Until we talk about racism openly and teach doctors and medical students how to tackle it, we won’t see real change, says Saroo Sharda

I want to make you feel uncomfortable. 

I was recently asked to speak at a conference for trainee doctors about diversity and inclusion. As often happens in such settings, questions and answers tiptoed around what was essentially a conversation about racism. Except that no one wanted to use that word—“racism.” When I eventually said, “I believe that what you’re talking about is racism,” the audience erupted into applause, and ethnic minority doctors in the room collectively exhaled with relief. 

Why is it that we find it so difficult to talk about racism, despite evidence that it is still rife in our medical ranks? Narratives of doctors from ethnic minorities being subject to racism from patients and colleagues abound in the literature with many more going unreported and undocumented. [1-3]  The consequences of such behaviour have ramifications for all practitioners, but responses by the medical establishment have been lacking. [4] Frequently, doctors from ethnic minorities are left to shoulder the burden of addressing the racism to which they are exposed themselves. 

If we cannot even say the word racism out loud, it is little wonder that our response has been underwhelming. Doctors have chosen to dedicate their life’s work to caring for others, so the possibility that we could hold racist beliefs, even if these are unconscious, is a difficult notion for many to grasp (including for those of us who consider ourselves racialised), particularly in a culture which has traditionally rewarded perfection. It is much easier to talk about “diversity and inclusion” than to do the deep self-reflection required to challenge the inherent biases which we all hold—be they about gender, race, sexual orientation, disability, or the myriad of other axes upon which we “other” those who do not fit into the traditional perception of a doctor.

When we talk about racism, things get uncomfortable, and as doctors we generally do not do well with discomfort. Doctors have grown up in a culture which teaches us that we must “know.” We must know the answer, the diagnosis, the treatment. Not knowing is considered failing, and failing is not tolerated. Our discomfort in talking about racism has caused us to magnify broad and sweeping statements about diversity and inclusion, while minimizing effort and resources toward embedding anti-racism and anti-oppression teaching into medical education. 

While it is important to engage in reflection at an individual level, we know that simply educating individuals about microaggressions, implicit bias, and cultural sensitivity does not produce desired change. [5-7] Institutional inclusion and diversity efforts cannot be separated from anti-racism efforts. This is the cornerstone of turning abstract notions of diversity and inclusion into tangible, real life action.  

Very few anti-racism curricula currently exist for medical students. [7] Research on anti-oppression training for healthcare providers, shows that education around the social determinants of health does not address the historical and ongoing racism in healthcare systems. [8] Teaching healthcare providers about how to talk about and address racism in healthcare is an essential component of medical education.Until this happens, we will be left with little knowledge and skill to facilitate complex conversations about racism. [2]

In order to critically examine and reframe how we approach the complexities of racism, medicine must look outside of itself and the fundamentally oppressive structures upon which it has been built. The scholarly work of the social sciences, humanities, theology and philosophy are crucial in helping us to re-examine the role we play as individuals and institutions in combating racism. 

Some ways that you can work towards true diversity and inclusion are

• include anti-racist and anti-opression curricula at your institutions. Seek out scholars from ethnic minorities doing this work and invite them to teach.  Ensure they are credited and remunerated for their work.  
• Speak to racial justice groups and learn from them about how to engage in allyship—do not assume that you know how.  Be prepared to do the work. People from ethnic minorities have spent a lot of time thinking about racism and speaking out against white supremacy.  How can you  step-up to the conversation?  
• Realise that disrupting the structures of oppression like racism and colonialism in medicine cannot happen in a way that is comfortable. 
• Take steps to recognise and acknowledge your own discomfort.

There is power in being able to recognise your discomfort as a force for change and create a meaningful narratives around racism.  

Saroo Sharda, assistant clinical professor, department of anaesthesia, McMaster University and consultant anesthesiologist, Oakville Trafalgar Memorial Hospital.

Competing interests: None declared

References:

1. BMJ 2019; 365:I2226
2. Acad Med. 2017 Mar;92(3):285-288. 
3. Acad Med 2017 Nov;92(11S):S1-S6
4. Sharda S, Dhara A. It’s Time To Talk: Gender and Race in Medicine. CMAJ Blogs July 2019
5. Am J Orthopsychiatry. 2014 Sep;84(5):590-6. 
6. Sukhera J. Perspect Med Educ (2019). 
7. Fam Med.2018;50(5):36468
8. Rai, Nanky. 2017. Uprooting Medical Violence: Building an Integrated Anti-Oppression Framework for Primary Health Care. Article in prep for publication