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.

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.

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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.

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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.

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  • That’s two really thoughtful articles. Thank you for dealing with these topics so well, but please stop writing. I feel compelled to respond, and can’t get anything else done! Good luck with your next job.

  • So most of the comments were to tell the author to stop complaining. Very telling. There are many types of abusive behavior that should be not be tolerated in any workplace and this is one of them. I’m disappointed in the blame the victim for being sensitive attitude.

  • Hi. Thank you for your article. We can use our privilege to support health care staff and patients when discrimination occurs. Our Human Rights & Health Equity Office at Sinai Health System in Toronto developed resource materials you can access on our web site free of charge including videos, privilege checklists and more. Please check out our Are you an ALLY? campaign at http://www.mountsinai.on.ca/about_us/human-rights/ally

  • Racism in medicine – that’s obvious. But what is the mechanism that continues to perpetuate it? I recently heard of a student from Rowan SOM being dismissed for not being able to manage time because it was spent caring for a disabled parent. The student also told me that the committee that decided his fate was “white-washed” – with only one person of color. As to the cultural and ethnic backgrounds of the cast members of the committee, “who knows?”

    Setting aside racism, without ignoring its effects, it’s clear that the 12th ranked school for ELDER care is behaving very undeserving of the title.

  • Funny about the restaurant line. I was in a similar line behind a lovely young lady in, admittedly, attractive tight jeans. Two workmen behind me and my child began making noises sort of like pigcalling (“Sooooeeeeee!!! Look at that @$$” etc.) about the young lady. I gave them my best offended mother glare and said “I BEG YOUR PARDON!” These two clueless miscreants ASSURED me they were talking about the lady in front of me, not about me. Not sure I did anyone except my child any good- I did not (wisely) get any feedback from the victim of their catcalls.

  • FYI For people of older generations the term “colored” was a polite way of referring to a person of your ancestry. E.g, NAACP.

    • I was gonna say. Maybe the person was just trying to be polite if in a somewhat awkward way. Are we too quick to think the worst of people?

  • When senior physicians set the tone for what is and is not tolerated, it makes a powerful impact. The same is true in any setting, the more insistent the powerful are about basic respect the more it is practiced by staff and clients alike. You may still in your heart of hearts hate everyone who isn’t you, but you don’t show it outwardly and it has a huge impact on morale overall. I was always taught if you can’t say anything nice, don’t speak. It works, more people ought to practice that.

  • Discrimination happens every day and on every basis. Including but not limited to your race, nationality, and even occupation. But you’re not going to change people’s minds by trying to change people’s minds. Can I be a little harsh here? Sob stories are counterproductive. Be the best damn physician/doctor around and prove them wrong.

    • Except this isn’t a sob story. Or the sob story. This is about facing racism instead of ignoring it and being “the best damn you can.” This is your lack luster way to face or rather ignore racism because it make you feel uncomfortable. If you even read the article, you would know your “pass it on, and ignore it” comment is EXACTLY what it is talking about. Face problems and actively work against them, don’t push it under the bed because it looks ugly.

  • We do not live in a perfect world. Sometimes we also perceive what is not, a thought painted by our fears or experiences. When I was much younger I was a visitor in a courtroom in north Texas. The elderly bailiff asked me if I had ever picked cotton, trying to make conversation . I said “no had you?” He said in fact he had since he was a child on a farm, the gentleman thinking since I was from an agricultural area I had too . It had nothing to do with the fact I was Hispanic. I will never forget this and how my own prejudices affected my perception. We live in a better world but perfection is only in heaven. Some people will always doubt those that are different from them. Do not let your own feelings embitter your life and taint your thoughts especially in the field of mental health where you are going as a career because others you will treat will depend on you having pure ideals and an unbiased mind.

  • I have to share something here. I am white and I did rotations in Atlanta. I can tell you that as a white female, I experienced racism from African Americans who were very outspoken about me being a “white girl”. I also had patients who refused to talk to me or who asked to talk to the African American students in the office. I did not want to cause a disturbance, so I of course respected the patient and maintained my friendliness.
    I grew up in the West and I have never been racist, nor do I support racism. I do have to say that racism is not limited to whites (or other races) being racist against African Americans, I think that there are many people who are also racist against White people.
    This should not occur in medicine, but it does. We need to respect and care for people of all races, and all cultures. We are humans and share this planet together

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