Race and Medicine

Race and Medicine

Issue: February 2021
Source: Healio interview
Disclosures: Williams reports no relevant financial disclosures.
February 25, 2021
7 min read

‘The whole world is behind us:’ Working toward psychological safety for black physicians

Issue: February 2021
Source: Healio interview
Disclosures: Williams reports no relevant financial disclosures.
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Anti-racism has become a global movement. In what feels like a sea change, we have engaged in difficult conversations around racism and discrimination within our division. On the institutional level, we are having some difficult conversations about how we promote equity.

I have now participated in two peaceful protests; the experience was empowering and meaningful in so many ways. I was not marching alone, I had the world with me and allies representing different races and ethnicities saying #blacklivesmatter. My favorite sign read “Why is ending racism a debate?”

Renee L. Williams, MD, MHPE, FACG
Renee L. Williams

People who have had the privilege to be unaware of racism and its everyday impact are now awakening to this experience that is shared by Black people. This is a part of our “normal.” It is becoming more clear to our colleagues in medicine that this even applies to those of us in the ‘Ivory Tower’ of academia and medicine. There is hashtag on Twitter that everyone should read, #BlackInTheIvory, where Black academicians are sharing their stories.

Sharing Our Stories

There is something different going on now in addition to the awareness; it just feels different. Black physicians are starting to share our stories and our colleagues are truly listening in an attempt to understand.

When we hear of these acts of police brutalities, our professional circles have not always connected us as Black physicians to those events, there is a disconnect that I have never understood. There is a feeling that these things only happen to certain people or in certain neighborhoods. We work side by side, but the concept that we may be a victim of police brutality is a foreign one.

One of my best friends who is also a physician got stopped by the police in Vermont on her way to a wedding for an unknown reason and ended up handcuffed with her family lying face down with multiple guns pointed at her. Her 17-year-old cousin is now scarred for life from the experience and even when she tells this story, some still believe they must have done something to warrant that treatment.

What is happening now is that people are starting to connect the reality of daily structural racism with their colleagues who are Black.

As physicians, we are starting to share our stories and show our pain. No one likes to put their pain on display. It is extremely difficult to openly discuss something so personal, but it allows the people who you work with and know you to see that this affects you in a deep and personal way.

It makes an impact when they realize their Black colleagues need to have certain conversations with their children around racism and police violence. The police are supposed to protect and serve, yet Black parents must have conversations in which we give our children strategies to use when interacting with a police officer. That is heartbreaking.

But before now, there was a culture of silence. We carry certain things within ourselves and we understand how our landscape works. Now, it seems the world is open to listening to what exactly has been going on for a very long time.

Structural racism has been integrated into the fabric of our lives. We cannot change an entire structure. But we can change a small part of that structure in our own way. Those small things can collectively make a difference. It will take a long time and not everyone is comfortable speaking. It’s extremely difficult to open yourself in that manner.

In the professional space, you are seen as a very strong person – you are calm, cool and collected. Nothing gets to you. Nothing flusters you. You maintain the persona of capability because you can’t ever be incapable. The sentiment among Black physicians is you can never make a mistake or slip up because you won’t get a second chance.

Whatever backlash that may come to you is going to be harder because you are Black.

Learned Fears, Behaviors

This sentiment is learned early in our lives and our academic careers and it translates into learned behaviors and a lack of psychological safety.

I’m Jamaican and came to the United States as a teenager. Growing up in Jamaica, I never had any doubts about my ability to succeed. There was no limit. I was surrounded by positive and negative role models who looked like me. Though I may not have realized it then, I had a net of psychological safety.

The first thing I noticed in the United States is there are so few positive Black role models. You rarely see positive images of yourself as a Black child. How do you counteract that?

In undergrad, I majored in computer science in addition to the pre-med curricula. I was told by a professor, “What you’re trying to do is impossible.”

For me, that went in one ear and out the other, because I inherently knew that it was not impossible. As a Black child, with the exception of your family members, who are you looking at in society that represents you? You often have music, artists and sports figures and certain actors but few doctors, lawyers or other people of color in positions of power.

Think about what that does to your psyche as you’re growing up.

That lack of representation, lack of seeing your own reflection in your peers once you begin to rise in the ranks of a profession feeds into your imposter syndrome where you feel like you don’t belong somewhere. We as a society need to get to a space where we can all feel that we belong here, deserve to be here and are qualified to be here rather than harboring doubt that you are in a position for the wrong reasons.

A Black student in medical school or a Black resident so rarely feels completely psychologically safe in their school or their workplace, whether they truly recognize that or not, because they are always in the minority.

And once you are in those situations where imposter syndrome will rear its head, you may rely on behaviors ingrained by society of what you ‘should’ be. If you’re a Black male, for example, you try not to be aggressive. You are taught to blend in during college and medical school. You aren’t loud. You don’t get too close to anyone. You keep quiet, stay in the background and blend in.

But think about that: these particular behaviors may impact your evaluation. This goes for most students from underrepresented groups who have these learned habits of protection; they can then potentially negatively affect how you’re graded, recognized or promoted.

From a structural standpoint, when you are being evaluated, you will automatically connect with someone from the same background.

If you are someone on a team of two or three students and two are in similar backgrounds as their instructor and you are the third person, the Black student, unconscious implicit bias comes into play. You are already on an unlevel playing field. That social connection is not there because you cannot connect the same way your colleagues can.

You can talk about enhancing learning, etc., but because of this extra layer of our existence, there is an uphill battle.

This current social unrest is bringing up a lot of difficult things for Black physicians to deal with. We are happy to see the world fighting alongside us, but it is difficult because it forces us to recognize feelings we’ve had for a long time that we didn’t realize are there. Each of us can see and read through the stories and recognize our own struggles.

Psychological safety is something everyone should feel but if you think about your Black students and trainees, are they psychologically safe? How does that inform how they perform?

Though someone can say “I’m not racist,” you may unknowingly or subconsciously participate in this structure that’s been in place for a long time.

It’s in medical care the same way. Black patients are less likely to be referred for care like chemotherapy or surgery. Why are physicians not referring Black patients for certain care? That’s where unconscious bias comes into play on the side of the physician. There are certain assumptions made based on what a person looks like. That now feeds into clinical care and then into the patient’s outcome.

I don’t think we – myself especially – realize the weight we carry with us in our professional space. To truly feel that safety, that team said, is to release a breath you never realized you were holding.

Education, Open Minds

What is different today is I am being asked by my colleagues, “How can we teach ourselves?” And that is different than it was before.

Our white colleagues can’t look to us to educate them. But you can read the available literature with an open mind and accept that you may be uncomfortable. But that discomfort is something I have lived with my entire existence.

We are often met with defensiveness because you have inherent feelings that you may not realize are there. Acknowledge those feelings and realize when your defensiveness may be misplaced. This is a system we are talking about. On some level, everyone contributes to that system and not just in medicine.

Take the steps to break down your own feelings and implicit biases you may not realize you have by educating yourself and putting aside your natural instinct to be defensive of those biases.

Acknowledge History, Change the Future

The father of modern gynecologic surgery made his name by experimenting on Black women without anesthesia. Think about the pain. Think about what this man did. He took Black women and experimented on them for gynecology without anesthesia. Prior to 2018 he had a statue in his name, which has since been removed.

We don’t learn that in history of medicine and the inequities that occurred. We know about some of the experiments, but not all of it. We have to look at the positive and negative in our history and talk openly about it.

I recently saw ‘This is what 100 years of protests for racial justice looks like in America.” We have been protesting police brutality for the last 100 years, if not longer. It was as if you were watching the same thing at different points in time.

The clothes change, the people change. The signs don’t change. They are saying the same thing. The images don’t change. We have not changed anything when it comes to this particular issue.

What is different now is that we have the entire world behind us. I hope that translates into something meaningful.

You can’t change the entirety of structural racism, but what can you do in your division, your institution, your town? What can you feasibly do to make a change in your landscape? Go from there.