How was I a racist today?

My husband and I have been having more and more conversations about race, racism, and equity. Being a biracial (sort of, I mean, Arabs are considered "White") couple, the issue of race probably comes up for us more than some of our friends. I've been drawn deeper into the world of racial equity and wanting to be more of an activist and advocate in my own right. We decided to listen to "How to be an Antiracist" together on audibles. We listen to a chapter each night (started two days ago, so we're two chapters in). I'm also listening to "So You Want to Talk About Race" by Ijeoma Oluo. In my learning about racism, privilege, and fragility, I'm taking stock of all the times I've been a racist. Sure, I don't go around using racial slurs, or burning crosses, or truly believing that people deserve to be offered less or valued less because of their race. Yet, I have often said racist things, thought racist thoughts, and held racist beliefs. Being able to sit with that knowledge has been uncomfortable and humbling, to say the least. It's strange to wake up and realize you aren't as "woke" as you thought you were. In this journey of self discovery in order to be an advocate, the one thing I've truly learned to do well is be wrong and learn from it. My reckoning last night was that I can be a racist and still be striving towards being anti-racist. I have to learn what I'm doing that is racist, and then stop, and try to topple the system allowing it. So I've been thinking back to some examples of when I was distinctly thinking I was not a racist, and still upholding racist ideas. I remember listening to a discussion about Black health disparities within psychiatry, and not being able to stand the notion that psychiatrists were racist. When given information about how Black people are more often prescribed older medications, instead of being able to see that this can be racist, I retorted with "maybe it's because we know our Black patients can't always afford the more expensive medicines, adn they don't work that much better anyway." When faced with "Black patients are more likely to be seen as aggressive in an ER" I came back with "sometimes a very loud, agitated patient can seem psychotic in that moment." I was so defensive, and standing up for psychiatrists. I honestly felt like because I was White appearing but not White, I had a better understanding of and ability to articulate what psychiatrists were actually trying to do, instead of listening to these Black advocates explain to me how my profession can be racist. At the time, I was so proud of my "performance" in this discussion, but now I'm ashamed of how I behaved. Anyone there would have been hard pressed to label me a "racist" but I sure was allowing a racist system to continue to go unchecked. This past weekend I was working in the psychiatric emergency room and a Black woman came in after being sexually assaulted. She told me she was in pain and asked for pain medication. My immediate thought was "she just wants narcotics." Why am I so quick to judge another person's pain? I ended up giving her medicine (non-narcotic, as I don't like prescribing opioids anyway), but when I went home, I had to seriously reflect on how much of the racist teaching we get about Black people in medicine (they have less pain, or thicker skin) that I don't even remember learning, had been imbedded in me. How much was my response due to her being Black. How much of it was bias towards pain in general, which (like sleep), I have difficulty wanting to medicate away. On Monday, I was waiting for my second patient of the morning to show up. As I was disgruntledly thinking "my Hispanic patients are always late" I remembered chapter two of Ijeoma's book, where she specifically gives an example of how this is a racist thought. Why am I always assuming my Hispanic patients will be late? Why, when a White patient is late, do I not have that same reaction? Why am I willing to generalize all of my Brown patients this way? I thought more about it, and realized that being "on time" is a construct of a White society. Many Brown people view time as more fluid. So my Brown patients are often late, but maybe it's not the same value to them as it is to me. Maybe, in reality, my White patients are just as often late (they are) but I don't assume they will be because of the color of their skin. How was I racist today? How will I be racist tomorrow? I've also been actively anti-racist, which definitely takes more work. Learning about what it truly means to be anti-racist (more than just saying I'm not racist) has been eye opening. Today I made sure my White students were able to acknowledge the racism within medicine. Today I was also able to call out a friend who had made racist comments on social media. Today, I actively made sure I was offering my Spanish speaking patient the same explanation of medication and offerings of services that I would my native English speaking patients. I'm actively trying to learn and teach and preach anti racism. What a strange journey this is. I apologize for all the times I was racist in the past, and hope to minimize the number of times I'm a racist in the future.

Psychiatry stigma in medicine

Today I led a small group session for 3rd year medical students on their first week of their psychiatric service. Every week they do a reflective writing piece based off of a prompt, and come together to discuss this. I vaguely remember doing this in medical school when I was a student. Normally the course director leads the group, but he was busy today and asked me to instead. Each of the four students sent me their reflection ahead of time. This week's was general: what are you nervous about for your psychiatry rotation? I decided to write my own reflection, but I couldn't really remember the start of that rotation. It was the last one I did in my third year (well, except for surgery which I had to make up at the end of the semester. I had failed my board exam and was pulled out of the surgery rotation to study). Maybe by that point I wasn't as fearful about a first day. Maybe I've just forgotten about it. Either way, I could only reflect on my first day of intern year instead. Having not planned to go into psychiatry, and only having done one rotation in pediatric psychiatry, I was pretty scared of psychiatric patients. I wasn't sure what to expect, or what I was going to do. I wasn't sure about what medicines to use, or how to treat people. I felt like I'd be going in at a distinct disadvantage to everyone else. And yet, I loved it. It was the start of my love affair with psych. The students all had somewhat similar reflections. Worries about 3rd year in general (this is only their second rotation of the year). Wondering how to talk to psychiatric patients. Worries that they'd be in harms way. What were they supposed to do with a psychotic patient? How does one even talk to a person who is sharing their trauma? What if I say something wrong and insult someone? or make them feel worse? Even though I remember worrying about these same things when I started my internship, now, years later, it makes me sad how nervous people are to be on their psychiatry rotation. Specifically, how different, other, and scary the patients seem. The preconceived notions people have about our patients, like they aren't "normal" or are somehow more dangerous or fragile. And I recognize how we perpetuate this stereotype within medicine. On the general wards, as soon as someone mentions depression, they're "one of those psych patients." A consult is called and everyone else ignores the problem. The patient is then treated differently for the rest of their stay. In medical school, we are teaching the students to fear their psychiatry rotations. Everyone has images of violent, aggressive, "crazy" patients that they couldn't possibly relate to. If even our doctors carry that bias, that psychiatry is somehow "other" or scary, how can our patients feel supported and safe in our communities? Imagine already being so scared by the voices you hear that no one else can, and yet you're seen as the scary one. How do we help patients get the care we need, if we continue this way of seeing our psychiatry patients? I don't think many of the other rotations ask for reflective writing. I imagine a general prompt of "what are you worried about starting your medicine rotation" would bring responses of "I'm worried I don't know anything, or I'll fail my patients, or hurt someone with my inexperience." I doubt they walk into a room fearful of the patient themselves, or the disorder they are presenting for. Yet there's no difference between the patients. They're all human beings asking for help, needing medical care. I asked the students today to think about this bias. I reminded them that psychiatric patients are more likely to be the victims of violence than the perpetrators. I expressed to them all the joy they could find in psychiatry. I tried to give them tips and pointers in how to talk to patients, be present with them, acknowledge their life stories, and remember they are regular, normal, human people needing and deserving of our care. There's such a shortage of psychiatrists in this country, and all over the world. How can we get our medical students more interested in this rotation? If we can't end the stigma of psychiatry within medicine, how will we be able to continue providing care for these vulnerable patients. I remember loving psychiatry in my third year, but not even considering it as a career for a second. I had to be a pediatrician. A "real doctor." I couldn't imagine enjoying this forever. I couldn't understand going through medical school to be "just a psychiatrist." I thought I'd "hang up my stethoscope forever." What would my family think of me? Or my community? Psychiatry had never crossed my mind until third year. Even with all the joy it brought me, I didn't give it much of a thought. I was blessed enough to not get into pediatrics. It was a tough blow at the time, but a blessing from God himself nonetheless. And yet, there are still some times when I feel like I'm "not a real doctor." I feel like I don't really help people. I'm not saving lives like a surgeon or a pediatrician. If they asked for a doctor on a plane, I'd be terrified. Why do we allow psychiatrists to feel ostracized like this? Why do we stigmatize psychiatry so much that even the profession has to face the bias. Being a psychiatrist still didn't stop me from being so biased against my own patient population that it took me years to get back on Zoloft, when I knew I needed help yet refused to ask for it. It's made me wonder whether I would want my daughter on the medicine I prescribe so many other children. Would I make her suffer unnecessarily with symptoms that can be treated because I'm worried what other people will think of me? How do I reconcile these warring thoughts and feelings in my head. Thankfully, I'm have a robust response to Zoloft. Being able to feel my mind clear, and my anxieties become more manageable, has helped me become a stronger advocate for my patients. Why should people suffer because of some stigma we've put out there? I'm hoping we can all continue to do better. I'm hoping I can help future doctors, one medical student at a time.