A 16-minute podcast from the Journal of the American Medical Association featuring two white doctors discussing racism roiled a divided profession this spring.
The cheeky Twitter headline promoting the podcast quipped, “No physician is racist, so how can there be structural racism in healthcare?” In the podcast, then JAMA deputy editor Dr. Ed Livingston pushed back when Dr. Mitch Katz explained that despite the 1964 U.S. Civil Rights Act, discriminatory policies still perpetuate health disparities.
Dr. Livingston complained that: “‘Structural racism’ is an unfortunate term . . . taking ‘racism’ out of the conversation would help. Many people . . . are offended by the implication that we are somehow racist.”
Prioritizing his discomfort over the injury done to minorities, Dr. Livingston also confused individual actions with institutional policies.
Maybe he should read The New England Journal of Medicine, which recognizes that: “Modern American medicine has historical roots in scientific racism and eugenics movements. . . . Racism is not simply the result of private prejudices held by individuals but is also produced and reproduced by laws . . . implemented by . . . government and embedded in the economic system.”
After the Feb. 24 episode was deleted and Dr. Livingston forced to resign, the comments section exploded. Angry doctors decried “divisive” discussions on race. Many altruistic healers deny harbouring unconscious bias or perpetuating discrimination. Their strident narrative centres the comfort of white physicians above harms done to non-white citizenry. Instead of paying attention to Dr. Katz and others, the masters of these bruised egos argue that unhinged social justice warriors encouraged by leftist conspiracies are running amok, tearing down a noble profession and, wait for it, are themselves racist for daring to call it out. Besides, medicine is hard, especially in the time of COVID-19. Why can’t the woke stop poking the bear?
Because racism kills.
Shutting down dialogue on taboo topics furthers harm so perhaps the infamous podcast should have been reposted as a learning tool. Talking past each other, hurling pithy tweets and lobbing clever rebuttals are exercises in rhetoric for adolescent debaters. In real life this strategy guarantees mayhem.
Science is neutral, right? Medical journals root out bias and uphold ethical standards. Still, perusing medical history should make us squirm. Dr. J. Marion Sims’s research on enslaved Black women who screamed in pain crystallized his now notorious reputation as a leading gynecologist. The physician-anatomist Dr. Samuel Morton who eagerly collected human skulls concluded in his 1839 opus Crania Americana that based on skull size, Caucasians were the smartest and “Negros” the least intelligent race. His Charleston Medical Journal obituary praised his craniological research which gave “the negro his true position as an inferior race.”
Canada, for all its milquetoast virtues, has a checkered past with the Black Loyalists who settled the Maritimes following the American Revolution. The plunder of First Nation territories alongside the tragic loss of their children has spelled catastrophe for colonized peoples who still chafe under the Indian Act.
While dying in Joliette, Que., Joyce Echaquan documented the slurs hospital workers flung at her. Yet we brush aside such accounts as one-off aberrancies while offering up anecdotal evidence based mostly on n’s of one that medical racism is a fallacy.
‘Doctors are my kin’
The past isn’t past, not when it stomps on the present and strangles the future. It haunts us when we ignore history, or pretend bad things never happened. That’s why the truth must be shouted aloud, over and over until we finally absorb it.
Doctors are my kin, my fraternity of intellectually voracious, generoushearted souls who keep giving even when there’s nothing left. But it’s disingenuous to pretend we’re not as flawed as the rest of humanity. I’m ashamed to confess that while rotating through pediatrics I bought into the racist trope that Indigenous parents neglect their children, never appreciating their fear of the medical establishment.
Many racialized (that pesky adjective!) colleagues are afraid. Some declined interviews with me for fear of professional consequences, confirming how power silences truth-tellers to the detriment of those hunkered below. If an accurate history is 80% of the diagnosis, why the reluctance to hear this particular history? Is it the special hubris of doctors who can’t admit to fallibility?
Dr. Cathy Cook
I went to med school with Dr. Cathy Cook, a Métis physician who, as vicedean, Indigenous health at the Rady Faculty of Health Sciences incorporated 70 hours of Indigenous health into the curriculum.
Balancing a grandchild on her lap, over Zoom, she recalled facing what George W. Bush coined the “soft bigotry of low expectations.”
“They expected us to fail.” Most of the class was kind, but a particularly vitriolic classmate couldn’t fathom how she’d gotten into medicine.
Dr. Cook cautioned that diversity doesn’t guarantee inclusion, that racism is less individual attitudes than structures based on exclusionary policy towards non-whites. Named inaugural vicepresident, Indigenous at the University of Manitoba in 2020, she applauds executive level commitments to reform but warns that dismantling policies that safeguard hierarchies is the real test. Relinquishing power is hard.
Endlessly unflappable, she attributes her sanguine nature to “really good parents.” After decades of advocacy, she reports, “It’s no longer acceptable to be racist. That doesn’t mean it doesn’t exist.”
Dr. Somto Ibezi
Dr. Somto Ibezi has practised medicine on three continents. She described how, “it’s draining to talk about these issues” although she lives them daily. “Whenever we talk about racism there’s someone who doubts the veracity and then there’s backlash,” she explained over the phone from Saskatoon, where she’s lived since 2017. After graduating in Nigeria, she undertook family medicine training in Britain and advocates with Black Physicians of Canada. Today she’s speaking personally.
The staring gets to her. “People stare at you. Who is this, what are you doing here?” The puzzled expressions make her wonder whether it’s genuine interest or wary curiosity. Staff who assume she’s not a doctor betray shock when they learn she is. The attention paid to her hairstyle (a low Afro-cut) depletes her too.
“Everyone’s eyes go straight to my hair.”
At a COVID-19 vaccination clinic, they called up patients in turn. A patient pivoted back to Dr. Ibezi’s colleague who gave the man his shot. When she raised the lack of professional support, the doctor apologized. She said, “I know you knew what happened.” She says: “You think you’re imagining things . . . this happens all the time.” When physicians cave to patients when they do things like that, it fuels discrimination.
Dr. Ibezi doesn’t play victim. She’s too busy exploring the lakes surrounding her prairie home and hanging with a tight group of “sisters,” finding solace in both geographic and emotional spaces of refuge. She’s optimistic, too. She has to be, she says ruefully, because she’s investing in the future of her children. “More people are listening now, maybe not agreeing but at least . . . acknowledging.”
She summarized EDI initiatives as, “who’s not there at the decision-making table? Invite them. . . . This is where mentoring and active recruitment come in. You need to make the table longer, and this is . . . upsetting.” Upending the status quo is chaotic, but this revolution was needed “yesterday” and, yeah, we need to pay people for their labour.
Dr. Saroo Sharda When Dr. Saroo Sharda’s multilingual father ended up in ICU, staff assumed his skin colour meant he couldn’t speak English. An anesthesiologist who practically lives in the ICU, she was flummoxed by their casually dismissive treatment. That cavalier attitude’s part of a broader pattern that discriminates based on appearance.
While pursuing her master’s degree in interprofessional teamwork, concepts of power helped her analyze her own negative experiences. After a race issue on Facebook forced women doctors to question their biases, Dr. Sharda co-wrote a CMAJ blog detailing how both gender and race shape professional experiences. “This is not a monolithic experience— being a woman in medicine.”
Recently appointed inaugural EDI lead at the College of Physicians and Surgeons of Ontario, she chuckles when I opine that Ontario doctors are terrified of the college. Given their mandate is to protect the public, college staff advise committees to consider race and culture when evaluating complaints. A doctor may not have intended to be racist, but the patient may perceive otherwise. They’re trying to name the problem, not in a punitive way but to encourage reflection, to foster brave conversations without alienating the profession.
Dr. Lisa Richardson Gauging the medical scope of Islamophobia proved Sisyphean. That’s when Dr. Lisa Richardson, the awardwinning Indigenous health advocate who declared to CPSO council that antiIndigenous racism kills patients, breezed in. I quizzed her on Muslim metrics.
“An excellent question,” she pronounced, but actually, accurate figures on minority physicians don’t exist. She calls data collection “a fraught issue.” Besides the risk of misuse, who owns this data? She affirms that, “we need to be accountable to the communities we serve,” because evidence shows populations do better when mirrored by their caregivers.
Recently named associate dean, inclusion and diversity at the University of Toronto, Dr. Richardson is a gust of fresh air, blowing cobwebs away. She muses on progress made. Advocates originally referenced “cultural safety,” a euphemism to deflect charges of reverse racism, the Kafkaesque tightrope activists balance to avoid being summarily cancelled. “Now we talk about anti-racist practice.”
In June her office partnered with the Muslim Medical Association of Canada to help learners navigate racism across clinics and academia. A survey of Muslim residents, part of an outreach allowing faculty and learners to anonymously report discrimination based on any ism, uncovered Islamophobia, a phenomenon some scoff at as imaginary. “Colour-blind” doctors invite this Richardsonian retort: “As with society at large, our faculty reflects the various forms of discrimination. We’re clear about acknowledging this.”
Someone marvelled to her, “isn’t it cool that what you’re doing is trendy right now?” She believes it’s something bigger, some seismic shift in civil rights. When I confess to devouring comments, she admits to the same. “I steel myself and I read. . . to learn what the pressure points are.” Although often nasty and downright abusive, they’re part of a critical dialogue.
Where do we go from here? Against the backdrop of George Floyd’s murder, disruptors exhort us to first sit with our discomfort. Life, based on arbitrary slings of fortune and birth that decide our worth, is inherently unfair. In the 1960s, Bob Dylan implored us that if we can’t be allies, to at least jump out of the way because “the times, they are a-changin’.”
Dr. Ferrukh Faruqui is an Ottawa physician.