Reflective Practice 101 – Session #5:
“There is a strange kind of enigma associated with the problem of racism. No one, or almost no one, wishes to see themselves as racist; still, racism persists, real and tenacious.” – Albert Memmi, Racism
In his book, Thinking Fast and Slow, Nobel prize winner Daniel Kahneman describes two ways our brains process information – predictably, fast, and slow. Our fast-processing system (which he describes as “system I”) is dependent upon heuristics. A heuristic[i] can be thought of as a mental shortcut that eases the process of decision-making, but which may not always lead to optimal decisions. By contrast, our “system II” allows us to make thoughtful, deliberate decisions. This is not to denigrate our fast-thinking capability – it offers innumerous benefits, and is likely responsible for our ancient ancestors’ survival (think about running away from a tiger) but it has its limitations. Specifically, system I makes us prone to biases and assumptions. These next three sessions of RP101 will allow us to consider our assumptions and biases as they relate to three topics that are both commonly encountered in the healthcare arena and often challenging for providers – Racism, Obesity, and Sexuality. We begin with the session on Racism.
Discussing race and racism can feel taboo. On a societal level, this may be due in large part to our national mythology that (1) describes our populace is as a “melting pot”[ii] in which we are all merged into a single unified entity and (2) tends to avoid discussions of the many historical injustices committed as a consequence of racism in our relatively short existence as a nation. On a personal level, engaging – and by that I mean truly, openly, and honestly engaging in a discussion about racism – is often challenging. Such engagement requires each of us to start by exploring our own racism and that of our family of origin and the community in which we grew up.
Such work, and it is indeed work – typically far harder that memorizing the Krebs’ Cycle – can be difficult for myriad reasons. We may feel guilty when thinking about our own actions in the past, we may feel disloyal for critiquing the actions taken and words said by our families and friends who have given us so much, and we may feel anxious wondering what others will think of us if and when we share. In short, for most of us, the challenge of this critical work, is that it can threaten our own personal mythology – and in so doing, requires us to be vulnerable.
This session, focusing on Race and Racism, begins with a panel of healthcare providers who will both share with you stories describing their own racism as well as the racism they have witnessed/experiences in the healthcare arena. In these narratives, you will hear about macro-aggressions and micro-aggressions and how significant an impact each can have. They will share with you their vulnerability, something which Dr. Brene Brown, an expert on the topic describes as the best measure we have of courage.
Recognizing our biases, in this case racism, and examining the impact they have on our interaction with patients is important for all healthcare providers, but especially so for military physicians who care for a community composed of people from nearly every race, religion, gender, age, and from a wide array of cultures. It is my hope that witnessing the panelists’ examples, and reviewing the session readings will inspire you to match their courage in your writing and small group discussions. I thank you in advance.
- Jeffrey Hutchinson, COL, USA is the Associate Dean of Clinical Affairs, Chief Diversity Officer, and Assistant Professor of Pediatrics at the USU F. Edward Hébert School of Medicine.
- Suzanne Minor, MD is the Family Medicine Clerkship Director, Faculty Mentor, Green Family Foundation NeighborhoodHELP™, and Assistant Professor of Family Medicine, at Florida International University in Miami, Florida.
- Jaclyn Skalnik, LCSW is a nationally known adoption therapist and adult adoptee who grew up in a military family. She has particular expertise in transracial and international adoption and is the founder of Adoption Wellness.
Preparation for the panel
Prior to the panel, listen/watch/read 1 or more of the selected readings at the top of the page. Thereafter, but prior to the panel, reflect on your own biases and assumptions about race. As part of this contemplation, consider times in the past in which you have committed/witnessed/experienced micro-aggressions and macro-aggressions as they pertain to race and how such aggressions might impact the provider-patient relationship as well as healthcare outcomes.
Reflective Essay (R.S.I.P. format)
Reaction: As stimulated by the panel and supplemental resources, identify your reactions to each of the following: (use bullets to list your affective reaction followed by 1-2 lines describing those aspects of the panel/resources that evoked your reaction):
- Your consideration of your own racism
- Two or more topics discussed by the panelists and/or in the readings
Sources/Your Story: Through the medium of your personal narrative, explore the sources of these thoughts, feelings, and reactions. Your narrative must include specifics and be written in the first person. Your sources will likely include one or more of the following:
- your perceptions of how race was viewed in your family of origin and the community in which you grew up
- your perceptions of how race was viewed among your peers and in your community during your early adult life
- your experiences to date discussing and considering race/racism and the impact it has on society at large and on your own personal relationships
- your perceptions of how race is viewed in the military and medical communities
Implications: For each reaction in your Reaction section, identify and examine both the positive and negative implications of those reactions for future patient care.
Plan: Develop a plan that you can implement in the next week that is:
- concrete, specific, and feasible
- is tied specifically to one (or more) of your reactions and its implications
To get some ideas, you may want to check out the resource section of this website and/or The Winter Institute’s Welcome Table Concept.