Experiencing racial discrimination in medicine
12 April 2022
To deny that doctors and medical students experience racial discrimination is to hide from an unpleasant truth. This discrimination can come from a variety of sources including medical colleagues, other healthcare workers and patients. While we must have zero tolerance to racial discrimination we must also acknowledge that it does occur. Unconscious bias, leading to stereotyping, false assumptions and prejudice, is a human trait. As individuals it is essential to carefully examine our own attitudes and behaviour and be aware of how preconceptions may impact on our decision making and stance. Self-reflection is the best weapon we have available to eliminate racial discrimination as individuals. In addition, we must all be prepared to call out any discrimination we observe.
Discussion here will be confined to the experience of racism by medical students, doctors and other healthcare workers. Racism experienced by patients also needs to be addressed and should not be tolerated. They are related and ignoring one risks a failure to address the other.
Some examples of racial discrimination that have been publicly reported include:
I was once told by the head of department that I was “too Asian to ever get onto a program”.
When I was a medical student, I swapped with another student on a surgical case. The scrub tech asked the surgeon if the student changed, and she said “that or they dipped the last one in bleach.”
Patients who refuse to shake hands or say they want to see a “white” doctor.
Associate Professor Kelvin Kong was striding into John Hunter Hospital in Newcastle to treat a patient with COVID-19 when he was stopped in his tracks. “Deliveries are out the back,” a hospital worker said to him. A surgeon with 13 years’ experience, Associate Professor Kong was offended to be mistaken for a truck driver. But he didn’t get angry. He simply explained who he was, entered the hospital and got on with his job. When the incident was described on Twitter by a colleague, Associate Professor Kong remained remarkably gracious. “Awareness of unconscious bias is required, so we treat everybody kindly,” he wrote. “I can manage, I worry for my mob.” The tweet prompted others to share similar experiences. One Indigenous general practitioner said he had been asked to refrain from eating food that was set up for a committee meeting he was attending. Associate Professor Kong said these acts are generally not malicious but highlight how much people need to be taught about unconscious bias and racism.
Experiencing racial discrimination in medicine impacts on the wellbeing of those targeted but also contributes to a toxic environment in a medical workplace. A positive workplace culture and psychological safety are dependent on fair and just management. Therefore, eliminating racial discrimination is important to all working in healthcare. Tolerating the presence of any bias or prejudice puts everyone at risk as it creates an environment in which values do not recognise the maxim of “do no harm”. If racism is tolerated, then other biases such as gender discrimination will also be tolerated. When the healthcare workforce tolerates discrimination within the workforce then it will also tolerate discrimination in the provision of healthcare. A lack of psychological safety in healthcare creates a risk to the safety and wellbeing of patients. The highest standards of respect must exist within the profession for the best patient outcomes.
If you experience racial discrimination:
- If the discrimination is expressed verbally speaking up at the time may be enough to stop any further occurrence. However not everyone will be comfortable to do this and depending on the situation and the perpetrator this may not be the best course of action at that time.
- If a patient or family member exhibits discriminatory behaviour or expresses a discriminatory statement towards you it is important to report this to a senior staff member and you can request not to be involved in caring for that patient.
- If you are working in private practice and you experience discriminatory behaviour or a patient expresses a discriminatory statement towards you, provided you ensure that the patient can access alternate care, you can refuse to treat that patient.
- It is normal to ruminate over an unpleasant experience and to feel angry, upset, afraid and distressed.
- It can be helpful to debrief with someone you trust.
- If discrimination is persistent or you are very traumatised seek professional counselling.
- Document what happened after any incident of discrimination to assist with recall when reporting the event.
- If the discrimination occurred in association with your employment (e.g., a work colleague or a patient) access your employer’s policy on discrimination.
- If the discrimination occurred in relation to your training program access your college’s policy on discrimination.
- Seek expert advice from AMA Victoria or from the Victorian Equal Opportunity and Human Rights Commission.
If you observe racial discrimination:
- Call it out at the time whenever possible.
- Seek out the person who was targeted and check in with them. Express your concern for their wellbeing and offer to support them.
- Assist with the reporting process, including recruiting other witnesses.
- Be active in any education and change of culture process.
Remember the words of Desmond Tutu
If you are neutral in situations of injustice. You have chosen the side of the oppressor.
AMA Victoria Coordinator of Doctor Wellbeing
Resources and further reading
- Racism in medicine | The BMJ
- Survey reveals ‘systemic racism’ in medical training – Croakey Health Media
- Calling Out Aversive Racism in Academic Medicine | NEJM
- Racism within healthcare hurts us all | Coda Change - Clinical Conferences and Podcasts
- Equity, Education & Healthcare: What is the legacy of our Eurocentric system? | Coda Change - Clinical Conferences and Podcasts
- Johns Hopkins University Conference: Reckoning with Race & Racism in Academic Medicine (May 5th & 6th, 2022, Baltimore) – Society for the History of Technology (SHOT)
- Surgical-News-volume-21-issue-6.pdf (surgeons.org) (Health equity feature pages 32-34)
- Racism in Medicine Is Alive and Well | MedPage Today
- About Respect | RACS (surgeons.org)
- Leadership Insight #3 – 2022: The role of controlled processing and intentional behaviour in combatting unconscious bias (amavic.com.au)
- Civility Saves Lives (amavic.com.au)
- Managing bullying and bad behaviour as a doctor (amavic.com.au)