RP101 – Racism – March 2018



Session Readings

 

Reflective Practice 101 – Session #5:
Racism


Background

“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.

[i] , coming from the ancient  greek word heuriskein (meaning to find out or discover through experience)
[ii] More recently this term has been replaced by the term “salad bowl”


Panelists

  • 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.

Assignment

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):

  1. Your consideration of your own racism
  2. 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:

  1. concrete, specific, and feasible
  2. 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.

NPRRacism is bad for your health Across virtually every medical intervention, from the most simple medical treatments to the most complicated treatments, blacks and other minorities receive poorer-quality care than whites. African-Americans who are college-educated do more poorly in terms of health than whites who are college-educated. And these racial differences in the quality and intensity of care persist for African-Americans irrespective of the quality of insurance that they have, irrespective of their education level, irrespective of their job status, irrespective of the severity of disease.
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tedmed_wh_rgbThe problem with race-base medicine Social justice advocate and law scholar Dorothy Roberts speaks on the injustices that race-base classification plays on proper medical diagnosis and treatment.
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this american life logoThe Problem We All Live With Right now, all sorts of people are trying to rethink and reinvent education, to improve outcomes. But there's one thing nobody tries anymore, despite lots of evidence that it works: desegregation. Nikole Hannah-Jones looks at a district that, not long ago, accidentally launched a desegregation program. First of a two-part series.
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HuffPost-social-icon-00-defaultI Thought My Ivy League Degrees Would Protect Me From Bigotry. I Was Wrong. Dr. Saadi shares her struggle with racist and stereotypical comments from patients and other healthcare professionals, despite clearly haven proven herself as extraordinarily capable in her work.
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SalonDotComI hated not being white: The lies I told just to fit in haunt me still Medical student Tom Phan shares his struggle with racism as an Asian-American, beginning with his name change from "Tung" to "Tom" and his childhood desire to "fit-in" to the white culture.
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thisibelieveprojectI Am a Racist and So Are You We can choose to believe that we are not racist...or we can be honest with ourselves.
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statTeaching medical students to challenge 'unscientific' racial categories Dr. Cunningham speaks of the racial stereotypes in medicine that are continuously delivered and poorly addressed in medical school curricula.
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logo-toast-homeWhat Goes Through Your Mind: On Nice Parties and Casual Racism Nicole Jung, Managing Editor of the Toast, shares a personal story that reveals not only the hurt that stems from microaggressive racist comments, but also the awkward and unsure way to navigate a reaction.
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Session originally created by: Adam Saperstein | SOM/GSN, Uniformed Services University | Director, Reflective Practice | Family Medicine