“So, you know that you’re basically a unicorn, right?”
That was the question posed to me by a postdoc in our research lab as he, another minority, considered the rarity of meeting an African-American woman physician, particularly one with subspecialty training and an academic medicine appointment. I wanted to deny that I was some rare, mythical creature, but the data speaks to a reality where African-Americans comprise only 4.1% of all US physicians. An even harsher truth is that I never escape the implicit and explicit biases that my skin color elicits when people meet me. As an “underrepresented minority” in medicine, my personal experiences of mistreatment while navigating the challenges of pursuing this career are mostly invisible to the rest of society; but, I know that they are far from mythical or unique. In fact, my experiences harmonize perfectly with the tales of so many African-American physicians before me and even in the accounts of the students I currently mentor. Everyone asks, “Aren’t things different now for African-Americans?” Yes. But, are they better? Sadly, not exactly.
Becoming an African-American physician predicates an awareness that you are inextricably defined by both labels. You are serving in a noble profession where physicians are held to a higher standard in society and take an oath to “First, do no harm.” You are also implicitly agreeing to dutifully wear a complex patchwork of endless tribulations with just enough triumphs to maintain your sanity as you persist in disrupting the stigmas, prejudices, biases and stereotypes of medicine’s assumed meritocracy.
To persevere despite the potentially cataclysmic dissonance of this duality requires an infinite amount of hope — hope that is inherently immortal and perhaps woven into the DNA passed down to us by our ancestors. As physicians, we do not live above or outside of the issues affecting us as African-Americans. We recognize the hope that sustained activists during the Civil Rights Movement as they sang “We Shall Overcome Some Day.” We feel the hope that thrives in today’s #BlackLivesMatter movement as some chant “We Gon’ Be Alright” at rallies. Simultaneously, we know that to hope is not to ignore decades of systematic oppression that have created alarming health disparities and inequities. The people who are marginalized in this society do experience repeated emotional, mental and physical trauma that is typically untreated and often exacerbated by situations beyond their control. Without physical, mental and emotional wellness, there can be insurmountable difficulties in pursuing life, liberty and happiness. This is glaringly true for many African-Americans, Native Americans, Asian-Americans, Latinos and other minority people living in the United States. So, we cling to hope despite the circumstances. Hope steadfastly remains to counteract the lassitude of those in society with privilege and power. Hope battles against the detrimental effects of apathetic complicity. Hope begs us to understand how generational cycles of poverty, violence and poor health create the space for seemingly inexplicable self-loathing and depraved indifference.
For physicians and scientists, hope may not supersede reliable and reproducible data. Fortunately, even the data informs us that diversity — from a molecular to a mass population level — is an absolute requirement for species survival. With such a preponderance of evidence, it is not an option to accept the status quo of our medical training, and this is where the struggle intensifies. Once we initiate challenge and change, we must not wither under the consequential negative reactions and relentless attacks. Racism, prejudice, implicit biases and even self-hatred permeate every aspect of our daily lives and addressing racism invariably creates tension, discomfort and denial.
To reverse the impact of racism, disparities and inequities in healthcare is to comprehend the intersection of seemingly unrelated social issues, such as the harm done by those who demand an #AllLivesMatter campaign in a misguided attempt to “not see color” and invalidate the rationale for #BlackLivesMatter. It also means recognizing how the efforts of those who decry “black on black crime” deflect from appropriate concerns about over-policing policies and instances of police brutality. The negative focus on such issues permits the cycles of poverty and violence in socioeconomically disadvantaged communities to persist, and these environments adversely contribute to the social determinants of health. To address health inequities is to also understand that some of these dangerous and unhealthy communities are products of systematic discriminatory housing policies. “Underrepresented minorities” in this country are “sick and tired of being sick and tired,” and we cannot falter in compassionately caring and advocating for them. To otherwise continue with the status quo belies the urgency of the situation.
To “First, do no harm” requires more than prescribing the right pill or performing the correct procedure. “Do[ing] no harm” implores physicians to address the socioeconomic determinants of health that adversely impact our patients. It necessitates a commitment to retooling the patriarchal and rigid models of medicine. Today’s medical education and training need to lay the foundation for physicians to leap into additional career avenues such as advocacy, policy, politics, justice and economics. Physicians can no longer be the bleary-eyed, burned-out and disillusioned healthcare providers struggling to save the lives of those that have been unethically experimented upon, poisoned, abandoned in toxic environments, removed from society, denied access to health care and left to prematurely die in communities like Tuskegee, Alabama; Flint, Michigan; Altgeld Gardens in Chicago, Illinois; Ferguson, Missouri; New Orleans, Louisiana; Rochester, New York and countless others.
Yes, something different and better is necessary now. Yes, I know that I am not a unicorn. None of us are mythical or magical beings. African-Americans are not even the stereotyped monolith many people perceive them to be. However, we are part of a vibrant and dynamic community. As members, we do not have the luxury to act as individuals disconnected from each other. We cannot expect anyone else to tell our stories, save our families or cure our sufferings if we are not actively participating in the process. Still, it can physically exhaust us. It can wreak havoc on our mental fortitude. It can adversely impact our health — hypertension, stroke, depression, suicide and so forth — because we learn that we are not expected to feel pain, allowed to display weakness or be free to express anger. Regardless, we must remember that we are phenomenal people gifted with intelligence, resilience, passion and the searing experiences of living as African-Americans in the United States. By girding ourselves with the memories and lessons of those who fought to “overcome” before us, we can get information and seek out every possible solution to achieve justice and equity so that we successfully eliminate health disparities.
In calling for action, one essay cannot answer every question on where to begin or how to do it — just like one minority group cannot do it alone. However, everyone can examine their biases and work to minimize them. We can stop making “diversity” a dreaded word and create meaningful dialogue around it. Medical schools and healthcare systems can implement strategic diversity plans that target professionalism, practice-based learning, patient care and system-based policies. This is a challenging and comprehensive process where some mistakes will inevitably be made, but I refuse to believe that they are insurmountable.
Eventually, equity and inclusion must evolve from priority to normalcy, and the real Hope is that more of us will recognize our personal obligation to actively engage until there are solutions. The deeper calling and purpose of becoming a physician, greater than our individual physical and mental capabilities, demands that level of commitment. Our individual Hope must therefore remain inherently immortal and absolutely immutable. Our collective compassion will also be critical to conquering the anger, hate and indifference that permeate throughout our day to day experiences. I challenge you to embrace the familiar imperative of our professional directive that we “First, do no harm.” Then, take steps to revolutionize and radicalize this philosophy into methods that dismantle the centuries of pernicious acts inflicted upon the marginalized, disadvantaged and oppressed people in this country and around the world.
Editor’s note: In honor of Black History Month, this article serves as an introduction to this month’s special edition in-Training newsletter featuring works we have published over the past few years regarding the topics of race, medicine, communities and education.