A 5-year-old African-American boy presents to the emergency department with left leg pain. His leg is exquisitely tender to palpation… If I read this vignette in the first year of medical school, I would have navigated to the multiple-choice answers to select anything related to sickle cell disease. The question writers are stating that the patient is Black, young and has a painful limb — this is not a difficult diagnosis.
Medicine is a discipline that claims to be based on empirical and scientific truth about human nature. Instead, its knowledge and practice are often steeped in biases like racism. For example, medicine was used in the nineteenth century to justify slavery due to the “biologically inherent superiority” of White races.
As a White male, there are certain things that I will never understand. I was raised in an upper-middle-class family in a safe neighborhood — one with adequate resources, education and funding. I have never had to live in fear in my community, worry about my safety on my street, or been threatened or condemned because of how I look. My reality is inexplicably shaped by the privilege and opportunities that I have been given. I realize that to me, racism appears nonexistent because I have not seen it.
I knew I moved through these spaces easily for many reasons, but being White is a big one that needs to be said out loud. And when you look and feel more comfortable in a space, it is easier to perform “well,” or to sound confident. This is directly related to what academic medicine characterizes as “objective” evaluations of students, and there is data to support this.
The histories of Fox Point and Brooklyn reveal how where we call home is deeply intertwined with identity, power and privilege. They tell the story of structural racism — a patterned, “normative, sometimes legalized” process by which communities of color are marginalized. The sequelae of structural racism have dire health implications at the neighborhood-level.
“Wow, your accent is so impeccable! How long have you been learning English?” “You must have so many doctors in your family, I’m sure it is easy for you.” “Do you really want to become a doctor? Or is it just because your parents are forcing you to do so?”
In 2006, India Arie released a self-empowering song called “I am not my hair.” For women of color, this song became an anthem that empowered and permitted a level of self-identity that challenged societal norms.
To be clear, for black medical students, supporting Black Lives Matter and other health equality and social justice initiatives is not a matter of a professional oath. It is a matter of life or death, close or distant — that of a loved one or of a stranger of the same hue and shared struggles.
When I first read that the Northam picture came from a medical school yearbook, I thought about whoever might have been his Black classmates at the time.
On Thursday, many of you will gather round a dinner table with your loved ones and give gratitude for your friends, family and good fortune. Many of you will think of the meal associated with the inception of this holiday, be filled with warm fuzzy feelings and gloss over the real history surrounding the relationship between those who supposedly attended the first “Thanksgiving” dinner. After eating a second helping of Grandma’s famous pie, few will be concerned about the side of historical oppression or racist colonization offered with this dinner because well, that isn’t so palatable.
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!
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.