In recent history, Sarah Baartman, a native South African woman, became a spectacle throughout Europe. Her body was dismembered, dissected and displayed at both private and public events. From about 1815 to 2002, the world examined exhibits of her closely and embraced the idea that she was defective, specifically focusing on her skin color, sexual body parts and femininity; the world accepted the Europeans’ representation of her as less than human, as a racial fetish and as a curious and extraordinary black body. In other words, her uniqueness was a disgrace and it was therefore acceptable to public mockery. Her story reminds us of how pervasive overt racism was in the past. Although this particular form of racism is less explicit today, it is still seen. In many ways, African-American and other students of color are on display while on the wards in medical school.
My recent psychiatry clerkship inspired me to examine racial relations during third-year rotations. This reflection originated from a physician submitting a particularly disturbing evaluation of me. She wrote: “[The student does not] recognize and address personal limitations or behaviors that might affect their effectiveness as a physician … [The student is] defensive, rigid, intense and intrusive; unable to see nuances in human behavior that is necessary for analyses of the human psyche; lower emotional quotient than peers.” Her response left me with an open-jawed, stuporous gaze. I could not believe that she had made this kind of assessment after interacting with me in only two patient encounters for less than half a day! Her overall evaluation of my clinical performance was positive and constructive; however, she still somehow managed to give me a barely passing grade. I began thinking through every interaction that I had with her while in clinic. Then I started to frantically review my other clerkship evaluations to see if other physicians had felt the same way. To my dismay, I found that she was the only one. I say this with disappointment because thoughts of racial profiling seeped into my mind. Had I just experienced my first case of racial discrimination on the wards?
When I presented my case to the clerkship director, he suggested that I speak directly with the physician who evaluated me. This seemed a ridiculous suggestion to me — why would I directly approach someone who viewed me as intense and defensive? I could only imagine a negative encounter with her. Furthermore, the physician happened to be a Caucasian female from Alabama, and as an African-American student from Mississippi, I did not feel comfortable approaching her with this complaint. Hence, I was reaching out to the clerkship director, who seemed all too eager to dismiss me. He even went on to say that he too felt that I was intense. I became very confused at this point and felt that I was being stereotyped as an African-American woman. Why were they viewing me as such and why were they unable to provide specific examples or a basis for these feelings? The meeting concluded with the director saying that he would “look into it.” From past experiences, I knew this meant that my case would be given very little attention.
However, and most importantly, my psychiatry clerkship experience brings up an even bigger issue — why was I graded more critically than my Caucasian colleagues on behavior alone? Perhaps, it is because I was the only African-American student on the rotation, and therefore, more visible and subject to scrutiny. For many years, Sarah Baartman was on display in museums and the like throughout nineteenth-century Europe as an exotic species. African-American medical students are also on exhibit while on the wards, being viewed as a rarity, and therefore, are closely examined by the attending physicians, who undoubtedly allow their preconceptions and lack of cultural competency training to affect their clinical assessment of minority students. More disturbing even than the lack of fairness and validity of these subjective evaluations, is the disregard toward students who seek help in these difficult situations.
My answer to these issues is that all minority students who experience racial prejudice or discrimination in medical school should not hide, but rather make a good faith effort to have their voices heard. There are ombudsman and safety net faculty who are available to help students address these problems; however, they are in the background and their identity is rarely publicly announced and promoted. One must actively seek them out. Additionally, cultural competency training should be a requirement for faculty and residents because it creates awareness of and sensitivity toward those who are from different backgrounds and who are not of Caucasian descent. Without such training, physicians and residents may disregard history, devalue uniqueness and further propagate white superiority. The result is a hostile environment for students and, as a reasonable corollary, a lack of sympathy for patients. Lastly, medical schools should encourage students to speak out or write about these issues, especially in a society with a dark and deep-seated history of slavery, racial segregation and discrimination. As physicians, we are trained to advocate for our patients’ health care. We should not forget to also advocate for ourselves. Addressing racial relations in medicine is a necessity and, if ignored, will only perpetuate feelings of inferiority in minority physicians and inequality in the practice of medicine.