President Trump recently made national headlines by calling a female reporter “Piggy,” an act widely decried as outrageous, even for a man who doesn’t shy away from misogyny. It’s one thing to intentionally refer to someone with a derogatory, dismissive label. This kind of behavior should appropriately be met with indignation and moral outrage. But what happens when we carelessly (and repeatedly) call someone a name that belongs to someone else of the same race? Where is the spotlight then?
Several years ago, a good friend shared a personal story that has stuck with me over the years. Nowadays, she’s a pediatric anesthesiologist at a major medical center. Back then, she was completing her anesthesia training at the same institution where I was an internal medicine resident. One of her supervising doctors approached her in the hospital unit to provide an update on a patient’s care plan. This is not uncommon between health care providers. But it soon became clear that this exchange was anything but typical. Instead of rattling off the usual suspects of medical acronyms that characterize verbal handoffs between health care professionals, the supervisor spoke in lay terms and asked my friend if she had any questions about the patient’s care plan.
Eventually, my friend figured out that her supervisor, with whom she had spent many hours together in the hospital, had mistaken her for the patient’s family member. My friend is an African American woman. So, too, was the patient. Unfortunately, my friend’s experience isn’t unique in medical education. A few years ago, when conducting interviews with residents who identify as racially/ethnically underrepresented in medicine, my research team and I found that issues of racial mistaken identity were a common theme.
Despite the frequency of these incidents, the health care field does little to acknowledge these errors. And it’s not just confined to one racial group. Over the years, I have had many South Asian and East Asian residents (mostly women) from a wide variety of ethnic backgrounds share that they are routinely mistaken for coresidents perceived to be of a similar race. It comes from all levels of the organization, including supervising physicians, nurses, care coordinators, and administrative leaders.
It would be one thing if this phenomenon only occurred between colleagues who are mere acquaintances, with little exposure beyond a passing smile in the doctor’s lounge. And we can’t blame face masks; health care providers have plenty of unmasked interactions in workrooms and educational spaces. In my friend’s case, and in the case of our research participants, they were misidentified by people with whom they shared the kind of experiences that would presumably lead to knowledge of identity (for example, dozens of hours together in operating rooms, or several educational touchpoints with a program director).
These kinds of errors do little to contribute to a sense of professional belonging in a field that already struggles to provide positive workplace experiences for health care professionals with marginalized identities. This is not just about people’s feelings. Practically speaking, it is only a matter of time before a health system that consistently misidentifies its staff has an HR nightmare on its hands. When this topic comes up in professional settings, someone inevitably shares a story of how a medical student evaluation was completed by a confused evaluator, or a time when it was unclear if a letter of recommendation was truly written with the right person in mind.
These days, trainees are less likely to stay silent about such mistreatment. And rightly so. After all, if we as health care providers have become cavalier about knowing who we’re working with, it begs the question of whether this lack of attention extends to our patients. Instead of the next headline about the wrong limb being operated on, will it be a story about how the wrong person was operated on?
To be clear, racial misidentification doesn’t make you a bad person. Psychology buffs will tell you that there’s a well-studied phenomenon known as the cross-race effect, in which people are more likely to remember faces that share their own race, compared to those of a different racial identity. This effect is likely exacerbated in a medical training environment, where trainees rotate through different patient care experiences. But the key lies in intentionality. Mistaken identity can and should be overcome by taking the time and effort to know people as individuals and resisting the urge to put our colleagues in racial “buckets.”
And if all else fails, we have ID badges. There is no excuse for not taking a moment to check a name tag. In an age when the health care field is devoting significant time and resources to create high-reliability organizations with lofty metrics for patient safety and quality improvement, let’s make sure we don’t forget the basics: knowing who’s on our care teams.
Racial mistaken identity in medical education matters more than we give it credit for, harming our providers, threatening our ability to fairly assess trainees, and embarrassing our profession. It’s time to pay attention and stop the bleeding.
Aba Black is an internal medicine physician.
