As a second-generation Canadian of East Indian descent working as a resident physician in Canada, I know that I am incredibly privileged and among the top tiers of society in income and status. However, no matter your career and status, being Black, Indigenous or a person of colour (BIPOC) means you will experience racism.
I recall early in my residency training being mistaken as the “person there to pick up the meal tray” by a hospital patient despite introducing myself as a physician and being dressed as one. The story has become one our faculty shares with others to demonstrate how roles in society are assumed by the colour of your skin. I know my story is by no means unique and I have endured far less than others in my position. But, as Chika Oriuwa, valedictorian of the University of Toronto’s medical school class of 2020, astutely said, “There is this misconception … that when I reach a certain level of professional competence and respect I can shed my skin in some way … no, no, no. There is no escaping.” The reality is that you are BIPOC before you are a physician.
Current events in the United States around systemic racism in policing have raised awareness of this long-standing, pervasive issue that is rampant throughout all facets of society. Healthcare is no exception. Issues of racism in healthcare are two-fold: the difficulty of being a BIPOC physician and how physicians treat BIPOC patients.
To address the first, changes need to be made at both the individual and institutional/system levels. At the individual level, we need to recognize our own biases and preconceptions when interacting with colleagues of ethnicities and backgrounds different from our own. This is difficult as our attitudes infiltrate our subconscious to the point that they become blind spots. As individuals, we need to put in the work to read literature on race and anti-racism. Examples of such literature have been covered extensively. A practical goal should be to keep some of the concepts from this literature in mind in our day-to-day interactions. Simultaneously, those of us who are BIPOC can try to share more about our cultures and ways of living. Diversity should be celebrated rather than deemed threatening.
At the institutional level, there needs to be a deliberate effort to increase diversity in medical school classes. An example of a step in the right direction is the news that 24 Black students have been accepted to the University of Toronto’s medical school for the incoming year. Aside from the obvious notion that diversity in medicine is positive in and of itself, it has been shown that patients participate more in interactions with physicians when they are of the same race, communication is more effective and, as a result, patients report greater satisfaction with their visits.
To address how physicians treat BIPOC patients, work needs to be done from the start of training in medical school and continue through to senior staff to ensure all are aware of situations in which BIPOC patients are mistreated as it is happening. Emphasis must be placed on developing skills in the health advocate role in CanMEDS during medical school. CanMEDS was created by the Royal College of Physicians and Surgeons of Canada to provide a framework for physician training in Canada. Medical schools across the country universally use the CanMEDS framework to train and evaluate medical students. As per the CanMEDS website, as part of being a health advocate, a physician’s role involves “promoting health equity, whereby individuals and populations reach their full health potential without being disadvantaged by, for example, race, ethnicity, religion, gender, sexual orientation, age, social class, economic status or level of education.”
We know what happens when the health advocate role falls by the wayside. There are countless stories of prejudice against those who are BIPOC, in particular Indigenous peoples, and of neglect in healthcare settings. The case of Brian Sinclair, an Indigenous man who died of a bladder infection in a Winnipeg emergency department after waiting for 34 hours, is just one notable example. To address and combat systemic racism against Indigenous people in the healthcare setting, the College of Family Physicians of Canada has issued a document that not only discusses systemic racism in healthcare but also provides suggestions on how to advocate for Indigenous peoples. Medical schools’ curricula should include exposure to all populations within BIPOC, discuss injustices that have been suffered and work on ways to alleviate these issues. Without addressing this early in training, stereotypes are reinforced in the clinical setting and often lead to subpar care.
Medical research is another area where there is great need for change. Clinical trials typically include primarily white patients. As shown in a JAMA Oncology review in 2019 that looked at landmark clinical trials leading to Food and Drug Administration oncology approvals between 2008 and 2018, race was reported in only 63 per cent of the trials and Blacks and Hispanics were underrepresented in these trials. We assume white is the norm and that everyone and everything aligns with that. This must change. How disease manifests, the risk factors for disease and the responses to treatments vary depending on race, among other things. We choose when it is convenient to lump everyone together with the assumption that a white person is the standard but then split people up when we want to judge them. This is ironic given the historical exploitation of Black people for medical research, as in the use of Henrietta Lacks’ cells without her or her family’s consent, that has then been used to gain insights into many medical illnesses and to test treatments against a wide array of diseases. Ultimately, we need to do better at accounting for the diversity within society when carrying out medical research.
When it comes to racism in healthcare and society in general, we must acknowledge that changing the future after centuries of injustice is not an easy task but is necessary for progress. As Taylor Branch, Pulitzer Prize winning author said in the King Years Trilogy, “…truth requires a maximum effort to see through the eyes of strangers.”