What racism in medicine takes from us

During my freshman year of college, Cornel West, the renowned philosopher, had been invited to speak at a campus event. My Black friends buzzed with excitement and rushed to secure tickets to his lecture. When a friend offered to get me a ticket, I hesitated and noted that I didn’t know who West was.

“You don’t know who Cornel West is?” she asked, incredulous that I was unaware of him and his contributions to American culture. My friend went on to explain that West was one of the most brilliant intellectuals and political activists of our time. As Black students at Harvard, we were standing on his shoulders. 

I thought I had received a good education. I had attended a prestigious high school in upstate New York. As the oldest independent day school for girls in the United States, my school prided itself on its historical legacy. But when confronted by this huge gap in my knowledge, I realized I had received a white education — one that had robbed me, a Black student, of my own historical legacy. 

As a doctor, my education, both what I know and how I have come to know it, has continued to be shaped by the privileging of white norms and experiences. From the exclusion of Black and brown skin from dermatology textbooks to the lack of illustration of Black fetuses in OB-GYN texts, Western medicine is largely concerned with caring for white bodies, to the detriment of others. My own specialty is also guilty of scientific racism. Psychiatric diagnoses have been historically weaponized against people of color to justify systems of oppression. As a Black psychiatrist, I often feel haunted by the prescriptions I offer my patients to salve the anxiety they feel in the face of police brutality or the uptick in hate crimes against Asian Americans. Yet agitation in the face of oppression is healthy. Racism is the disease.  

Racism also impacts who gets to do the caring. STAT’s recent investigation into orthopedic surgery expertly illustrates the systemic racism that doctors and patients of color encounter on a daily basis. The investigation found that less than 2% of those practicing in the field are Black, just 2.2% are Hispanic, and only 0.4% are Native American. STAT’s Usha Lee McFarling writes of the epic battle for belonging that marginalized communities face in orthopedic surgery, the fragility of a tokenized diversity, and the purposeful indifference of the ivory tower. She shows how diversity and inclusion require an investment in change, while exclusion and homogeneity require an investment in the status quo. 

In McFarling’s reporting, I was most moved by the story of Erica Taylor, the first Black female orthopedic surgeon at Duke Health. “You buckle up and put on your armor,” Taylor, also the chief of surgery at Duke Raleigh Hospital, said of pursuing a career in orthopedics. It is not disease she describes battling, but systemic racism. Despite her monumental accomplishments, I wondered how much of her time, energy, and talent have been wasted going to war everyday. I am both proud of her journey and angered by it. 

The epidemiologist Sherman James described “John Henryism” as the belief that one can overcome systemic injustice by sheer effort alone. This year I’ve seen too many Black physician friends and relatives die young or become afflicted with serious illnesses. I worry about the impact of that phenomenon on medical professionals who have been historically marginalized. We often need to work twice as hard to earn half as much as our non-marginalized counterparts. This chronic over-functioning and extraordinary exertion of effort comes at a great cost to our mental, physical, and spiritual health. I’ve written before about my own experiences with racism in medicine. I know too intimately that Black excellence in the face of systemic injustice can be costly. 

Over the past few years, I’ve tried to become more intentional about decentralizing whiteness in my own life and as a Black female physician. It started with confronting my own internalized racism by wearing my hair in its natural form and embracing the curls I’d learned to be ashamed of at my high school. I read books by Black authors filled with beautiful Black illustrations to my children every night. College will not be the first time they too learn of James Baldwin.

At work I’ve stopped responding to unsolicited invitations to join diversity and inclusion efforts. Not because these efforts are unimportant, but because I’m not sure we’re doing them right. I don’t know how to make sense of the diversity recruitment efforts that have lured me into racially toxic and traumatizing situations. While physicians of color are more likely to serve marginalized communities, medical training is an intense reenactment of the injustices that seeded marginalization in the first place. In the words of the writer Audre Lorde, “the master’s tools will never dismantle the master’s house.” I refuse to accept a cycle of suffering that requires Black and brown doctors endure racism in order to alleviate the health consequences in our communities caused by racism. 

I need time to heal the wounds from my own battles and figure out how I can develop a strengths-based approach to uplifting Black and brown people in medicine that does not center the sins of the white medical establishment. Fighting racism will not be the central story of my personal or professional life. I’m discovering that Black doctors deserve peace.

As Cornel West explains, “justice is what love looks like in public.” Justice will be achieved when diversity in the physician workforce becomes the default and when the field divests itself of racism. Caring for all people should be a core principle of our profession, not a side project.