Dn my freshman year of college, Cornel West, the famous philosopher, was invited to speak at an event on campus. My black friends were buzzing with excitement and rushed to get tickets to his lecture. When a friend offered to buy me a ticket, I hesitated and noticed that I didn’t know who West was.
“Don’t you 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 brightest intellectuals and political activists of our time. As black students at Harvard, we stood on his shoulders.
I thought I 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 was proud of its historic heritage. But in the face of this huge gap in my knowledge, I realized that I had received a white education – one that robbed me, a black student, of my own historical heritage.
As a physician, my education, both what I know and how I learned it, continued to be shaped by emphasizing 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 treating white bodies to the detriment of others. My own specialty is also guilty of scientific racism. Psychiatric diagnoses have historically been militarized 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 allay the anxiety they feel about police brutality or the rise in hate crimes against Asian Americans. Yet restlessness in the face of oppression is healthy. Racism is disease.
Racism also has an impact on who should take care of it. Statistics recent survey on orthopedic surgery expertly illustrates the systemic racism that physicians and patients of color face on a daily basis. The survey found that less than 2% of those practicing in the field are black, only 2.2% are Hispanic and only 0.4% are Native American.. STAT’s Usha Lee McFarling writes about the epic battle for membership marginalized communities face in orthopedic surgery, the fragility of symbolic diversity, and the willful indifference of the Ivory Tower. It shows how diversity and inclusion require an investment in change, while exclusion and homogeneity require an investment in the status quo.
In McFarling’s report, I was most moved by the story of Erica Taylor, the first black female orthopedic surgeon at Duke Health. âYou buckle up and put on your armor,â Taylor, also chief of surgery at Duke Raleigh Hospital, said of his career in orthopedics. It is not the disease she describes fighting, but systemic racism. Despite his monumental accomplishments, I wondered how much of his time, energy and talent had been wasted in war every day. I am both proud of his career and angry.
Epidemiologist Sherman James has described “John Henryism” as the belief that systemic injustice can be overcome with simple effort. This year I have seen too many black medical friends and parents die young or have serious illnesses. I am concerned about the impact of this phenomenon on healthcare professionals who have been historically marginalized. We often have to work twice as much to earn half as much as our non-marginalized counterparts. This chronic over-functioning and this extraordinary effort come at a considerable cost to our mental, physical and spiritual health. I have already written 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 have tried to become more intentional about decentralizing whiteness in my own life and as a black female doctor. It started out by confronting my own internalized racism by wearing my hair in its natural shape and embracing the curls that I had grown to be ashamed of in high school. I read black authored books filled with beautiful black illustrations to my kids every night. College won’t be the first time they also learn James Baldwin.
At work, I stopped responding to unsolicited invitations to join diversity and inclusion efforts. Not because these efforts are irrelevant, but because I’m not sure we’re doing them well. I’m not sure how to make sense of the diversity recruiting efforts that have drawn me into racially toxic and traumatic situations. While doctors of color are more likely to serve marginalized communities, medical education is an intense re-enactment of the injustices that sowed marginalization in the first place. As the writer Audre Lorde writes, “the master’s tools will never dismantle the master’s house”. I refuse to accept a cycle of suffering that forces black and brown doctors to endure racism in order to mitigate the health consequences of our communities caused by racism.
I need time to heal the wounds of my own struggles and figure out how I can develop a strengths-based approach to uplifting blacks and browns in medicine that does not focus on the sins of the white medical establishment. The fight against racism will not be the central story of my personal or professional life. I find that black doctors deserve peace.
As Cornel West explains, “justice is what love looks like in public.” Justice will be served when diversity in the medical workforce becomes the default rule and when the field sheds racism. Taking care of everyone should be a fundamental principle of our profession, not a side project.