Starting a new clinical rotation can be daunting; however, after the first few weeks, you begin to get used to the demands of that specialty, your team, and your role as a medical student. The part that, I think, nobody expects or gets used to is encountering abuse (of any kind).
During my psychiatry rotation, I encountered my first experience of racial abuse as a medical student. In the midst of a consultation, the patient was recounting a familiar story from their childhood and used an ethnic slur during her description of this event. I immediately saw my White colleagues in the room tense up; although they appeared to be quite uncomfortable, they corrected the patient, noting that the term used was unacceptable. Though I have a personal understanding of the alarming and disparaging nature of the term, I chose to move on swiftly by continuing the consultation, as though nothing had happened. I did not reprimand or educate the patient about the inappropriateness of their words like my White colleagues did.
Reflecting on this moment, I feel conflicted. Of course, it was wrong for the patient to use a racially derogatory word, let alone one that seemed to be directed specifically at me. However, the patient was experiencing an episode of mania at the time and required treatment. Such a reflection led me to ask myself the following questions: Does the patient being sick excuse racial abuse? Should allowances be made if the patient has lost capacity or is experiencing psychiatric symptoms, like the patient I encountered?
These are questions that I feel nobody speaks about, though, and ones that they have failed to teach us in medical school. As a Black woman in medicine, I don't feel as though I have been adequately prepared for how to approach such scenarios; perhaps, this led to my nonconfrontational response. According to the British Medical Association (BMA), 20% of doctors in the UK experienced racism directly from their patients. And it's even more in the US, where about 23% of physicians have had patients directly refuse their care owing to their race. Racism in the workplace can come in many forms: through subtle microaggressions (eg, a patient mistaking you for a nurse and not a doctor), refusal of care, or through the use of derogatory ethnic slurs, like in this instance described. When these injustices occur, whether or not they are aimed at us, how are we to move forward in the moment, emotionally and mentally?
After speaking with various doctors and healthcare workers about such questions, I realize that everybody has a unique way of navigating scenarios of racial abuse. Some have recommended that I simply carry on treating patients even if they are racially abusive toward me, whilst others have a zero-tolerance policy regarding racial abuse toward themselves and their team members.
Though I was lucky to have been supported in the moment, it is actually quite frequent for physicians of color to experience racism in the workplace. In fact, the BMA highlights that 71% of physicians do not report their experiences of racism (from patients or colleagues) due to fear of being negatively labeled or due to lack of confidence that adequate action would be taken following the incident. Though such a statistic initially seemed staggeringly high to me, after hearing colleagues suggest that I should simply "brush aside" the situation, I find myself, sadly, able to see exactly where this 71% is coming from. In all honesty, the fear of being labeled "difficult" or "confrontational" held me back from reacting in this situation and many others since then.
Even though continuing with treatment is the response that I gave in the instance that day, I have since come to realize that if the patient had been physically abusive to me, I would not have been expected to continue treating them, regardless of whether they were experiencing a manic episode. Why, then, do we not all agree that the same severity and response should be given to instances of racial abuse?
I believe that support can be offered from institutions (eg, hospitals and medical schools) by providing some sort of training and support to all members of staff about how to approach and deal with such situations, who to escalate the incident to, and how to support their colleague who is the target of racial abuse, both in the moment and afterward. Similar to the Active Bystander training we receive at university in the UK, which teaches how to intervene in situations where a stranger may be displaying threatening and dangerous behavior toward another person, having universal training and teaching similar to this would be instrumental in teaching teams how to react and support their colleagues of color.
As a Black medical student and future doctor, I know that I am bound to experience racism again in my career. Equipping physicians and physicians-to-be, like me, with the confidence and assurance that our reports of racial abuse will be heard, and also diminishing the taboo aspect of such conversations, will allow future generations to learn from those already in practice in order to build a more comfortable and equitable medical environment.
The Florez Lab, formerly known as the Duma Lab and the Social Justice League, was founded in August 2019 and focuses on social justice issues in medicine, including discrimination and gender bias in academic and clinical medicine, cancer health disparities, and medical education.
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Cite this: Miranda Ntorinkansah. Encountering Racial Abuse as a Trainee: A Call to Action - Medscape - Sep 13, 2022.