Arundhati Dhara is an Assistant Professor at Dalhousie University in the Department of Family Medicine
Saroo Sharda is an Anesthesiologist in Oakville and an Assistant Clinical Professor at McMaster University
There are few data available on the racial make-up of Canadian female physicians. What data exist suggests that South Asian and East Asian groups are over-represented relative to their proportion of the general population and Black and Indigenous people remain underrepresented.
There is also evidence that non-white physicians experience discrimination from colleagues and patients ranging from daily microaggressions to more overt acts. While organizational anti-discrimination policies often exist, we are generally ill-prepared to deal with incidents when they occur and in their immediate aftermath. The clinicians experiencing bias are often left to act, and must weigh power dynamics against speaking up. The damaging effects of physician discrimination based on race or gender are clear, and yet we know little about the ways in which gender and race intersect to further marginalize women physicians of colour.
Kimberle Crenshaw, a black feminist scholar, first coined the term “intersectionality’ in 1989 as a way to describe the ways that sexism and racism act synergistically against black and brown women. She noted specifically that insistence on considering the two separately is a strategy that can be used to silence or dismiss the experiences of black women. When considering sexism in Medicine we have largely taken the experience of women as universal and, as such, we have rendered racialization of women physicians invisible.
Obviously, participating in conversations about race is challenging and can bring up discomfort for us all. So how can we empower physicians to engage in what can feel like a powder-keg of misunderstanding? Clearly there needs to be a multi-pronged approach. Training programs and institutions must invest in and take responsibility for the development and delivery of evidence informed programs. However, personal reflection is also important - there are ways that we as individuals can learn to approach our peers in conversations about race.
There are unspoken rules about racism, and one is that we don’t talk about it. When we do, people often shut down. However staying open during these conversations is critical to making change. In training we are taught that a carefully taken history will lead to the diagnosis 80% of the time. What we don’t learn is that in order to listen well we must, for lack of a better term, “check our privilege”. For racially privileged women in medicine to acknowledge that their racialized colleagues face discrimination - that they may themselves be perpetuating - disrupts the idea of female solidarity and community that we tell ourselves we hold. Often, we aren’t even aware that this is happening because of the implicit bias we all experience.
Satyantani Dasgupta, a physician and medical education scholar, calls on us to listen with what she terms narrative humility .
“Taking a position of narrative humility means understanding that stories are relationships we can approach and engage with while simultaneously remaining open to their ambiguity and contradiction and while engaging in constant self- evaluation and self-critique about issues such as our own role in the story as listeners, our expectations of the story, our responsibilities to the story, and our ownership of the story”
What if we extend the concept of narrative humility from interactions with patients to conversations with our marginalized colleagues? We have found that keeping the idea of narrative humility in mind is helpful in moving beyond feelings of awkwardness and defensiveness when entering conversations about discrimination.
As a way to operationalize engagement we offer the following suggestions, balancing our desire to do good with our inevitable participation in a marginalizing system.
- Consider who has the moral authority to speak and who has the moral obligation to listen. Centre the experiences of those who have been marginalized or silenced. They have important knowledge to share, if they are able. Understand that they may not feel safe speaking up.
- 'Check’ your privilege. We must examine our implicit biases and consider our personal experiences of privilege and how they relate to the marginalization of others, no matter how uncomfortable.
- Listen with Empathy. Medical training emphasizes careful listening and the extension of empathy to our patients. Offer the same empathy to colleagues who may be in a difficult or vulnerable position.