Week of 11.14.16

I agree to this article having experienced myself as a "colored girl". I have been ID'd as "that Indian girl", or "the brown girl" as a means to quickly identify me and I have not taken offense to this because yeah sometimes it helps to locate someone quicker. But there have been times when it is used with a derogatory intent when a patient says something like "I don't want that little brown girl asking me questions about why I'm here" (and yes this has happened) and it catches me off-guard. Not all my attendings have ignored situations such as this or looked the other way. Sure, no one outright reprimanded the patient or told them that they were wrong to voice such racist comments. But the doctor in attendance during that particular incidence did state, "She is a doctor training with me today and is asking you everything that relevant in order to better help treat you." This not only addressed the disrespectful "girl" component, but also showed that color has nothing to do with my performance. It was addressed in a similar way that you would a patient with delusions. You would not directly challenge this patient, as well as neither agreeing nor disagreeing with them, but rather you would simply move on and address the current medical issue at hand. As a physician, you are not there to get into political or religious debates with the patient, you are there to care, treat, and discharge. Unless, the situation hinders your treatment plan or your ability to provide appropriate care, or there was a deliberate insult directed towards your ability to treat as a colored person, there is no point to confront the patient about his or her beliefs/attitude. There are, of course, many situations where it is absolutely unacceptable for certain comments to slide, and have to be approached depending on the severity of the situation. It would be an entirely different matter if another physician, supervisor, or a colleague had used the reference "colored girl" in relation to a student, patient, or colleague, as the author stated happened to her. That type of interaction shows that her attending was encouraging the practice of treating people differently according to race, which is wrong. In those cases, students should learn from their attending's ignorance and apply more compassion when it's their turn to supervise or be a doctor. Most of my attendings or my colleagues feel that nothing a patient says outside of answers to his/her questions, is important or relevant. I do feel that once out of the patient's room, the attending/preceptor should make sure the medical student is aware of why the situation was addressed in whatever manner it was handled. The article is on the mark when it refers to medical students being unsure and cautious of what they can and cannot say or do because their evaluations or letters of recommendation is dependent on their actions, putting their entire career on the line. This makes a lot of us confused as to what to do when put in awkward, uneasy situations. It does help when people with years of experience and doctors who have been through where we are now, share their pearls of wisdom and guide us along the way. In conclusion, there are many scenarios people can make up and various ways to address racism in said scenarios. You just have to pick and choose your battles. In an ideal world, yes your sex and color does not define your worth, it is instead defined by your intellect and your compassion. Bottom line, we do not live in an ideal world. You will have all kinds of patients who need treatment and help, you are a doctor and have to rise above it all.

Unfortunately the reality of our world is that there still is racism and sexism. I think it would be appropriate for anyone, including our attending, to step up if a patient is being racist. Unfortunately this student was not helped out at all by any of her attendings. Maybe the Dr's weren't sure how to handle it but even addressing her by name vs the coloured girl would have helped out. It appears that we as a society have a long way to go yet and in positions of authority and leadership as future physicians we need to address this behaviour if our patients don't know how to properly address other human beings.

I agree that there is racism as well as stereotyping in medicine whether it comes from the physician or from the patient. From my own experience, I have not come across issues where I was targeted by patients or my peers at work based on the color of my skin or even my ethnic name. I have however faced situations where there was bias against me being a Caribbean medical student. As I have rotated through four different hospitals in the past 2 years of medical school, I found that this matter is highly dependent on the superior role-model. The attending leaves an impression on the resident and the resident leaves an impression on the student. When I rotated in Detroit, an area that has a very high population of heroin addicts, the attendings and residents were very quick to judge their patients who would complain of pain. They easily stereotyped many patients as drug seekers and would not take the time to see the patient. At another hospital in Michigan, the attendings were extremely kind to their patients and took the time daily to speak with them and address any of their concerns. Their attitudes on treating patients left an impression on residents to do the same.

Racism, sexism and inequality that exist our society don't get reported enough however, in our profession its disregarded. When students are not treated fairly by physicians or patients, we're not suppose to mention it. Students are considered to be leeches and solely there to absorb knowledge while disregarding any mistreatment we receive in the process. As author mentioned, attending physicians writes our evaluation that puts medical student in sticky situation if we dare to even speak up. Author of the article maybe a great student but according to her evaluation, one who may read would probably think she is not. As Dr. Schwartzstein writes: “Typically, students enter medical school idealistic, eager to improve the human condition, and excited about becoming doctors. And then we do various things to change them.” I am sad to see patient being racist towards student doctor, but more disappointed to see attending doctor letting the matter go like it means nothing.

This article is really on point as far as racism and sexism. Although I have not experienced racism personally, I have experience sexism. Before starting medical I was a firefighter/paramedic. Being a very male dominated profession, I was treated as less of a firefighter and some days even told my place was in the kitchen and not on the fire apperatus. I could never be as good as the guys. I acknolwege that physically, I will never be as stong, but I was able to work around that. I have seen the same be true regarding race. I have seen many coworker mock the spanish-only speaking grandmother, and the "steriotypical" Black druggy. Although I have not seen racism in medical school to that degree yet, I assume that it is alive and well based on my experience. The current generation and the one before us may be to late to save, but the best hope we have is to have this open conversation with our children and teach them how to be kind and accepting of all races, sexes and choices.

I think that racism and sexism in any form, in any situation is intolerable. We are all one human family. It is very sad to think that the medical field is also tainted with racism and sexism and I think it is very challenging as a student in regards to fighting against it. As a medical student on rotation, I am aware that the situation is my attending's hospital or private practice. I am aware that everything I do and say, every patient interaction is being judged, graded, and evaluated which will affect me in my own grades and letters of recommendation. This puts me into a very awkward position when I experience negative or offensive situations because I want a good grade and evaluation. In the example of the confederate flag shirts family from the article, yes the shirts are offensive but is it my place as a medical student who is representing my school and attending to call the family out on their shirts? To tell them that they are offensive to me and in effect lose the patient's from the practice and upsetting my attending? I feel that in that situation, I would have to follow the lead of the attending. I do believe it would be highly appropriate to ask my attending after that encounter how to deal with offensive patients in a professional manner. I think by starting the conversation, the attending would realize that I was upset by the encounter and I believe that the attending would definitely have some wisdom through experience to share, which is invaluable. I believe that it is very beneficial to have a strong communication between student and attending. In my experiences on rotation, I have found that besides learning how to treat medical conditions, I am learning how to manage the varied social situations of patient encounters.

Jennifer Ganzhorn MS3

It's a little hard for me to fully form thoughts on this matter as I have been lucky enough to not have faced any racism so far in my medical career. I grew up in North Carolina and used to get asked almost daily what race I was, usually phrased as "what are you?" Having gone to medical school overseas that catered to many countries I felt that my colleagues and even our patients were very open and now being in Atlanta, I feel that most patients I have encountered have not stopped to judge me about my race, at least not outwards. I have been worried due to my size and being a woman that some patients may not take me seriously, and that also reflects the sexism and ageism that is also seen in this field. I hope that if and when I have an encounter with a patient where I am merely subjected down to my race and sex that my preceptor would have the courage to address it. It's a difficult situation to amend I'm sure, as we are taught to treat patients with an almost "customer is always right" approach. I am grateful to thus far have not experienced racism but I hope that my peers are evaluated based on their merit as opposed to the color of their skin. Tying back to the election article I believe this is an issue that made people very anxious about the outcome and I hope that people being more outspoken about injustices and subtle prejudism will push our society in the right direction.