The headline of the article sent by a colleague hits my heart. I can’t read further. I’m tired of reading these sorts of titles. I’m exhausted by reading headlines about interactions between African-Americans and the police. I don’t read such stories anymore and I desperately try to avoid them.
I constantly have to deal with racism and homophobia. In Boston. In America. When I leave work and go home, I have to prepare to deal with the same prejudices the following day. Why would I ever go out of my way to read such stories in my spare time, as I recover from the day behind me?
But this newsprint my colleague sent me stops me cold. It makes me pause. Perhaps because it hits home in a deeper way. It drives that knife of, sometimes constant, racial pain a little further than the others.
“Black Miami doctor handcuffed while helping homeless during pandemic.”
The story goes on to talk about Dr. Armen Henderson, a doctor in internal medicine at The University of Miami Health System, being arrested. He is arrested while standing in front of his own home. Arrested while loading tents for undomiciled individuals during the coronavirus outbreak. Imagine the humiliation. Imagine the minority stress and subsequent fears this causes Dr. Henderson and his family.
Those words pull at my heartstrings that much more because I’m a physician, too. An African-American, gay, psychiatry resident who wears a pager on my belt even when I’m not working. It’s a clunky, retro addition to my outfit that I hope will be enough to stop any untoward and uncalled for interactions with police when I go for walks. I sometimes wear my badge outside of the hospital as well, hoping it’s a shield.
Because this story sadly isn’t a new one for minority physicians.
There was Dr. Tamika Cross in 2016, who was asked for her credentials on a Delta flight and was told by the flight attendant, “We are looking for actual physicians or nurses or some type of medical personnel. We don’t have time for you.” In 2019, Dr. Fatima Cody Stanford was questioned several times about her credentials on a flight, even after producing them. This was all while she was actively trying to help a person in distress on said flight. Then there are the reports of community and professional isolation due to minority status.
The internet is littered with such stories where the take-home point is: if you’re African-American, you can’t be seen as a doctor in America.
And these stories rarely highlight, if at all, the discrimination African-American physicians face in the hospital.
Yale researchers found that multiracial students experienced higher rates of discrimination in a 2017 American Association of Medical Colleges survey of graduating medical students. Discrimination was defined as at least one episode of mistreatment, including offensive remarks or names based on race. Women who were also underrepresented minorities experienced the most discrimination when compared across all groups. Stories about physicians who are called janitors despite wearing a white coat are regularly passed down to minority medical students as warnings for what the future holds. Tales where African-American physicians are mistaken for their African-American colleagues are all too common. There are far too many heartbreaking stories of discrimination in a place where we are supposed to confer healing.
And work is followed by the worry that your credentials will be questioned on your way home. There exists that constant underlying question: if I encounter a policeperson, will I make it home? When an African-American physician leaves the hospital, they are immediately thrust into another world that is racially charged. Physicians who are African-American often don’t even have the luxury of relaxing even when they are in their home neighborhoods or on a plane flight.
Because leaving work is never truly leaving work for us. Our skin color follows us everywhere. It is not a white coat we can take off at will.
With all of those experiences, with racism inside and outside of the hospital, one might wonder: how can you advocate for such physicians? How can you help?
A literature review by Drs. Heather B. Leisy and Meleha Ahmad has extensive recommendations for addressing racism in the hospital setting. Although these recommendations are broader in terms of speaking about bullying during residency, their suggestions would also help with issues of discrimination that African-American physicians face.
The first of these recommendations is the expansion of education around reporting issues of bullying in the workplace. An issue that often arises is that new residents do not know how to report incidents of bullying and discrimination. Building education about those channels into orientation when residents first arrive at an institution is key. This includes information about who to reach out to, the ways in which residents are protected when reporting issues of bullying and discrimination, and what to do if retaliation for speaking up does occur. The review also notes that modules about “emotional intelligence, communication, leadership skills, assertiveness training, work-life balance, empathy, burnout, conflict management, and stress relief” should be part of the residency curriculum.
Programming that focuses on building a support network of physicians is also important for reducing incidences of bullying. By this, Dr. Leisy speaks to the fact that a community where collegiality and supportive relationships are encouraged “mitigate stress and increase worker retention.” Not only are those facets important, but the implementation of mentorship has also been shown to decrease the occurrences of harassment.
Two other facets that Drs. Leisy and Ahmad mention to reduce instances of residency bullying include the creation of a team-based mentality and the formation of committees for mediation and investigation of bullying events. By team-based mentality, the authors mean involving all members of a patient’s care in daily decision-making — social workers, nursing, physicians, physical therapists, etc. — which has been evidenced to reduce the too-often hierarchical nature of medical training.
And, well, if all that fails, police officers could simply stop arresting minorities in front of their homes.
Image credit: rectangles by Dean Hochman is licensed under CC BY 2.0.
Fellow Physician Contributing Author
University of California, San Francisco
Chase T.M. Anderson is a child and adolescent psychiatry fellow at the University of California, San Francisco. He received his B.S. and M.S. from The Massachusetts Institute of Technology and an M.D. from The Northwestern University Feinberg School of Medicine. And he completed his residency training in adult psychiatry at Massachusetts General Hospital and McLean Hospital.