ADVICE FOR BLACK PHYSICIANS AND PHYSICIANS IN TRAINING

Having a mentor who shares the same experiences as you is important when traversing the Canadian medical profession. Two special benefits gained by having Black mentors: having a source of aid in case of trouble, and more importantly, possessing a guide to success. Discussions with someone who understands the challenges that you are facing, have faced and will continue to face are important. Someone who understands the obstacles that are inherent to the medical profession as a Black minority and who accomplished what you want to accomplish can be a good role model and a critical resource in navigating your career. As well, having someone who believes you can do it is crucial to success. Inherent to academic settings is the politics and bureaucracy that you need to know. Any mentor will be able to help you tremendously, but someone who is Black and has previously experienced the politics and bureaucracy can help you a little more to navigate exactly what you need to do, who you need to talk to and how you need to present things. Based on the reported experiences Black physicians and residents of needing to do more to get the same recognition, they believed a Black mentor successful in their career must have broken through more barriers than someone who was white. Black mentors can be more critical than non-Black mentors in an effort to make sure you "make it." In addition, we encourage nurturing several important relationships with non-Black mentors who directly address the race issue and make promoting your career a priority.

As you encounter obstacles and challenges within your career, it is fulfilling and empowering to help those that come after you to achieve the same success and to avoid the same pitfalls that you encountered. Remember that you did not get here on your own. So as you rise, always remember to lift those who follow. Be purposeful and deliberate in word and action. Be unapologetically excellent and unapologetically different.

Seek a therapist who will understand the  obstacles and challenges that you encounter on a daily basis. Unresolved emotions and feelings of sadness, anger and shame need to be worked out and holding these feelings internally will erode your mental health and happiness. The emotional burden that Black physicians are encumbered with is not inconsequential and taking action against it is critical to safeguard your mental health and well-being. 

Build a support group around you of Black individuals and non-Black allies. Relationships with Black colleagues, mentors, support staff, family and community can be better sources of support. These relationships can provide day-to-day psychological comfort, professional development and help with career planning. It can be relieving to find people whom you can share this experience with … people who look like you, talk like you, and can understand you. Find a variety of very strong social supports, including Black patients, support staff in the hospital,  colleagues and dedicated mentors (both Black and non-Black). Black physicians uniformly report that Black patients take special pride in having a Black physician. Many Black physicians state that Black support staff give them similar encouragement. This support includes expressions of admiration and support as well as concern for your personal welfare. A number of Black physicians experience a comforting sense of familiarity in seeing Black faces among support staff. Another source of social support can be the peer network of other Black physicians and physician trainees, and so, actively seek them out. Endorse a functioning network of communication, shared experience and support.

Confronting non-Black physicians about racial injustices may seem like a bad idea because perpetrators may have influence over your career. You might ask yourself: What would I say to them? How do I expect them to react? Likewise, you might feel that reporting the incident to an administrator will prove futile, and possibly even damaging to your future. Most people are not blatantly racist, and may have trouble understanding why you had interpreted them that way. You might fear that these influential people will perceive you as a hypersensitive, borderline-militant Black physician looking to make everything into a racial issue. You might also have an aversion to controversy, and shy way from the possibility of a reputation that might endorse that. You may turn your anger, humiliation and hurt inward and just work harder as to not live down to people's expectations. However, internalizing injustices will wear you down and racial injustices must be addressed to evoke any type of change. When you are witness to a colleague who expresses racial prejudice, understand that you have an important role as a physician to step in and confront your colleagues. Patients in the care of people who have racial prejudice will not receive the optimal care that they deserve if their healthcare providers hold these beliefs about them. Report mistreatment to a superior. Report it to a governing body. Report it to us and we can advise you on how to navigate the issue. Seek legal counsel. We have experience communicating with CMPA (Canadian Medical Physician Association) who may be able to advise you on any legal action you can and wish to take. 

The decision-making process of any physician would first need to consider the medical condition of the patient and the necessary duty to provide care. The questions you may be asking yourself include:

• What was going through the patient's mind when they made that request?
•  Why did they not offer any space for discussion or to debrief? 
• What prevented my supervisor or colleague from saying something directly to the patient? 
• What prohibited my supervisor or colleague in engaging in a conversation with me to elicit my experience of this encounter? 
• What do I make of my supervisor or colleague's silence? 
• Am I expected to manage my emotions on my own? 
• If so, why is this expectation an acceptable one?

It is important to understand that these racial assaults can and do cause harm to you, as does the silence of your supervisors and colleagues. There is a growing literature by health care practitioners that chronicles episodes of racial bias and discrimination and the emotional harm that they have experienced. In such cases, there are guidelines provided (in the form of a decision tree) for emergency department physicians to consider when presented with patients’ requests for reassignment based on race or ethnic background. The decision tree balances the duty to provide care to racist patients with recognition of the harm to targeted physicians by taking into account whether the patient is medically stable. Institutions should not accommodate patients in stable condition who persist with reassignment requests based on bigotry. When there is no imminent danger of patient harm, you or the institution may, and should, deny requests that are based solely on bias and bigotry.

Because the experiences of Black physicians and physicians in training are individual and multifaceted, it is difficult to trace which consequences arise from race-related encounters. However, you may at some point contemplate leaving clinical medicine due to the strain of racial tension, either completely or into a different career within medicine. The emotional consequences can include a damaged sense of self and a lack of confidence in professional roles, as well as feelings of being on guard at all times, doubting yourself and being frustrated with the system that surrounds you. Career consequences can also be variable, including choosing an institution based on racial diversity among faculty and difficulty advancing into leadership and faculty positions because of bad evaluations or a lack of systemic support. To counter this, it is important to establish a coping strategy. One important coping strategy is strengthening social networks by seeking rapport with non-Black colleagues and with Black colleagues and faculty. If you are a physician in training, actively seek out other Black trainees as roommates. Another coping strategy is standing up for yourself and race because you may only have a few advocates. Correct people who use culturally insensitive language. Another mode of assertiveness involves making sure that your strengths and accomplishments are recognized properly. Unfortunately, you may have to perform at a higher standard than your majority colleagues. Many Black physicians and residents believe that they have to work harder, go the extra mile, attend more carefully to details and be more aggressive in group settings to ensure their own success and to protect themselves from punishment. Constantly remind yourself of your own self-worth. 

You may be unnerved by the idea of ‘forcing’ yourself to fit in to a culture that is seemingly the antithesis of who you are. It is difficult being your “true self” at work, especially when you face challenges reconciling your professional and personal identity. As the workplace becomes increasingly diverse, we encourage you to bring your “whole self” to work, which may inspire and encourage other Black colleagues to do the same. 

Be forewarned, the journey on which you embark is often unkind to people who look like you. There will be days when your brow is beaten by micro- and macro- aggressions, designed to rob you of your dignity. At times, they will imply that your Black life does not matter in this profession. At times they will just say it outright. It will be said with snide comments, masked with a thin façade of humour. It will be said with off-putting looks and glances, subversive nonverbal speech and back room conversations to your exclusion. You will be told that you do not fit the mold. That you should just be happy to have a seat at their table. That your name, hair, accent, mannerisms, etc. are not reminiscent of their concept of what a physician should be. When those days come, we need you to fight. Fight without fear or hesitation. Fight with every ounce of your brilliance. Fight, as if the lives and livelihoods of generations of Black people depend on it. Because they do. We need you. And we need you to be you. Your unique perspective and experiences make you invaluable to elevating the standard of patient care. You will forge iron-clad, therapeutic alliances with your patients, that will enrich your life and theirs. Your viewpoints will allow you to redefine, not just what a physician can be, but what a physician should be. But if said viewpoints are lost on this journey, what good does that do? So, when that ever-present shadow of insecurity attempts to enter the back door of your mind, remember the great host of witnesses who surround and support you. When they attempt to gaslight you, disenfranchise you or just straight up ignore you, remember that you stand on the backs of giants. But even more importantly, remember to use your platform to speak truth to power. Use your influence to speak for others when they cannot speak for themselves. Use your bully pulpit to overturn the status quo when it perpetuates injustice.

-Excerpt from a letter written by Dr. Kwadwo Owusu-Akyaw