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Medicine struggles with a chronic disease: racism.

Medical schools try to combat this disease with diversity initiatives and training in unconscious bias and cultural sensitivity. I’m about to graduate from the University of Virginia School of Medicine, so I’ve been through such programs.

They’re not enough.

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Every one of us needs to own the principles that protect us and our patients from racism and bias. That means learning to see prejudice and speaking up against it. But that is far, far easier said than done.

Again and again during my four years of training, I encountered racism and ignorance, directed either at patients or at me and other students of color. Yet it was very hard for me to speak up, even politely, because as a student, I felt I had no authority — and didn’t want to seem confrontational to senior physicians who would be writing my evaluations.

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These situations made me worry for our future: How can medical professionals address the needs of a rapidly diversifying population, when we cannot address prejudice within our own community?

I did try, once, to speak up, but it didn’t end well. My first clinical rotation was in the ear, nose, and throat clinic. On my first day, I overheard the attending physician grumbling about accommodating an elderly Haitian man with limited English who had misunderstood his appointment time. “We’ll stick the med student on him,” he said. I was excited to test my skills, but I couldn’t help but feel that my seeing this patient was intended as a punishment for him — and that made me uncomfortable.

A few hours later, when it was finally time to see this patient, the attending physician told me I had the pleasure of conducting my very first patient interview on “Amadou Diallo.”

That was not his name. The only similarity between Amadou Diallo, the young man who was shot and killed by four New York City police officers in 1999, and this elderly Haitian gentleman was their skin color. My skin color.

“That’s not his name,” I said, instinctively but respectfully.

I was pointed in the direction of the patient and clinic, and proceeded as usual.

A few weeks later when I received my clinical evaluations, I perceived some of the feedback as unkind. I couldn’t tell if the comments actually reflected my performance or if I, too, was being punished for speaking out, or maybe even for being black. It was terrifying not knowing the difference.

As my clinical training progressed, I had several opportunities to point out intolerance and injustice. I always chose amicability over advocacy. I didn’t want to jeopardize my grades and evaluations by calling attention to intolerance, so I stayed silent instead of voicing the values I believed in.

During my internal medicine rotation a few months later, a patient called me a “colored girl” three times in front of the attending physician. The doctor did not correct the patient, nor did she address the incident with me privately.

Despite all the other positive interactions I had with this teacher, her silence in this circumstance diminished my presence. I wondered if she thought of me as a “colored girl” too.

Looking back, I don’t regret my timidity. It’s what I felt I needed to do to survive. But I feel angry and frustrated that my mentors in the medical profession didn’t raise these issues themselves. Diversity and inclusion initiatives challenge bias in the abstract. Checking bias in real-time, with real people, is much more challenging.

Maybe they didn’t notice the bias. Maybe they didn’t feel it was important enough to talk about. Maybe they didn’t know how to talk about it.

They should have.

To be truly inclusive, communities must be places where everyone feels they have equal worth and where people can have honest conversations without judgement. There’s not enough of that spirit in medical school, or in the medical profession.

One more example among many: During my obstetrics and gynecology rotation, I helped perform a prenatal ultrasound on a woman wearing a Confederate flag shirt. Her husband and son watched. Both were wearing Confederate flag hats and belts.

The optics of the encounter were jarring. I wondered if my patients hated me. Again, the attending physician did not address the racially charged awkwardness of the encounter.

Although this physician was otherwise kind to me, his silence left me with a lasting impression. And too many toxic questions.

As the Brazilian educator Paulo Freire writes, “Sometimes a simple, almost insignificant gesture on the part of a teacher can have a profound formative effect on the life of a student.” All these years later, I still wonder if these physicians — my teachers — respected me. It was difficult to reconcile the compassion they showed their patients with their apathy towards me.

I needed to know if my experiences were anomalies, so I checked in with two well-respected black physicians who focus on diversity in academia. Dr. Marcus Martin, a vice president at the University of Virginia, and Dr. Eve Higginbotham, a vice dean at the University of Pennsylvania, both assured me that I wasn’t alone. In fact, they said such experiences were all too common.

“It really is over the lifetime of one’s career that you ultimately understand how to actually deal with these very difficult situations,” Higginbotham said.

Medical school often erodes aspiring doctors’ empathy, compassion, and idealism. As Harvard Medical School professor Dr. Richard Schwartzstein writes: “Typically, students enter medical school idealistic, eager to improve the human condition, and excited about becoming doctors. And then we do various things to change them.”

This is most often the byproduct of the intense pressures of academic and clinical work. As a medical student, however, I fear my heart was hardened by an extra burden, of my educators being blind to my worth as a woman of color.

As I advance in the training hierarchy and acquire students of my own, I will certainly do my best to foster inclusion. While my experience as a black medical student has made me hyperaware of racism in medicine, I know because I am human, that I have blind spots of my own.

I will work to stay aware of tense moments. And I will always stand up for my students. I also hope I can cultivate a community where my students feel comfortable calling me out.

Until we all commit to taking action every day to foster a true spirit of inclusion, we’ll risk perpetuating racial harms and undermining the true spirit of medical professionalism. I know race relations in medicine will not change overnight, but learning to see what is hidden in plain sight will be a crucial first step.

  • Around 2008, while in med school at Puerto Rico (same US medical system, but obviously the patients spoke Spanish) I had a colleague named Tarek. His parents were from the Middle East (honestly don’t remember if Saudi Arabia or Iraq). The man spoke 3 languages and won EVERYONE over with his personality and wit. Once, during hospital rounds, in the nurse station, in front of the FEMALE attending physician (who happened to be the freakin’ medical director of the hospital!), the nurses started to haze him, asking how to pronounce his last name. One nurse said, “I’ll just call you Dr. Taliban!” They’re implying he’s a terrorist because of his name, heritage and accent. I told the nurse jokingly, “hey, you know that’s not fair…” Tareq cut me off and told the nurses, “you know Taliban means ‘student’, right? So yes, I’m Dr. Taliban and I’ll always be a Taliban for my patients”. The hazing was in good faith, but he flipped the tables on them and made them look silly. The second they realized how much they screwed up, he laughed, went behind the counter and gave each nurse a big hug (Puerto Ricans are quite affectionate). The attending smiled and said: “you can’t pull those stunts on Tareq, many have tried and all have failed!” The man got honors in the rotation, and received glowing reviews from ALL the staff. The cultural environment was a bit different from the author, but it occurred in the harsh, hospital environment. He was a white male, and the experience, while culturally inappropriate, is nowhere near a black female doctor performing an ultrasound on the white confederate family. Wait, I take it back – jokingly being called a terrorist, in front of nurses, other doctors, and patients, is right up there as one of the most racist and demeaning things I can think of. I’m quite sure Tareq had plenty of horrible experiences. But you bet those nurses learned something new that day, with the subtle reminder that when they next complain of “abusive behavior” or hazing by male doctors, they too had engaged in abusive behavior in FRONT of the FEMALE medical director. Yes, med schools need to do more, not just on racism, but on many things (starting with how females are treated). All of these experiences have been very unfair to the author. Period. Not everyone is like Tareq. I know I’m not, and the author mentioned she is quite shy. But young doctor, maybe, maybe, you should realize all you experienced were missed opportunities to demonstrate how to behave in an uncomfortable situation with a patient. For example, to break the ice when being called “colored” several times: “I realize Dr. Okwerekwu is quite difficult to pronounce. You can call me Dr. Jennifer, or just Jennifer if it makes you feel more comfortable. I’m from X state – where are you guys from?” How about talking to the dad, or asking the child if he’s happy about the new brother – or perhaps a new sister? She subtly implies the white family with the confederate shirts is not only racist but ignorant. That attending may have been testing her with that family – I bet it was a genuine shock for the “confederate family” to see a female doctor, much less one of color. Well then, time to educate them. In fact, the author states the color of her skin is black, but if you’re talking about race, at least tell us something about your background and ethnicity. I’m a white Puerto Rican male, with a thick, Latin accent, but speak impeccable English and grew up in American culture. Now I’m a pediatrician in Texas and see families from all over, each with their own preconceived notions about life and how their doctor should behave, look, and speak. I get yelled by a mom at least once a week. But think how different this article might have been if you had asked that confederate family where they’re from, and maybe looked for something in common. Don’t assume anything. What, they’re in Virginia so automatically they’re rednecks and inbred there for 3 generations? YOU could have led that “honest conversation without judgment”. I’ve seen young doctors behave admirably during a tough patient encounter, winning the patient over, only to see them later choking back tears in the parking lot. Heck, last week I had to punch a book (the wall would’ve made too much noise) to keep my anger in check against a smart-mouthed mother, and I really tried. Racism often stems from ignorance, which means “not genuinely knowing”. By definition, physicians are in positions of leadership. We have to lead by example… even if we have to choke back some tears or punch a book, then pretend nothing happened. It’s not fair, young doctor. Perhaps all those attendings were waiting on you to act to actually provide some feedback. Woman of color (not just black) experience more challenges than a white male. Lastly, you mentioned your evaluations. I’ll share one of mine, provided on my very last med school elective. It was an hospital-based pediatric rotation, in the same hospital I already knew was accepted to train as a pediatrician. The attending, an older male doctor, sensing my hubris about being “the new hot stuff that HE was going to have the pleasure of training”, wrote in the evaluation “the doctor needs to be more assertive in his management”. I’ve never been hit so hard by someone who never touched me. I know you’ve had it tough. Denounce straight-up racism firmly and with dignity – but be the better person, teach them, and give them the space to fight those mistaken beliefs.

  • @ Equitable, whether official policy or not, many doctors feel that the term student doctor is deceptive because some patients may only hear the doctor part. As for scut my guess is that you graduated med school within the past 20 years. During my time third year med students were expected to do everything from drawing blood, starting IVs, holding retractors, transporting patients, tracking down labs and xrays and doing on call coffee runs for the residents, heaven help you if you got the order wrong. You were also probably never pimped to the point of humiliation in from of your peers. In my day medical students were disposable commodity since we were only paying $3,000 year. Now that some of you are paying $300,000 for your MD you are too valuable a commodity to be called a scut monkey. Need blood drawn? Call the phlebotomist. Need to start an IV, put in a Foley, draw an ABG? Call the specialty team. Not to get your hands dirty. In my day residents were not evaluated on their handling of med students, but now they are, so continue to expect the kid glove “student physician” treatment.

  • What I find also bad is when medical students mislead patients by calling themselves “student doctors”. You are not doctors, yet, and some med schools forbid the term. I know you think you might be ever since med schools introduced the silly custom of the “white coat ceremony”. Also if you are ever called a “scut monkey” please don’t take it as a pejorative. All third year med students are called that. And if that term offends you good luck.

    • What medical school forbids the term “student doctor”? Please, name one. I actually became familiar with this term because it was how many of my attendings introduced me to patients. I am interested to know how this would mislead patients, you are literally explaining you are student training to be a doctor. In fact, medical student is often a much more misleading term– I cant tell you the number of times I have told someone I am a medical student and they want to know what kind of medical I am studying, and if I am studying nursing. A student studying to be a pharmacist is called a “pharmacy student”. A student studying to be a veterinarian is called a “veterinary student”. A student studying to be a physician assistant is called a “PA student”. Students in med school are not studying to be “medicals”, they are studying to be doctors. The term “student doctor” is both accurate, and specific, as well as correct.

      Additionally, while you may refer to 3rd year medical students as “scut monkeys” and feel it is an appropriate term, you should be informed that the overwhelming majority of people do not. You may have been watching too many medical dramas. In my four years of medical school I never heard it once, nor have I ever heard any of my colleagues say they had either. In fact, at my institution such language falls under the mistreatment policy and would be a reportable offense, the took school mistreatment very seriously. During my medical education I knew of at least one faculty member that was banned from teaching students due to referring a student as any other than that.

      It seems you may have been misinformed. Hopefully this post can help educate.

  • While I understand where this writer is coming from, as an RN I feel it is never the practitioners job to ” correct” a patient’s language..I have asked some people privately to refrain from obscenity, but never “corrected” them..colleagues voicing inappropriate language or racist remarks are another story..I don’t feel as if medical schools have “failed” minorities by not ranting at obvious prejudiced patients..I was taught to treat All patients equally ,even pedophiles and cop killers( worked ER for awhile)

  • Most doctors don’t really respect med school students. You don’t deserve respect “just because.” The reality is that all med school students are challenged by physicians. Your race and gender are pretty much irrelevant to everyone but you. The physician probably doesn’t condone a patient calling you a colored girl. He just doesn’t have the time or energy to care.

  • Wake up and know the historical context. Because every situation has one. A history lesson for those born after 1975: “colored girl” in the South is the term white people used for maids, cooks, and any black woman beneath them, i.e., ALL black women, no matter age or profession. This student is not a “girl” as I am sure she is at least 18 years old. The term is demeaning, derogatory, and yes, racist. I grew up in the South where it was common to call all black men “boys,” even if they were 90 years old!

    I would have corrected the patient on the spot by saying , “Oh, are you referring to Miss Okwerekwu? She is a medical student….She is not a girl. Please do not refer to her or to any of the staff in our hospital as ‘colored girls’ as we find the term offensive. If you need help remembering names—and I know there are many names to remember!—any one of us can help you.”

    One must break the cycle of prejudice. It is silence that tacitly allows racism to fester.

  • Chastising a sick/injured person for not using a politically correct term is disgusting to me. (This is NOT a “teachable moment.”) One of the first things I learned as a medical practitioner is to be non-judgmental in regards to my patients’ language, dress, social norms/biases and focus instead on giving them the best medical care I could provide.

    • Of course your privilege won’t allow you to see the issue with being called “the colored girl”, it’s a disgusting word. The doctor is an individual as well. And she still provided unbiased care to those patients. People like you who refuse to see acknowledge prejudices and injustice even when spelled out in front of you are disgusting to me.

    • Stephanie, I am mixed, and I can tell you that the term “colored” is not a derogatory term. In fact, I don’t need to have the credibility of being black to tell you that. The NAACP stands for the “National Association for the Advancement of Colored People.”

      Even “negro” isn’t derogatory. It’s just old fashioned and weird, so people don’t use the term anymore. Are you a minority? Did you not know this?

      I’ll admit its embarassing to see a young woman that is a minority, like the author of the article, not knowing her own history well enough to know what is racist and what isn’t, then jumping all over sick people, as a doctor, for using a term she seems to be ignorant about. Of all the things. Its embarassing.

  • If you are the only colored girl in sight and patient doesn’t know your name, what better way is there to explain who is being referred to? I have one arm. What better way to refer to me as “The guy with one arm?”
    “The doctor with the dark skin.”
    But to be more respectful the parient ought to have said “The doctor with the dark skin.” I’d almost think you weren’t proud of your “colored” skin.

    • A better way to refer to someone of color? Chances are she was the only student in the room or one of few in the room, so simply refer to her as “the student”. Not a derogatory term that is used to negatively describe someone. If you do NOT know that the term is derogatory, this mistake is only understandable if you did not grow up in the United States or did not take any history courses within the United States. Otherwise, you should be completely aware that the term is inappropriate.

  • I am wondering what we as students can do to address this now? We take diversity training in our first year and then throughout school we have random encounters with physicians and professors who themselves disrespect students and then teach them how to address situations that challenge their ethics. Then we also encounter teachers who provide us with the basics of how to address racism but I don’t know what to do anymore because what they never provide solutions for is how to address issues with patients and attendings during rotations that doesn’t leave you with a negative evaluation.

  • For those doctors who haven’t yet taken their boards or are up for renewal get real familiar with the term “cultural competency”. You will be tested on it and in many states just to be able to keep your medical license you will have to periodically take seminars for the CME credits you will need to keep your credentials current.

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