Physicians have been front and center in stories about problematic individual behavior and commentaries seeming to deny that structural racism and gender bias exist in healthcare delivery systems.
We don't think about this enough. We are oblivious to this in our daily experience. Many of us have the privilege of being able to tune in or out on these issues depending on what happens during our day, whether seeing patients or handling administrative responsibilities.
It is laudable that the CDC on April 8 declared "Racism is a Serious Threat to the Public's Health," but as much as we may think we understand these issues, the truth is, we don't.
We can't, because we are white men.
Both of us have benefitted from the inherent societal advantages of these traits. From admission to competitive colleges to medical school to various other opportunities, there is no doubt that being white and male carried an inherent advantage. Despite awareness of and training in implicit bias, there is no way that we can truly appreciate the day-to-day consequences of racism and sexism on colleagues and trainees who are not white men like us.
During our recent year as Officers of the American College of Physicians, we became closely involved with the role such an organization can and should play in establishing policies in the areas of justice, equity, diversity, and inclusion (JEDI). Much work over the past few years culminated in policy papers on topics such as social determinants, gender equity, , and .
These papers contain expansive and important ideas on how to move forward. Organizations can use them to craft JEDI policies -- but we wonder how to translate these concepts into needed changes in personal, professional, and societal norms.
Stories in the news have shown how well-intentioned individuals, , healthcare delivery systems, and other organizations struggling with difficult decisions around bias and discrimination are trying to balance doing the right thing with legal ramifications and concerns over bad publicity. The clear pernicious impact of structural racism and structural gender inequity on so many individuals and groups has been .
How do we make these JEDI principles part of our daily lives? We have created our own to-do list: Avoid microaggressions in our daily personal interactions and call out those that we observe in others; watch our words carefully; try to imagine walking in the shoes of others; redouble our efforts to mentor students, residents, fellows, and peers who are not white men; don't dismiss the feelings or perceptions of others because we cannot ever fully understand the experience of other genders or individuals with non-white skin. As white male physicians, we need to act within our professional societies to advance both women and persons of color to leadership positions at all levels. Doing anything less means we are enabling a tacit perpetuation of the status quo.
We catch ourselves in our own biases every day. One of us, when hearing from his wife about family members seeing doctors, has typically responded, "What did he think?" And the response is frequently, "The doctor was a she, not a he." Ouch. Despite being surrounded by many women as fellow physicians for over 30 years, the instinctive assumption, the bias, was that the doctor was a man.
Similarly, when told a nurse called and relayed some message, the response was, "What did she say?" Unbelievably, this still happens. We all know that nurses can be of any gender. Yet, stereotypes and bias lead us to automatically speak with certain words. The patterns of thinking and speaking are so ingrained that it takes conscious effort to recognize and resist them.
Recently, in adjourning a medical student class, with 60% women, one of us said, "OK, guys, have a good day." Guys? How could that happen so instinctively, when it was clear that "folks" was more appropriate? Even these slips of language, though not intentional or malicious, are small reminders that this is a male-dominated world.
There are innumerable allegations of racism and gender discrimination committed against patients and fellow healthcare professionals. As physicians who presumably lead many aspects of our healthcare delivery processes and systems, we simply cannot stand by silently. Structural racism and gender bias permeate our society, including our healthcare system, and we must wherever it occurs. The responsibility to do so falls heavily upon us as white male physicians.
Like COVID-19, we might have been stricken with a condition, called White Male Privilege, unknowingly and without overt symptoms. But it is there, it is contagious, and it is harmful. And like COVID-19, denying its existence carries grave risks. White male physicians in particular need to be part of the solution, to recognize the immense benefits we have received through no particular effort of our own, and to do everything we can to promote JEDI principles consistently and vigorously today, tomorrow, and every day thereafter.
We must make a commitment to point out where there is under-representation of the perspectives or experiences of non-white people or other genders. But it is not just bringing them to the table or inviting them onto the committee. It is actively listening and being agents of change ourselves.
Robert M. McLean, MD, is an associate clinical professor of medicine at the Yale School of Medicine in New Haven, Connecticut, and practices primary care, internal medicine, and rheumatology at the Northeast Medical Group of the Yale New Haven Health system.
Douglas M. DeLong, MD, is an associate clinical professor at Columbia Physicians and Surgeons in New York City, and a general internist at Bassett Healthcare in Cooperstown, New York.
The authors' opinions are their own and not written on behalf of an employer or organization.