Many health care professionals go into health care to help people, no matter their race, socioeconomic status, or other identities. Even as white health care professionals start to learn about the systemic nature of racism, something that our Black and other colleagues of color have experienced their whole lives, we may still see health care as “different” from all those other systems out there that are racist. Because we care for people of all races and we think of ourselves as good people who have dedicated our lives to our profession, we don’t see ourselves in that narrative.

Unfortunately, health care is just as complicit as the other systems in our society. The data showing the disproportionate effect of COVID on Black and Latinx people wasn’t anything new; it was highlighting health care disparities and inequities that have been there for hundreds of years.

It’s not always obvious. Yes, we can all look at examples such as the blatant misuse of HeLa cells from Henrietta Lacks, or the Tuskegee study, and think that this is the only way that racism shows up in medicine.

It isn’t.

But it serves to allow us to get outraged at these horrible examples and let ourselves off the hook. We can point our finger at those other events and reassure ourselves that we would never participate in such racist acts.

To even begin dismantling systemic racism at its root, we have to talk about something that makes many people uncomfortable.

White supremacist culture.

Before you click that little red x at the top left, lean in for a moment. To understand, we must broaden our view of the term itself.

When we talk about white supremacism, we are not necessarily talking about the extremist white supremacist movements like the KKK, proud boys, or people who go to white pride rallies. While they are an element of white supremacism, they are not the entire thing.

Our whole culture is one of white supremacism (rather than white supremacists) in that it is designed to keep white people in power. Groups like the KKK and white nationalists are the fringe, while the culture is the fabric of our daily lives.

As a Black female physician, it’s not uncommon to be with white male or white female physician colleagues in the hospital’s patient rooms and be referred to as nurse while they were referred to as doctor. Or even to be asked for another tray of food.

While it seems subtle, it sends the insidious message that because they were white, they were automatically thought of as higher status. That is an example of white supremacism as a way of thinking … as a culture. There are at least a dozen more examples we could mention, but it’s important to remember that cultures define and shape the people who live within that culture, and it is often unnamed, unwritten, and uncodified. Just by the very fact of living within the white supremacy culture of the US, every one of us gets influenced and racialized by it. Not just white people, everyone. One way to think of it is the water we swim in or breathe air. Because it’s so pervasive in our lives, it’s hard to notice it, but the fact is, it’s all around us all of the time. We can’t avoid it.

When we as physicians can recognize (and name) these occurrences that represent the ideals of white supremacist culture in the systems within which we operate — personally and professionally — we can create a new culture that is equitable and just.

Dr. Tema Okun wrote a widely-referenced article about fourteen characteristics of white supremacy culture. While it’s beyond the scope of this article to talk about all fourteen, we’ll explore one here: paternalism.

We invite you to notice your own reactions and emotions as you read about paternalism. It may also be helpful to take a few deep breaths and even take a few minutes to write about the emotions that come up.

Paternalism occurs when people in power make decisions and set standards of normal and right on behalf of people who do not have power and assume they are qualified to make these decisions. They rarely consider the needs or viewpoints of people for whom they are making decisions and setting standards, and the people without power clearly do not have the power to make these decisions on their own.

We can see paternalism in health care leadership. We, the health care leaders (some of whom have no medical experience), know what’s best for the health care system, patients, doctors, and the health care providers. It’s no wonder so many health care workers are burning out.

This can also show up in our doctoring. “We” (doctors who know better) recommend this treatment for “you” (who doesn’t know better), and if you speak up for yourself, we will likely consider you non-compliant or difficult. And we’ll write about it in your medical record. “White saviorism” is another example of paternalism that can show up in international medical mission trips.

If you’re already feeling uncomfortable (and even reactive) to what you’ve just read, please know that this is a normal response, and it means you are human. You may notice your “ooh, I totally do that” or strong feelings of “I never do that,” or “other people do that but not me or my organization,” or even other strong emotions of defensiveness or guilt coming through. Those reactions are not signs that you are a bad person; rather, they are clues that more work needs to be done.

This is just one of many symptoms of white supremacist culture. As you begin to recognize it in your own life — either externalized or internalized — this is a good sign, as it is an essential step in being able to take action to dismantle it.

Learn more about the Conscious Anti-Racism programs.

Jill Wener is an internal medicine physician and can be reached at her self-titled site, Jill Wener, MD. Maiysha Clairborne is an integrative family physician and is the co-author of Conscious Anti-Racism: Tools for Self-Discovery, Accountability and Meaningful Change.

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