A piece of their own heart

On the night of August 21, 2020, a young, white man was caught spraying black paint over the eyes of the George Floyd memorial at the intersection of 38th St. and Chicago Ave. Pictures were posted across social media, asking anyone with information to contact community activists. It was not long before he was identified as a 4th year student at the University of Minnesota Medical School.

A few days after the news of his actions became public, a meme began to circulate on social media. Yellow text on a background of maroon, emblematic of the University of Minnesota’s colors, declared that “you can’t be a doctor and a racist except… if you attend the University of Minnesota School of Medicine #takehiswhitecoat” (@projectdiversifymedicine). The post was meant to be provocative. I thought it missed the point.

In a lecture on Structural Racism in Health Care during Becoming a Doctor week, an important reminder was given to us- “Do not assume that medical training has inoculated you from practicing racism, in fact the opposite may be true.” Becoming a physician does not automatically grant an individual moral superiority or purity. And it certainly does not give one immunity from the influence of a racist society. And how could it? Medicine does not exist in a vacuum. There is nothing inherently anti-racist about anatomy lab and biochemistry. Western medicine is an American institution, like all other American institutions, meant to advantage white people through historical, cultural, and interpersonal dynamics. Let us not forget the American Medical Association’s historical practice of barring black doctors from membership, delegitimizing black medical schools and supporting segregationist policies (Baker et al., 2008). While the @projectdiversifymedicine post was met with a chorus of “I can’t believe it” and “this is so shocking”, one user wrote:

“That first slide is confusing to me… because I know many, many racist doctors. The anti-racist doctors are the exception in my opinion. (@minamooshie)”

Medical school admissions committees are the gatekeepers of our profession. When the lack of diversity in medicine is highlighted, the spotlight often falls on the medical school admissions process. How to increase the number of underrepresented students at our medical school. How to create a process that mirrors our utopic vision of America’s future doctors. The idea that somehow the rigorous process of medical admissions will select out racist individuals is naive at best, damaging at worst. One might argue that, in fact, medical school admissions are designed, whether consciously or unconsciously, to benefit those with privilege, resources and institutional power. Who else has seen the studies correlating socioeconomic status to standardized test scores?

I knew the student who defaced the George Floyd memorial. He was one of 12 in my faculty advising group. During the first two years of medical school we spent hundreds of hours together, learning how to take a patient history and complete a physical exam. We even sat in a conference room on the 6th floor of the Phillips Wangensteen Building on a wintery day in 2018 and discussed the social construction of race. What will be unsettling to some is this- he was not extraordinary. He did not stand out. In all of our discussions he never gave any hint that he was a closet bigot. A more meticulous admissions process would not have picked him out. There were no red flags. He was decidedly average- a white, Christian male, from a family of great socioeconomic means. He was a prototypical medical student.

The idea that “you can’t be a doctor and racist expect…” gives people comfort. It furthers a narrative that the way to prevent damage to communities of color is by identifying and weeding out bad actors. It creates separation. I would never, so therefore I am not. Like all things in life, it is not that simple. How do you prevent other students like him if they are not waving confederate flags and spewing hate at every opportunity?

We expect extraordinary acts from institutions that were created to uphold the status quo. Despite the talk about commitment to underserved populations, diversity and equity, medicine has historically been an institution for the elite, for the people who have always benefited from power in America. The process of becoming a doctor is a series of checkpoints, each one an opportunity to narrow the field. You can trace the disparities back to before an individual was born. Medical students from the top 5% of households (based on income) are overrepresented not just compared to the U.S. population but students at all U.S. colleges (Youngclaus & Roskovensky, 2018). Medical school admissions committees know this and yet they continue to value ivy league education over state schools and HBCUs, high test scores and experiences not available to students from lesser means.

Undoing the legacy of medicine in America requires a departure from the way things have always been done, but this reality would be painful for those who have enjoyed the benefits of our current institutions. Upending the status quo would mean for many turning away their brothers, children, and friends. I am reminded of a quote from The Gulag Archipelago by Aleksandr Solzhenitsyn (Solzhenitsyn, 1974-78). Reflecting on the Soviet forced labor camps he writes:

“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” 

If the medical field is truly committed to lasting change, it will need to do more than appoint chief diversity officers and mandate social justice training. We had lectures and discussions on race in our curriculum, one of our peers still defaced the George Floyd memorial. A process which produces significant change will not be easy.

For many it will feel like they are destroying a piece of their own heart.

…

References

Baker, R. B., Washington, H. A., Olakanmi, O., Savitt, T. L., Jacobs, E. A., Hoover, E., & Wynia, M. K. (2008). African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide. JAMA, 300(3), 306-313. doi:10.1001/jama.300.3.306

Solzhenitsyn, A. I. (1974-78). The Gulag Archipelago, 1918-1956: an experiment in literary investigation New York: Harper & Row.

Youngclaus, J., & Roskovensky, L. (2018). An Updated Look at the Economic Diversity of U.S. Medical Students. Association of American Medical Colleges, 18(5). Retrieved from https://www.aamc.org/data-reports/analysis-brief/report/updated-look-economic-diversity-us-medical-students