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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.

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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.

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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 in the lives of the medical students following in our footsteps.

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.

  • Of course there is still racism in medicine, as there has been since before the time of Hippocrates. Racism is a cycle of evil as old as humanity. As a white man on med school rotations in Detroit some years ago, I was the target of many racial insults directed at me by black patients. Never once had an attending nor senior resident do anything but ignore such insults. But IMHO- They did the right thing. The stress of serious illness can cause people to say inappropriate and hurtful things they may not truly mean. Starting a confrontation at that point would do nothing to cure the patient’s disease or ease their suffering- which is what medicine is truly about. A confrontation at that point would also be most unlikely to change any underlying biases. It would not help the cause.

    Fast forward 25 years to my academic practice in different urban area. The med school, with 12-15% minority faculty, has long been making great efforts to recruit the best and brightest minority residents onto the faculty. Including a program of matching mentors with minority residents of similar interests to help develop research and teaching projects to (hopefully) launch young academic careers. Unfortunately, over past 15+ years very few accepted. Most all joined private practices at significantly higher pay and (typically) shorter work hours. I cannot blame them. Minority or not, the sad fact is that it takes a very special person these days to make the sacrifices necessary to pursue a career in academic medicine.

  • Don’t wait for someone to defend you – say, “I am Ms. (Miss, Mr., Mrs., Dr.) Smith and I am a medical student or a nurse or a physician etc., and I am here to care for you.” Don’t excuse rude , humiliating or “racist” behaviors, but it is also not necessary to give them undue attention. Referring to the “colored girl” does identify one as opposed to the brown-haired boy or the blonde man. Give them your name and use theirs! Always treat others with the respect they deserve. Address your patients with the same respectful titles that you expect – and remember – you are not going to change how they behave by becoming defensive.

  • Some of the comments below reflect the thoughts of some people with different worldviews. They would rather you not speak about such things. They would rather make false analogies without actually addressing the issue at hand.

    Just like you, I was called “colored girl,” “negro girl,” and had many inferences to affirmative action during my training (and even now) by patients and physicians. As an intern/resident, you are already beaten down by the system– like everyone else. Then the venom and pain of racism/acts of prejudice just adds to the physical and mental toll– it can break you. Additionally, your error(s) are magnified or unforgiven, possibly because they can’t imagine you as they once were– a med student or intern– or like their son or daughter. Personally, I think this lack of empathy is the biggest driver of the lack of support (as with many issues in medicine).

    But the one great thing is that there is a forum to air this “dirt laundry” that makes some people feel very uncomfortable. As we know, discomfort solicits attention and perhaps the attention will elicit change.

  • I went to medical school getting close to 50 years ago. Women doctors were assumed to have defective “gender identities” and be specious in their commitment to the profession. (“You’re really here to find a husband and have babies.”) We were a small, defensive percentage of our class. We all handled dismissiveness of mentors and crude-talk of male classmates differently. We were isolated from the guys and from each other. One of us blew her brains out junior year. She put the gun to her mouth in her dormitory room. The “teach by humiliation” methodology was in favor, perhaps due to a belief that shame produced more competent, if not dysthymic doctors. There is a lot of misery in medical school for a lot of reasons.

    What you are doing to respond to “explicit racism” takes courage and serves to humanize that community for everyone. What could be more important than raising consciousness? Scapegoating is at the expense of everyone’s spirituality. And while medical schools entertain lofty goals, spirituality is not one of them. Without that sensibility, there is little incentive to restrain the competitiveness and egos addicted to affirmation. The latter two do not bring out the best in students and can be crushing when endorsed by Medical School authorities.
    Keep on with your courageous acts and hopefully you will know you are equal because you will feel it. You will also be helping whatever community you are in. How can we imagine we could be present for patients (admittedly a spiritual goal) if we can’t treat our peers with respect and kindness?
    Sadly many can’t because their purpose on earth and in medicine is defined by the DSM V and the ICD9. You’re the next generation. Forget about equal. Be better.

  • It’s true that racism exists in medicine; we are dealing with people of all stripes. However, I find it disingenuous that there is no mention of racism perpetuated by POC. I am a young, white physician and I can tell you that without a doubt the most blatant and subtle episodes of racism are perpetuated by POC. Granted I, like most medical professionals that work in an academic setting, serve communities predominately of color. But to completely ignore this fact is wrong and divisive.

    Issues of race have to be approached in an honest and realistic manner.

    • Huh? Are you going to get into that argument? The author is talking about discrimination that is solely based on color. Differences between your and her definition of minority is not the topic discussed here.

  • You are an injustice superhero, doing what others are unwilling to do for the greater good. This instance hopefully helped others in the restaurant reflect on racism rather than ignore it because they will think, talk or even if they forget about the incident for a while, when confronted with the question does racism exist, they will recall it does and is something we need to be proactive to fight. Thank you for being proactive.

  • Not being a Black man I cannot say I have seen it other than very subtly, but there is no doubt that racism is present exactly as depicted here. Racism from persons in health care apart from patients should be addressed with the vigor that sexual harassment is addressed.
    Patients are a different matter. Sick people are quite nasty often times, revealing the ugliest sides of themselves. Not only have very sick patients said stupid, outrageous, & obnoxious things about me (one threatened to kill me if I continued to drain his abscess, & three days later came back to call me God’s gift), they have done the same with respect to my physician & nurse colleagues in front of us both. This applies to emergency room & hospital settings; in outpatient areas, almost all can be expected to act politely & reasonably.

  • Sadly, as long as people are classified by a particular box on a screen or form (i.e. black, white, latino), racism will continue.

    Regarding the senior physician who was mute when you were blatantly disrespected and insulted, sometimes people just don’t know how to respond or what to say so they “turtle” (and ignore the issue at hand). In our sue-happy era, if he had corrected the “redneck” (for lack of a better term of non-endearment) and advised him that you were one of the people responsible for making sure he made it out of the hospital alive and well, could the racist offender sue him?

    At any rate, his lack of support seems to go hand in hand with what’s deemed acceptable – saying nothing generally means you neither deny nor support what the offender said.

    All in all, it’s sad and unacceptable.

  • You must have slept through your class in Sociology since you obviously don’t know the difference between “race” and “culture”. My Israeli cousins are darker skinned than some of my Afro-American friends but there is a world of difference between attitudes and outlook amongst the two groups. A plantation mentality with rancor, recrimination and resentment does nobody any good.

    • Your are obviously part of the problem. I suppose you definitely slept through your sociology class, otherwise you would have realized that the so called plantation mentality is a reaction to ongoing repression and racism by plantation owners and their offsprings who lack understanding of genetics to understand that the genetic make up between the different colors are only skin dip.

    • She quotes a nurse who said “It only takes a few to spark a culture change” She meant the culture of not standing up to your colleague, who is being denigrated for race reasons. So there was no confusing race with culture. Your next statement referring to plantation mentality shows that you are exactly the type of person she is talking about that and you have an MD after your name! It surprises me you would say that .

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