Posted on March 4, 2019

Racist Like Me — A Call to Self-Reflection and Action for White Physicians

Deborah Cohan, M.D., M.P.H., New England Journal of Medicine, February 28, 2019


And yet I am racist, shaped by the sometimes subtle tendrils of white supremacy deeply embedded in our culture. I mean this not as a sanctimonious admission of guilt, but as a call to self-reflection and action for us white physicians.

{snip} My mission as a white physician is to be humble and respectful toward my patients, not only as an act of compassion but as a revolutionary act against racism, elitism, and hierarchy. And yet I am racist, shaped by the sometimes subtle tendrils

{snip} So what am I, an obstetrician, doing about the disproportionate burden of maternal mortality and other poor reproductive outcomes among black women?4 How am I confronting the underlying forces that facilitate increased suffering and death among certain groups because of their skin color? Although it’s necessary, it is not enough for me to provide respectful health care to pregnant women of color.

If I truly want to be part of the solution, I need to explore those parts of me that are most unwholesome, embarrassing, unflattering, and generally not discussed in the context of one’s career. My goal is to dismantle the insidious thoughts that reinforce a hierarchy based on race, education, and other markers of privilege that separate me from others. {snip} Until I bring to light and hold myself accountable for my own racist tendencies, I am contributing to racism in health care.

{snip} I invite myself to notice the moments when I’m inclined to do more for a white patient than for a patient of color. Moments when I spend a bit more time and effort educating a white patient, or objectify a black patient, or connect more deeply with a patient who looks like me. Are my flashes of implicit racism just fleeting thoughts, or do I act on them? {snip} Having an intention to treat all my patients and colleagues the same is a key first step, but that intention is ultimately irrelevant if their experience of obtaining health care or working with me varies according to the color of their skin.

{snip} Not dealing with our racism is a manifestation of our privilege and reinforces a system that allows white physicians to dip into the waters of self-inquiry only when it feels safe. This fragility keeps us fundamentally weighted down by our own limitations and compromises our effectiveness at upending racism.5 In the meantime, health care is not safe for people of color as long as the overwhelming majority of U.S. physicians are white and we avoid examining where racism lives within us and how it lives through us.

Though implicit bias is unconscious by definition, it is a treatable condition. As I become more aware of my biases, they begin to loosen their grip. When I realized I was sitting farther than usual from my hospitalized patient, I moved closer. I am now aware enough to know that I will need to pursue a lifelong, iterative process of exploration, education, and realignment. Aware of my capacity to be racist, I can notice when that part of me threatens to influence my actions. {snip}

{snip} I acknowledge my privilege; I recognize that the system that benefits me causes others to suffer. I openly and humbly acknowledge that my racism is harmful. And I commit to a process of uncovering and exploring my biases wherever they lie, lest they wield power and I abet a culture of racism. If we white physicians are to heal others and ultimately the health care system, we must first heal ourselves.

The first step, I believe, is to train ourselves to question ourselves and each other reflexively, consistently, and with curiosity: How am I perpetuating systemic inequities for patients? What am I doing to ensure inclusion and promotion of physicians of color? What are my practices for checking myself? And how can we acknowledge the racism within us without making it a character judgment that precludes behavior change?

{snip} As I wrote this essay, for example, I consulted many people, mostly people of color, working in the social justice arena, as well as friends and colleagues. They reminded me to prioritize references by people of color, questioned my ego-driven motivations, and prodded me to explore and express myself more transparently.

Humans are inherently adaptable. If we approach this monumental responsibility with humility and hold each other accountable, we can change. In fact, we must change.