How the culture of health care perpetuates racism [PODCAST]

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“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.”

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.

They share their stories and discuss the KevinMD article, “How the culture of health care perpetuates racism.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. On today’s show, we have Jill Wener and Maiysha Clairborne. Jill is an internal medicine physician. Maiysha is an integrative family physician. And together they wrote the article “How the culture of health care perpetuates racism.” Jill and Maiysha, welcome to the show.

Jill Wener: Thank you so much. It’s good to be here.

Kevin Pho: So we’ll get into your article in a little bit, but I’ll ask both of you to briefly share your stories and journeys to where you are today. Jill, why don’t you go first?

Jill Wener: So I am an internist, as you mentioned. I practiced hospital medicine for 10 years and transitioned out of clinical medicine in 2016, unwittingly, but ended up becoming a meditation instructor and EFT tapping practitioner. And I started getting into anti-racism work in 2016, after I got called out, or maybe I got called out, about a blog post I had written, and I started to take the work very seriously. Then I attended a training in 2019 called Allies in Action with Leslie Mac and Paige Ingram that really opened my eyes to even more things and helped me start to even conceive of taking this work outwardly, instead of it just being something for my own life.

And my contribution as a white woman, for people listening who can’t see my skin, is that I am part of the problem. I do a lot of hard work to try to realize how I might be contributing, and I use the tools, the meditation, the tapping, and other tools, to give myself the emotional intelligence, really, to hang in there when it gets really tough. And I was nothing until I met Maiysha, so.

Kevin Pho: So hey, Maiysha, briefly share your story and journey to where you are today.

Maiysha Clairborne: Of course. So as stated, I’m an integrative medicine family physician, and I retired from clinical medicine in 2016. My journey actually was to physician wellness, so I’ve been very committed to the health and well-being of moms in medicine.

However, in 2020, and we’re going to fast-forward because I’ve done a lot of things in between, when the deaths of Ahmaud Arbery and Breonna Taylor and George Floyd, the murders of these three, happened in succession, it hit very close to home. And of course this was amid the pandemic, and I was already feeling a little bit restless about, you know, how I could contribute. For me, with my particular brand of expertise as an NLP practitioner, hypnotherapist, and person who’s got expertise in communication, conscious communication, I felt like I could bring something different to the world of, you know, this diversity, equity, and inclusion conversation.

Enter Jill, and she had created Conscious Anti-Racism, and together, you know, we found our complementary selves, to be able to expand and do this work inside of health care systems and beyond, and to create the course and re-create the course. So for me, it was the events of 2020 that sort of catapulted me, because of lived experience. I’ve dealt with this all my life, and it was the events of 2020 that really flipped the switch for me.

Kevin Pho: Sure. Then you talk more about both of your anti-racist work and that intersection with health care in the KevinMD article “How the culture of health care perpetuates racism.” So Jill, for those of you who get a chance to read that article, just walk my audience through it. Share the story, why you and Maiysha decided to write it.

Jill Wener: Sure. So there’s a really, really incredible article called “The characteristics of white supremacy culture” that was written by Dr. Tema Okun and her mentor, Kenneth Jones. She talks about 15 or 16 attributes of culture that perpetuate racism, that perpetuate the power structure that is in place right now, which is keeping white people at the top and other people, to varying degrees, not at the top. And that’s one of the things that our Conscious Anti-Racism curriculum is really based on: how to recognize those characteristics within ourselves and also in the world around us, and then the tools to improve that, to process the emotions, and then also to do better moving forward.

So what we really wanted to do was take a look at how these characteristics show up in health care, because they’re everywhere, and health care is no exemption. As a white, liberal, well-meaning physician, I never would have said, “Oh yeah, I’m part of the problem,” back when I was practicing medicine. And I think bringing some of this to light can really help people to see where they might be. Even if it’s not telling, you know, racist jokes and stuff, there are still things that happen all the time that contribute to this culture that upholds the power structure. And so that was really what we wanted to highlight. One of the characteristics that we highlighted was paternalism, which is something that’s widespread everywhere in our world but also extremely widespread in health care.

Kevin Pho: So Jill, when you talk specifically about paternalism in health care, what are some examples that you can cite?

Jill Wener: Maiysha, do you want to jump in?

Maiysha Clairborne: Sure. Well, you know, particularly the fact that this is a very male-dominated industry. We can look at the pay structure. We can just start with that, the pay structure: If you were to look at the pay structure, you would see that between male physicians and female physicians, there is a gap in pay. So that’s just part of it.

And then there’s this whole idea of “one knows best,” like, as a physician, we know best, and without any feedback. Now, that’s something that’s bred into the culture. That’s something that I learned: “You’re the doctor, you know best.” But that’s a very paternalistic attitude that is conditioned into the culture. I mean, that’s just one or two examples of many, many that we can provide. And it’s subtle. It’s not like people who are paternalistic are racist. It’s like these are some of the attributes that coexist and hold up racism.

And there’s, I mean, assuming that someone wouldn’t want a job promotion because they have a family, or “Oh, they wouldn’t want it because it would be too many hours,” or something like that: making decisions on behalf of other people without actually asking them. That comes up a lot as well, and it even exists in attitudes toward moms and women, and women, I should say, the attitude towards moms in medicine. And not just from men to women, but women to women, women leaders to other female physicians: the attitude towards when a woman physician chooses motherhood, chooses family, and chooses to take care of herself over, you know, breaking her neck in the clinical space.

Kevin Pho: So if one sees an episode of paternalism, such as you and Jill describe, what are some things that we could do next?

Maiysha Clairborne: You know, I think that noticing is probably the first thing, and one of the reasons that we wanted to bring this article is to bring in awareness. A lot of things are in our unconscious, or in the background, or in our blind spots. But when you begin to understand the nature of paternalism, then you can notice it in oneself and in another, and you can sort of gently name it, right? Sometimes it’s gently. Sometimes, for some who are experiencing it, it may not be so gently. But noticing and naming are probably two of the most powerful things that can happen in the space, if it feels like a safe space to do so, because we have to acknowledge that medicine has not always been a safe space for people to name things, especially when it goes against the grain.

Kevin Pho: And Jill, same question to you. If one notices instances of paternalism, what are your recommendations in terms of how we can respond to that?

Jill Wener: I think it’s like Maiysha said: When you learn about it, you see it everywhere. It’s like once you’re aware of it, it’s everywhere. So if you’re on rounds and seeing someone with the attitude that they know better than the patient, and the patient doesn’t, they don’t know enough about their own body, we’re the ones that are making the recommendations, how dare they question us, pipe up. You know, “I wonder if it would be helpful for this patient to share more about their experience.”

Or with, like, international medical missions, white saviorism is a really big example of that, and I’m totally guilty of it. I’ve done it myself, so there’s no finger pointing out there. It’s pointing back at me at the same time. So just questioning, like, “What is it that I’m really looking to do out in this country? Do I think I’m better? And if so, why?” And questioning that, noticing it, naming it, and then questioning, like, “Is this right? Is there another way to think about it?” I think is also important.

Maiysha Clairborne: Can I just add one more thing? I love what you said, Jill. There’s a way that you name something, and it’s, you know, using the “I wonder” and the “I notice” words: “I noticed that,” “I wonder if this would be helpful for us to do.” In addition, the “yes, and” is often very powerful in language, because it’s not the naming itself, it’s how it gets done that can cause the backlash. So the “I notice,” and the “I wonder,” and the “I’m confused about something,” you know, we call it the Columbo.

Kevin Pho: So let’s put some of those ideas in action. As you know, medicine is a very hierarchical organization, and sometimes it’s difficult for medical trainees, students, or even junior attendings to speak up against that. So take some of the ideas that you just mentioned, and maybe give a case example of how someone who is lower down on that medical hierarchy can speak up against some of the patriarchy that they may see. So I’m going to ask Maiysha. Why don’t you take that question? Put some of those ideas in action. What are some specific things that they can do or say?

Maiysha Clairborne: Well, before I say that, what I want to say is, it’s in our culture: It’s not safe for residents and medical students to speak up, as of now. So a lot of the onus falls on the leadership, and they have to make it safe, right?

So perhaps if a junior resident or a medical student wants to speak up about something that they’ve seen, then maybe they bring together a consortium of students, because oftentimes membership helps, right? And then there could be maybe an indirect approach. Like, a letter could be written, because that gives some space between the recipient and their ability to react in response, and then they can go get checked in, and then come back and respond. That could be an approach for, say, medical students particularly, but even a resident could write a letter or write an email saying, “Hey, can we meet?” Taking it to the side rather than doing it in public, you know, so maybe not in front of the patient, because there’s an automatic defensiveness that could come with that. But maybe later: “Hey,” just knock on the door. “I just wanted to say that I noticed something, and I wonder if this could have been helpful.”

So in a sense, it’s not questioning the authority, but it’s, you know, getting some context. So I would say those would be very practical ways to approach it, if a junior is wanting to speak up to, say, a senior physician or a resident. I mean, yeah, a senior physician, an attending.

Kevin Pho: And Jill, you mentioned that in the beginning there were 14 characteristics of white supremacy culture that sometimes are infiltrating health care. We talked about patriarchy as one. So what’s another one that you would like to talk about today?

Jill Wener: Oh, God, there are so many. So yeah, paternalism for sure. Perfectionism is one of them, and I feel like anyone listening to this who is in health care at all can probably relate to perfectionism.

Only one right way: Because we learned about it in allopathic medical school, then that is the way that it should be done. And therefore, you know, chiropractors sometimes cause vertebral artery dissections, so therefore they’re all quacks. You know, it’s that mindset of “we are one right way, and if it’s not like us, it doesn’t work.”

Defensiveness. So Maiysha, when you were talking about, you know, when someone speaks up, the first thing that happens generally is defensiveness. That’s the sign of a culture where we’re not going to challenge the power structure. And so for people to learn when they’re getting defensive is huge in shifting culture, because that’s like learning the skills to recognize when it’s happening, like, “Ooh, I’m starting to, I hear myself saying these things,” or, “My heart’s pounding.” When we realize we’re being defensive, it’s like, how can we learn to speak up, but also, how can we learn to receive the speaking up? How can we be called in? And so I think defensiveness is a huge one that is so powerful to recognize. I mean, I’m defensive all the time. It’s so much a part of our culture. And it’s also using tools to get to know yourself better. It actually is something that can be addressed. So those are a few, but there are so many more.

Maiysha Clairborne: Another one I definitely want to add is either/or thinking. We call it binary thinking. Either/or thinking is very exclusive thinking, and it doesn’t leave space for creativity, which, you know, as much as medicine is a practice of science, it is an art as well. And there are solutions that can be arrived at when we do the both/and rather than the either/or. So that either/or is another characteristic.

And then worship of the written word. Particularly as a person who’s in integrative medicine, there are practices that are still emerging in their evidence-basedness, right? And with that worship of the written word, it’s like if it’s not in the textbook, you know, right here, then it is not valid. So that is another example of one of the characteristics as well.

Kevin Pho: So let’s talk about next steps. We’ve identified several characteristics where the culture of health care perpetuates racism. So let’s talk about the path forward. Jill, what is the path forward?

Jill Wener: Well, train yourself. Get yourself educated. I think really the first step, if you’re anybody, any identity, is to recognize that this white supremacy culture impacts all of us in different ways. No one is exempt from it. And it doesn’t mean that we’re all racist. This is not a personal judgment at all. It’s just a sign that there’s discovery and an inquiry that needs to happen. So recognizing, like, “I’m part of the problem. I’m impacted by it. In what way?” Not “Am I?” but “In what ways am I perpetuating it?”

We trained a board of a health care organization, and the CEO was a Black woman, and she was like, “Oh my God, I’ve been doing things in my business, the way I’m running the business, that are characteristics of white supremacy culture,” that she hadn’t even seen. So it’s not only about white people. This is everybody, because it gets internalized if you’re kind of the object of it and on the receiving end.

So recognize that you yourself may be part of the problem, and then start to do the inquiry. Look within. Start to read stuff. Ask. You know, don’t depend on people of color who are on the receiving end of racism to educate you, but start to educate yourself. We have an online course that’s CME-accredited, so something like that. There’s a bunch of stuff out there. We have a book. There’s so much wonderful education out there for people to learn, to take accountability, because there’s so much work that needs to be done on a systemic level, and also the system is made of individuals.

Kevin Pho: Maiysha, tell us about the path forward.

Maiysha Clairborne: I think that, you know, just to piggyback on what Jill said, one of the biggest things is to be open. Be open to that, that maybe the way that you think is not the only way to think, and that it has been influenced by the culture around you. And then once you start to be open, it makes it easier to look within, right? As they said, we’re not convicting people. This is an exploration.

And I do think, and I know that this is beginning to happen, but there definitely needs to be top-down commitment. So we need the commitment of CEOs, leaders, and leaders of departments. This can’t just fall on, you can’t just throw a person of color in a DEI position and say, “Here, handle this.” This needs to be a collective leadership effort if we’re going to shift the culture. And we have to also understand that it’s not going to happen overnight, so we’ve got to be ready for the marathon. This work is not easy; however, it must be done, right? That’s a paraphrase of a quote.

Kevin Pho: And my final question to both of you: take-home messages to the KevinMD audience. Jill, we’ll start with you.

Jill Wener: Ooh, OK. The take-home message is: This isn’t just about racism. It is a lot about racism, and everyone in this world has someone that they love that is impacted by, on the receiving end of, policies that don’t include people. You may know someone who has autism or ADHD, or they have hearing issues or other physical disabilities, or they’re gay, or they’re not citizens. There are so many different identities that are impacted by this, and the more of those identities you have, the more you’re impacted. So the take-home message is: This is for everybody, and doing this work benefits. It doesn’t make white people have less. It brings everybody up, and I think that’s really important to remember.

Kevin Pho: Hey, Maiysha, your take-home messages?

Maiysha Clairborne: I love what you said, Jill, of course. And I think what I would add to that is to begin to just notice. Notice your thinking. Notice your space, even listening to this podcast. Notice what’s going on in your body. Let that be an indication for what work needs to be done, and be open to do it, because just being willing to be uncomfortable, I mean, this is not even comfortable for people of color or for people with marginalized identities. People think it’s easy for, you know, Black people to talk about racism. Nah, it’s not. So just notice what’s going on. Be willing to sit in the discomfort, because that is where the transformation occurs.

Kevin Pho: Thank you so much for sharing your time and insight. Thanks again for being on the show.

Jill Wener: Thank you, Kevin. We appreciate it.

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