The Tainted White Coat: Realizing the Physician’s Role in Social Injustice

Stepping into the world of medicine, from the first time I took the oath to the first time I donned that crisp white coat, I was filled with an overwhelming sense that I was part of something so pure, so philanthropic, and so authentic in its passion to heal. Yes, on great days, I still remember that feeling and revel in it but that feeling can also be detrimental. Hospitals and physicians and healthcare in general, because of the philanthropic nature of the job and the difficulty it takes to attain the status of a physician, tend to be placed on a pedestal and celebrated as “all-knowing” when that is not the case. Black mothers have a three times higher maternal mortality rates than their white counterparts (1), African Americans are routinely under-treated for their pain compared with whites (2), heterosexual providers have been researched to favor heterosexuals over LGBTQIA+ patients while their explicit preference for heterosexuals over lesbians and gay men were “moderate to strong” (3). These are just a few examples how physicians not only practice medicine, but also practice social injustices like racism and homophobia. Because of the position of power that physicians have, issues like these do not garner enough dialogue. I urge the dismantling of the pedestal and the realization that our healing hands are also deadly.

It is significant to realize that though medicine is founded on science, it is also founded on a society that was and still is oppressive to marginalized groups, and because of that, we can become implicit to this injustice without realizing it. The lack of access to care in general, how fiscal disadvantages of low income folks inhibits them from getting the best care, insufficient cultural humility that may be present in a lot of providers, inadequate evaluation of health literacy, and the overall racism, sexism, homophobia, and classism embedded within implicit and explicit biases in providers and medicine as a whole makes it so often times the medical community contributes to the systemic oppression that vulnerable populations face. Nothing exists in a vacuum - we can rely on the scientific facts in order to treat patients, but our beliefs, decisions, and science ITSELF developed from a society that is oppressive, and thus yields, knowingly and unknowingly, practices that parallel with this oppression. We should be aware that our practices - how we treat Black patients versus white patients, misgendering our transgender patients, stressing reproductive and sexual health in women more than men - are not perfect, and in fact contribute to social injustice. We cannot sweep it into the rug, or hide under scientific evidence.

If we can think critically about pathophysiology and biochemical pathways, then we can think critically about our position and how, instead of being sources of justness and equity in a patient’s life, we might instead represent injustice. But realizing it is the first step. By doing so, we can start dismantling the ways in which we aid in the systems that abuse them and find ways to regain their trust. The best initial step, I think, is by knowing what we don’t know and to dive right into it. Physicians and health professions in training tend to practice their scientific mind, but it is just as important to study racism, sexism, homophobia, etc. Again, if we can think critically about enzymes and physiology, then we have the capacity to think critically about our patients as well - to realize the intersection of psychosocial factors rooted in institutionalized oppression that leads to toxic stress in our patients and ultimately produces the mental, emotional, and physical symptoms that they currently and will suffer from. Racism in the hands of medical professionals are killing patients, and if we don’t realize that these forms of oppression exist within the romanticized white walls of a hospital and actively explore them as intense as we explore the pathophysiology of a disease, more patients will suffer at the hands of our ignorance.

As hard as it is to hear: medicine is racist, it is homophobic, it is sexist. Once we realize this, the next step is asking oneself: How can I change how I practice medicine in order to make it as free from social injustice as possible? Serving vulnerable populations means having to navigate the social injustice that patients face on an everyday basis in order to treat them as a whole. Why should that injustice also exist within the exam room?

To put it simply, I urge the reframing of our narrative: that yes, physicians can be healers and advocates but to always, always, always include the caveat that we are just as capable of being agents of oppression. As I stand on the precipice of with my entire career in front of me, I ask myself: what am I going to do to change that?

Instead of doing no harm, why don’t we try doing good instead?

Candice Mazon   DUCOM 2019

 

References

1. https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why
2. https://www.washingtonpost.com/news/to-your-health/wp/2016/04/04/do-blacks-feel-less-pain-than-whites-their-doctors-may-think-so/?noredirect=on&utm_term=.51b88adc7e59
3. https://www.advocate.com/commentary/2015/07/27/op-ed-how-we-can-address-homophobia-doctors-office
4. https://www.health.harvard.edu/blog/racism-discrimination-health-care-providers-patients-2017011611015