When Race and Gender Intersect in Medicine: Microaggressions for Doctors

Becoming a medical doctor takes years of training, including grueling hours of clinical practice. It would seem that graduating from medical school and completing all the required internships and residencies would entitle the graduate to the respect of peers and clients-but not if you are a Black woman. It’s not that Black male doctors don’t experience disrespect because of race, but the intersection of race and gender means Black female physicians experience a double dose of it.

A useful term for describing a lot of the disrespect that Black female physicians experience, and the ensuing impact, is microaggressions. Emma Goldberg of the New York Times explains that microaggression is a term coined in the 1970s by Dr. Chester Pierce, a psychiatrist, that refers to “subtle, stunning, often automatic, and nonverbal exchanges which are ‘put downs’” of Black people and members of other minority groups. She notes that “micro” refers to the routine nature of these exchanges, not the scale of their impact. In fact, the impact can be quite damaging because the injuries to self-esteem and confidence are often cumulative for individuals. Goldberg cites Dr. Kimberly Manning, an internal medicine doctor at Grady Memorial Hospital in Atlanta, as explaining, “It’s like death by a thousand paper cuts” and “It can cause you to shrink.” Dr. Sheryl Heron, a Black professor of emergency medicine at Emory University, explains that “after the twelve-thousandth time, it starts to impede your ability to be successful. You start to go into scenarios [in your head] about your self-worth.”

What do microaggressions look like for Black female physicians? Here are some examples:

  • Onyeka Otugo, an emergency medicine doctor, was often mistaken for a janitor or food service worker, even after introducing herself as a doctor. She goes on to say that people would often ask her when the doctor was coming and ask her to take the trash out.
  • Phindile Chowa, an assistant professor of emergency medicine, describes one patient who repeatedly forgot her name while quickly learning the name of her white male colleague during the course of her hospital visit.
  • Damon Tweedy, in an article he wrote for the New York Times, described a patient telling him to “go back to Africa,” and his white supervisor said and did nothing once he was told about it.

It does not help, of course, that there are very few Black female physicians. Goldberg notes that

  • Only 5 percent of the American physician work force is African American, and roughly 2 percent are Black women.
  • Only 3 percent of emergency medicine doctors identify as Black.
  • Just 7 percent of the student population at American medical schools are Black.

The recent revelations from the Covid-19 pandemic about the dramatic health disparities between white people and African Americans highlight one reason why it is so important for there to be more Black physicians. Goldberg notes that “a 2018 study showed that Black patients had improved outcomes when seen by Black doctors, and were more likely to agree to preventive care measures like diabetes screenings and cholesterol tests.” Black patients have a good reason to distrust the medical establishment. Tweedy notes that as recently as the 1970s, “Black people were experimented upon under the guise of scientific study and sterilized without their consent.” Black female doctors are aware of the importance of their presence to reassure Black patients that they can trust preventive care measures. Black physicians are also attuned to discriminatory practices that create hardship for their patients. For example, Black patients are prescribed less pain medication for injuries comparable with those of their non-Black counterparts and are often left to suffer needlessly without the advocacy of a Black physician.

Both Goldberg and Tweedy suggest steps that the medical establishment needs to take to support the success of Black female doctors and to undo the racism deeply embedded in the medical establishment. Some examples include

  • Publish the experiences of microaggressions for Black female physicians, as was recently done by four female physicians of color in a paper in the Annals of Emergency Medicine. The authors Dr. Melanie Molina, Dr. Adaira Landry, Dr. Anita Chary, and Dr. Sherri-Ann Burnett-Bowie hope to reduce the sense of isolation of Black women doctors by shining a light on microaggression. They also hope their work will raise the awareness of their white colleagues who will change their own behavior and become white allies.
  • Continue to diversify emergency medicine departments to reduce the isolation of Black doctors and to amplify their voices.
  • Conduct training of doctors and physician educators on implicit bias, and evaluate their behavior in tangible and accountable ways.
  • Root out the racism still deeply entrenched in the cultures and curriculum of medical schools.

We need to address health disparities in our country, and we cannot make progress until the medical establishment changes.

Anne Litwin, Ph.D. is an Organizational Development and Human Resources Consultant, Keynote Speaker, and Author of ‘New Rules for Women: Revolutionizing the Way Women Work Together.’

Originally published at https://www.annelitwin.com on November 2, 2020.

Author of ‘New Rules for Women: Revolutionizing the Way Women Work Together', OD Consultant, Keynote Speaker, and Workshop Trainer

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