Opinion

‘Painful and difficult’: A BIPOC woman’s journey in medicine

Today’s International Women’s Day and Thursday’s first Canadian Woman Physicians’ Day, coming on the heels of Black History Month, are opportunities to reflect on what it means to be a Canadian BIPOC woman in medicine. Journey is the best word I can use to describe my experience – a journey of fulfilment, privilege and honour to be able to walk with my patients and their families through exceptional and poignant moments in their lives.

At times, though, navigating the medical profession and its culture has been a painful and difficult journey. How far, actually, have we come in ensuring that women, and women who experience intersectional oppression, are supported in their daily work and allowed to thrive within the system? How have medical institutions created space for voices that aren’t white, cis-gender, heterosexual able-bodied males?

I am a Chinese, heterosexual, settler, second-generation Canadian, cis-gender female with more than one disability who is now 17 years into a career as an academic, a palliative care and family physician and a researcher.

In 2015, I gave up my hard-earned tenure at age 36 and resigned from a university faculty position due to racist, sexist and (young) ageist abuse and the complicity of silent witnesses. Some of these witnesses turned a blind eye to the abuse while others said they could not afford to risk their own standing within the university’s power structure to speak up with me. This includes men and women and white and non-white colleagues alike. I had not played by the rules that apparently were in place for me: to work inhumanely hard and get things done quietly and invisibly. And to do it in a way that did not threaten those whose work I was changing. I was not to overtly disagree with those who were part of the old way of doing things despite the fact they were permitted to be belligerent and bullying toward me for enacting needed changes toward equity and empathy in medical education.

Let me be clear, the bullies were both men and women. I clearly remember the day my then 2-year-old son was having surgery for the first time; I was berated by a colleague (who knew about the surgery) several times for an “issue” I assure you was inconsequential compared to being stressed about my baby having surgery. I was told often that I was not behaving in an “appropriate” manner by not deferring to “how things have always been done” and “not letting it go.”

This is coded language; as an East Asian female, I am expected to be docile, subservient, hard-working and deferential. During the abuse, I thought that I was the problem. Those in leadership with the power to protect me did not support me but rather added to the gaslighting. My health and my young family’s wellness were adversely affected for years because I thought that I did not have any option but to stay.

In the six years since, it has been proven that I was not the problem. I am grateful that the University of Calgary provided me with an academic home in 2016 where I was treated with respect by my colleagues.

Six years later, however, I now find myself in a situation reminiscent of my previous trauma. I spoke out against a member of a volunteer group of which I was a founding member after he publicly attacked racialized women on social media. The male physicians (white and Asian) who hold power in the group rose to his defence, insisting that Canada is in a post-racial state and that we must believe in “colour-blindness”; my critique of colour-blindness as another way of marginalizing vulnerable groups was repeatedly and forcefully shut down over days and weeks. All but one white male stayed silent while males of colour propped up their white-adjacent privilege by silencing me. 

I resigned.

White and BIPOC women in the group were complicit with their silence, a complicity that is insidious. I understand the nuanced power dynamics that occur in groups and that their safety was not assured, just as mine was not. But to quote Elie Wiesel, a Holocaust survivor, writer and Nobel Peace Prize laureate, “We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”

Changing our medical culture means making it understood that everyone belongs in our community. This will help with burnout and the stress of physicians, which in turn benefits all of society by providing quality patient care that is culturally safe and anti-oppressive.

We must ensure not just representation, but true safety and belonging through more diversity in leadership. Physicians and leaders in medical schools, health authorities and medical societies must come from diverse backgrounds – female, BIPOC, those with disabilities, those who identify as part of the LGBTQ2S+ community, from rural backgrounds and with less privileged upbringings. This means that we must do a better job at making that leaky pipeline more robust for under-represented groups. We must ensure that we are not teaching bad habits that need to be unlearned from ongoing colonialism and perpetuating harm within our work environments. This includes learning about the history of Black slavery in Canada, the segregation that existed in Canada, the legacy of trauma from residential schools and the Sixties Scoop, the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and the Truth and Reconciliation Commission Report and its 94 Calls to Action.

We must scrutinize the physicians learners are exposed to. We must listen and respond when people tell us they feel unsafe around a preceptor, colleague or patient. We must hear and act on the stories from those who discuss harm inflicted on them by patients, peers, leaders and institutions alike. Simply having a “diverse” faculty member or teacher isn’t enough to ensure safety. Being BIPOC does not make one immune to enacting racist harm. Checking off a diversity box does not make one immune to perpetuating oppression.

And there must be accountability for such oppressive harm within our medical culture for any change to be affected. This is not “cancel culture,” this is consequence culture that is long overdue. The turning of a blind eye to known perpetrators of oppression because of “otherwise good work” cannot continue within medicine. Allowing the status quo to be protected means that oppression and harm continues.

I admire Canadian medical students who are leading the way in demanding accountability for anti-Indigenous harm that has been inflicted upon Indigenous board members and students by the Canadian Federation of Medical Students board.

While I am optimistic that the medical culture will change with the next generation, the current generation has a responsibility to improve our culture now for the benefit not only of our colleagues and profession, but for the sake of our patients.

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Amy Tan

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Dr. Amy Tan, MD, MSc, CCFP(PC), FCFP, is a palliative care and family physician and an ethics, palliative care and health communications researcher. She advocates and writes about health equity and anti-racism.

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