“Too sad to cry, too hurt to feel, too paralyzed to move and too embarrassed to come out of the room, I sat and pondered over what happened. Racism had just completely and tectonically shifted the power away from me. Racism stripped me of my white coat, my stethoscope, my doctor’s badge, my degrees and credentials, my titles, my skills and my determination to serve.”
These are the words of a primary care physician, Dr. Jacqueline Olayiwola, MD, who wrote about her encounter with a racist patient in her clinic at UCSF. Dr. Olayiwola was recently joined by Dr. Rachel Hardeman, PhD at University of Minnesota, and Dr. Anna Reisman, MD at Yale University, for an event put on by Systemic Disease titled “Social Justice and Clinicians of the 21st Century.” A health justice advocacy organization, Systemic Disease partnered with The Robert Wood Johnson Foundation Leadership Network and in-Training to create a webinar for health care professionals to learn more about the pervasiveness and adverse impact of racial bias that exists both within and outside of the clinic.
Though overt and explicit cases of racism do occur such as that faced by Dr. Olayiwola, we may not recognize the more prevalent and unconscious biases we hold in our day-to-day lives. These automatic preferences for one social group over another have bearing on what we do and how we interact. Within the health profession, there is no way to filter out this bias with patients or even providers-in-training, and when such bias goes unchecked, it can manifest itself in hurtful and offensive ways regardless of intention. In promoting health justice, our team at Systemic Disease believes it is vital to recognize the connection between bias and adverse health outcomes. We utilized a discussion model provided by in-Training’s Beyond Illness Roundtable toolkit to guide a discussion on such interactions that exist across all interprofessional relationships and those that may cloud, strain and negatively impact individuals from teaching, learning and, above all, healing.
Each of our panelists brought a unique perspective to our webinar. Dr. Olayiwola spoke in depth about her experiences as a minority health care provider and how strongly held values and belief systems drive the propagation of prejudice. As an academic, Dr. Hardeman spoke on health care disparities and structural racism, specifically how the white racial frame oppresses patients and providers of color. She indicated that moving the conversation forward requires hospitals and academic institutions do a better job of educating all of their constituents on the very damaging effects of racial bias. As director of the Humanities in Medicine program at Yale, Dr. Reisman called to mind the greater import of forging a connection between medicine and the humanities for young health care providers-in-training — the implications of which have potential to develop a more humanistic practice of medicine across all of its branches.
The in-Training’s Beyond Illness toolkit posed a few questions key to advancing this dialogue, namely how health care professionals should be involved in fighting for equity and health justice in our country. As leaders in the health care community, providers should seek to create a space in their practice for shared dialogue on bias or to empower trainees with a teachable moment that encourages listening and mindfulness in interactions. When conversations happen at both personal and community levels, a greater awareness can be fostered about the harmful effects of overt or subtle bias. Other characteristics, such as the importance of language, cultural humility and inclusivity of care further highlight the values that future clinicians should seek to employ in their patient interviews. The webinar drew several discernible definitions of the “new clinician,” namely in the recognition of bias, active political engagement and the mindful stewardship of health care as a public good by maintaining a growing awareness of the social determinants of health, changes in access and delivery of care. Within the medical community, clinicians must actively seek to revise medical education and training to advance the cause of health justice for all.
When we strike up these conversations among leaders and future leaders in medicine, we can begin dismantling the architecture that allows bias to harm health care. Our hospitals and schools can utilize the Beyond Illness model as a stepping-stone to deeper conversations on the kinds of clinicians we wish to have in our health care system. By envisioning the kind of providers we hope to see, we can work to address the inadequacies that currently plague our medical education and training programs.
Authors Valenza Stearns and Fowaz Hussain are the Co-Chairs of Coalition Building at Systemic Disease.