I remember driving to the hospital with my mother when I was 6 or 7. We pulled up to the physician parking lot, but the attendant refused to open the gate, telling my mother the lot was for physicians only. “I am a physician,” she said, “and I work here.”
I’d accompanied my mother to the hospital enough times to know this was abnormal. When I asked her why the attendant didn’t want to let us in, she explained to me that sometimes people see only the color of your skin.
I would feel the sting of that lesson again and again in the decades that followed. I learned to shoulder the burden of being black in America. But even after a lifetime of living with the (not so) benign buzz of racism, I was unprepared for the bolder forms of bigotry I would encounter as a medical student.
I recently wrote an essay about the racism I experienced in medical school, including the time a patient referred to me as a “colored girl” — and the senior physician in the room said nothing. I’ve received hundreds of comments. Some readers told me to “grow a thicker skin” or “stop looking for racism in every corner.” One tweeted: “People are not responsible for creating a safe space around you.”
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But others came forward with empathy and advice, sharing experiences that helped me put my own struggles in context and helped me think through ways of combating racism.
From all of you, this is what I have learned:
We don’t know how to talk about racism
It was difficult for me to open up in my essay, not only because it forced me to relive painful episodes, but also because it forced me to focus on the fact that some people fundamentally believe my place in the world is predicated on my skin color.
I learned from readers that I’m not alone. Racism permeates medical education and medical practice, and it has for decades.
Reader after reader told me they were well-aware of these issues but didn’t know how to address them. They had no idea how to respond to a racist comment from a patient or a colleague — or a medical school professor.
“No one knows what to do, so no one does anything,” said Rebecca “Becca” Dirks, a classmate of mine at the University of Virginia. “We took cultural competency courses, but they were lacking in actually giving me tactical tools,” she reflected. “I feel unequipped to deal with that kind of situation.”
Doctors are generally not trained in how to handle those difficult situations, said Dr. Sue Taylor, the former medical director of palliative care for Tucson Medical Center in Arizona.
This is a problem.
As doctors, we recognize that our patients are often stressed and in pain; some readers reminded me that we should be able to “rise above” any rude remarks and focus on delivering care. But that said, we should expect — and insist on — professional respect.
That means we have to learn to communicate better: We have to find ways to stand up for our colleagues when they’re insulted by patients — or by others on staff. As Dr. Sachin Jain, an executive at CareMore Health System, told the New York Times a few years back: “There’s something wrong when a person can go to work, be subject to intolerance or abuse, and have it be ignored and accepted by colleagues as part of the job.”
Silence in the face of injustice not only kills any space for productive conversations, but also allows cancerous ideas to grow. Inclusion is not passive; it needs to be actively practiced. And the medical profession needs to uphold this principle by training us to do just that.
Small gestures can make a big difference
Taylor, the Arizona physician, has a ready response when she hears racist remarks.
“I just say, ‘It surprises me you would say that’ and then they have to stop,” she explained.
As a white attending physician, Taylor believes it’s her responsibility to protect her students by speaking up for those targeted by racial aggression. Students hang on every word from senior physicians. If they don’t see their mentors actively moving to curb racism, that sends a powerful message, she said.
So mentors need to speak up.
My classmate Joey Merrill told me a story that illustrates this principle: During her family medicine rotation in rural Virginia, a patient made demeaning remarks about how women were better suited to be nurses than doctors. Merrill’s attending physician rebuked the patient, telling him that Merrill was working incredibly hard to become a doctor — and to learn to take good care of patients like him.
Having this well-respected doctor stand up for her was “huge for me,” Merrill said.
It only takes a few people to light the spark of cultural change, said Mike Isaac, a nurse at Norman Regional Hospital in Oklahoma.
In the emergency department at his hospital, profanity is not tolerated. “If somebody cusses at a nurse or doctor, they get told, ‘You don’t talk to my people that way — and you owe them an apology,’” Isaac said. “And they stand right there until they apologize.”
It’s an unwritten policy that’s embraced by all the staff in the department, Isaac said, because it enforces respect and decency.
I’d like to think even the act of publicly sharing our experiences helps in some small way. Readers told me it did: “Thank you for your courage in speaking up,” one wrote, “and reminding us that we have the potential to be far better.”
Things won’t get better on their own
Many minorities in medicine, from undergraduates to seasoned professionals, try to avoid being labeled as a “troublemaker” by putting up with intolerance, putting their heads down, and “pushing through.”
In many of the emails that I received, I heard promises of a better tomorrow. I used to have the same hope: It has to be better for future generations, I thought, if only because there will be more physicians of color in the medical profession, committed to serving disenfranchised communities.
But after talking to physicians at senior levels of the profession, I’ve learned it’s not so easy.
Underrepresented minorities occupy only 8 percent of all medical faculty positions — and that’s barely budged; the number was 7 percent two decades ago. During my clinical rotations at the University of Virginia, I interacted with just one black physician.
It seems that racial fatigue often drives us away from academic medicine — and away from the positions of power where we dreamed we could make a difference.
We need more doctors of color to go into academia because they can serve as mentors, promote research agendas that benefit minority communities, and help make sure medical schools actually live up to the mission of diversity and inclusion.
So medical schools need to do more to make talented minority doctors feel at home in academia.
We need to get comfortable with being uncomfortable
Some readers thanked me for writing the essay on racism in medical education.
“As a white man, it pained me to read it. But I also very much admired your courage and wisdom,” wrote one reader.
“We need to raise awareness as you have bravely done,” one black physician wrote.
Perhaps it was courageous, but it was also a calculated risk: I’m leaving the University of Virginia to start my residency in mental health in the Boston area. I will probably never return. The closing of this chapter gave me a cathartic clearing to reflect on my experiences.
But these clearings are few and far between. I realize that we can’t afford to put convenience over conviction and wait silently for the right time to speak up. Minority physicians can see injustices that others cannot — and what we allow, will continue.
As minority physicians, we all need to create more space to fearlessly uphold the Hippocratic oath we freely took, including the obligation to “teach the secrets of medicine to the next generation.” While we each have a lot to lose by speaking out, we also have much to gain; our voices must be central in the movement to build communities of inclusion.
Together we can demand more for ourselves and more for our patients.
I’ll close with one more memory from my childhood.
As the only black student in my preschool class, I was frequently singled out and punished for things I did not do. I was ridiculously well-behaved, so my punishment made no sense to me — or to my white best friend. Before we even knew what racism was, we realized that my skin color somehow made me different.
To combat this injustice, my friend would lie in the sun during recess and I would lie in the shade. We hoped that we would turn the same color, so other people would treat us the same.
Twenty years later, with my MD in hand, I’m still yearning for that equality.
I have a skin issue to but it’s not because I’m black. I have NF1 and the Children I Nurse their parents reported me in the past “Because a Nurse with lumpy skin touched my child on the head and now it’s come out in a rash. (Called the Clinic 3 days later to complain) or they just plainly ask what’s the lumps about and are not happy that I care for their child. I have struggled to get where I am and the pleasure gets stripped right from underneath you. So I feel the Dr’s pain. I always say to my Patients you’re in the best hands, I’ve worked with them for a very long time. I’ve also nursed for 34+ years and patients are getting more demanding, nasty, bad mannered and impatient.
To be honest, throughout medical school, rotations, and residency, I never felt any bit of racism. Not in the least. Not even in fellowship. Not by attendings, nor patients. I did experience sexism by a female patient who refused to allow me into the room as a medical student, but that was as far as it went. But now in practice for 7 years, I have seen institutional racism which is probably the most egregious, and it is by the Arizona Medical Board, comprised of all caucasians in a fairly diversified metropolitan city. The worst kind of racism in this country is at the institutional level, not the street level (protest level).
as a very gentle and caring female asian physician, I encountered a lot of biases. This is not about minority matter, this is about people’s overal attitude. we should agaist all type of biases, it should not only be “black life matter”, it should also be “Asian life matter and all life matter”. While finghting again discrimination and biases, we should be aware that using one type of discrimination to against another type of discrimination is wrong. We should all follow one equal standard and against all types of discrimination and biases not only in medicine, everywhere.
Great column, Dr. Okwerekwu
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