to voice their disdain in a way that feels less as an empty threat and more of a declaration of resistance. The goal would not be to convince an offensive person that offensive comments are wrong, but to assert as a profession that we will not tolerate such comments, and that we stand in solidarity with all of our medical professionals. We will rebuke the racist views of others, we will defy a system that has failed to support black lives, and we will not stand alone.
The ideals behind these changes directly apply to racist comments, but they do not stop there. These changes are an opportunity to create an environment that is welcoming to many other communities, from gender equality, LGBTQ rights, to people with disabilities.
There are more changes to make, more wrongs to right. But right now, it is essential to support our fellow black colleagues, to no longer propagate the paralysis of shame, and to exchange the silence of acquiescence for the unabashed declaration of equality.
-By Esteban Davila, third-year medical student at Baylor College of Medicine