When Oaths Are Broken: A Call to Action

August 12, 2020

The medical community must examine how and what we can do to welcome and serve the black and brown communities that may view us as the authority they dare not call.

COMMENTARY

Series Editor: H. Steven Moffic, MD

Doctor 1: The patient tested positive for coronavirus? Oh my!

Nurse: Well, hand over the chartlet me see the name.

Doctor 2: Is it Asian? Ha, ha, ha!

Nurse: I know I’m racially profiling here. But you know . . .

Doctor 1: We’ve got to stay safe. [Jeers]

During my third-year clerkships in medical school, I overheard this racially explicit workroom exchange between an attending physician and his nurse colleague. At the time, COVID-19 had only just begun spreading throughout China. In my small town of the Southern United States, many “pooh-poohed” the virus as a foreign problem of bats and comedy.

As the only person of color in the room—and specifically, Chinese-American—I remember the waves of humiliation and helplessness I felt as I watched an entire room of Caucasian providers laugh along to this trite and unoriginal “joke.” Though my ears roared with blood, I stayed silent. Silent because my grades depended on the attending’s evaluations, and those evaluations would be collated for my residency applications. Silent because I felt like a traitor and coward for putting my grades before the ignominious suffering of generations of Asian American immigrants who faced exclusion and internment. Silent because the burden of racism is not felt by the privileged oppressor, but rather borne by its victim.

Being a native to both Los Angeles and the San Francisco Bay Area, I often take for granted the rich diversity in the metropolitan neighborhoods where I happily came of age. Moving to a tiny suburb in the South was a reverse culture-shock, and I have encountered uncomfortable situations in the community regarding my race. In general, being on hallowed hospital grounds means a safe shelter from these awkward situations because our medical school culture celebrates diversity and inclusion as vibrantly as possible. But I, like many others, have found recently just how little it takes for institutional hierarchies of power, and those who benefit from it, to dismantle progress towards equality, justice, dignity and respect for the human condition.

As I reflect on my encounters with micro-aggressions, the recent attacks on Asian Americans, and the heinous murders of Ahmaud Arbery, Breonna Taylor, and George Floyd, I see how racism has mutated to survive in our increasingly complex society. Thanks to obligatory cultural competency and diversity training in virtually every American university or corporate welcome packet, individuals may sleep peacefully thinking they have done their due diligence to learn about and reject prejudice. Unfortunately, this is a false sense of security because racism has shifted from obvious displays of imbalance like segregated buses to more covert manifestations like housing gentrification. Actually, both are consequences of institutionalized racism that perpetuate and normalize flawed individual assumptions by creating systematic practices that endorse these assumptions.

Interestingly, recent abuse of racist power by the woman in Central Park who called 911 on an innocent black man observing birds transformed these abstract concepts into a concrete demonstration. By willfully exploiting her position as a white woman to falsely incriminate a black man, she revealed her precise knowledge of how systemic racism aids, abets, and absolves privileged individuals to marginalize and manipulate the disenfranchised. When she invoked law enforcement to intimidate her victim, she augmented and confounded her individual act of flawed prejudice with the almighty cloak of institutional racism because obviously, law enforcement would side with her snowy white screams. The woman, the police officer responsible for George Floyd's death, as well as everyone who laughed along in the inappropriate workroom exchange I witnessed, wield privilege and power—whether from the genetic lottery or their chosen employment. Physicians and police officers are civil servants who have sworn to protect, defend, and do no harm, but this can be violated by unexamined, unbridled privilege and power.

Now approaching the start of my career as a physician, I wish to call for action in the medical community. Rather than focusing on what separates us from each other, we can open ourselves to relational empathy and compassion for our shared humanity. With awareness and self-reflection, we can turn to allyship: “an active, consistent, and arduous practice of unlearning and re-evaluating, in which a person in a position of privilege and power seeks to operate in solidarity with a marginalized group.1 As a learner in the medical system, I am constantly awed, and mostly terrified, by the amount of power physicians wield. Perhaps at the attending level, so far out from training, it is easy to forget about the power that one exerts almost automatically on a daily basis. Especially in psychiatry—my future home—I shudder at the phrase “chemical restraints” and its relation to the populations that I will serve: the vulnerable, incapacitated, elderly, minority, pediatric, incarcerated, homeless, and so on. But as I continue to learn and progress through my training, that shudder is a necessary reminder that I have power, and power is a privilege.

I hope then, it is clear that every physician must be an ally, for we all wield power and we all are privileged. As allies, we, the medical community, must examine how and what we can do to welcome and serve the black and brown communities that may view us as the authority they dare not call. Let us mourn the egregious deaths this year, and all the years in black history—the world’s history. Let us give space to the nuanced experiences of oppression and resilience that marginalized persons of color, gender, and disability navigate on a daily basis. Let us walk forward together as allies in our professional and personal duty to our patients, our colleagues, and ourselves as we actively fight to recognize and expunge every facet of individual and institutional racism. A healthy garden blossoms with color. I believe our world can, too.

Ms Guo is a 4th year medical student at Wake Forest School of Medicine, Winston Salem, NC. She is applying to psychiatry residency this fall.

The views expressed in this article are those of the author and do not necessarily reflect the opinions of Psychiatric Times®. -Ed

Reference

1. Allyship. The Anti-Oppression Network. Accessed August 12, 2020. https://theantioppressionnetwork.com/allyship