June 17, 2020
By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP Board Member
When I was in elementary school in the 1970s (I know, I just gave away my age), we had to fill out a form stating our future career choices and our skills. I was the only black child in my class, my family having moved to a white suburban area in New Jersey. Many people at our school didn't know it, but I was the daughter of a surgeon and a nurse/midwife.
I also was an overachiever. I wrote down "doctor."
The following week we were given our "future career" sheets. Mine said, "secretary." Now, there is nothing wrong with that profession, but I knew they must have made a mistake because I had clearly chosen "doctor." So, I raised my hand, and my white male teacher came over to me. I explained that there was an error because I was going to be a doctor. He tilted his head, smiled and said, "Oh no, you can't be a doctor. But if you study really hard, maybe one day you can work in a doctor's office as a secretary."
At that time, I thought all adults were all-knowing and wise and that he must have been telling the truth. So, when I went home that afternoon, my mom asked why I looked so sad. I informed her that I had really wanted to be a doctor, but it turned out I could only be a doctor's secretary.
I won't repeat all the words she uttered, but at the end she said to me, "You can be anything you want to be. Don't you ever let anyone tell you what you can or cannot be. If you want to be an astronaut or the president, so be it!"
(Little did we know we would send more than a dozen black astronauts into space -- including a woman physician -- and elect a black president in our lifetime.)
That was my introduction to racism.
In high school, on the junior varsity volleyball team, none of my teammates would sit with me at lunch during away games. (Again, I was the only black person). They would joke about my hair. The coaches never intervened.
Life was better at my all-black medical school because I fit in. Note that at this time I was training outside the United States, so the history of slavery was not part of the fabric of society. However, I did an OB/Gyn rotation at another site, in a different country, where I found racism to exist even in a country with a black majority population. I witnessed a nonblack attending use a scalpel to puncture a black patient's ovaries during a pelvic surgery. He closed her up and said, "These people breed like rabbits. We have to do our part to control the population."
I was horrified. I spoke to someone in administration and was told that it was not my place to complain. The attending found out and swore I would fail his rotation. I was able to find a workaround and made sure to schedule all black female patients with other surgeons and told them to spread the word to their friends and family members.
Then there was residency back home in New York, where I was the only black person in my class. My family medicine faculty were kind, but a few attendings from other specialties would make snide comments. I remember being on call for OB and calling the attending to give an update on a patient he needed to evaluate. He asked my name, and when he realized which resident I was, he told me I was foolish for calling him. He said he wasn't going to discuss this case with me and that I should get a senior resident on the line. I informed him that not only was I the senior resident, I was also the chief and if he didn't want to speak to me, I would have no choice but to call the chair of OB. This kind of back and forth didn't happen to my fellow residents who weren't black when they were on call with him.
And I can't forget the time a nurse refused to let me use a room for lactation because, she said, I would "contaminate" it. (Other residents were allowed to use the same on-call room. There were three of us, out of 27, who had newborns).
Or when we had an unspoken rule of laboring white patients getting epidurals and people of color getting the meperidine/promethazine IV combo, which did nothing for pain. (Thank goodness for order sets that came through to semi-equalize treatment).
Or as an attending (director of the hospitalist program) when a white male patient who was having an MI told me he wanted an "American doctor" to look after him. (Now understand this: I was born in Brooklyn and thought that qualified, but I digress.) My first order of business was to make sure he didn't die, so I called a white male colleague who came in to care for the patient.
Let me tell you what my colleague did right: He treated the patient, but all the while he kept saying, "You really missed out on the best doctor in the building. She is actually my boss. And she knows her stuff. You don't know how you messed up an opportunity for some amazing care."
Did I mention the patient was a cardiologist?
So yes, I have learned that racism exists on both micro and macro levels at all stages of life. (I've written about how it affects my family recently on my personal blog.)
I won't even begin to tell you about how I was treated as a black female patient; that is for another blog post.
So, my job now is to not stay quiet when someone is making a racist remark toward another individual, be it a patient or a health care professional. Silence is one of our biggest problems, and we need to learn to intervene and ensure the person is aware of the inappropriateness of their comment and why.
I try to remind myself to speak up at work meetings. However, when I find myself the only black person in the room, I still feel I must balance the need to be vocal with not sounding too aggressive, lest I be considered an "angry black woman." If only others would ask, "Hey, Tochi, what do you think of this idea?"
And I try and try to not be discouraged each time I request a position or ask to be included in a strategy or operations meeting and am denied -- and younger, less experienced white men are automatically given the positions. When I point this out, I am met with, "Well, we didn't think you would be the right fit," or "Oh, I didn't think of you, maybe next time," or "You know, I just need your support to rally the troops, leave the hard work to the rest of us."
I could give up, but I know there are many young black people who have hope because they see my picture online for various organizations or they bump into me in the medical school or the corporate buildings or hospitals.
I thank God every day that I have the New York State AFP and the AAFP, where I am encouraged to spread my wings and share my ideas.
We make sure to mentor as many people of color as possible -- clinicians, administrators, housekeeping, dietary staff, etc.
We keep trying.
But we need others -- including our nonblack friends and colleagues -- to try, too.
It's a heavy burden to be the victim of an injustice and at the same time be expected to create the solution.
We look forward to sharing the resources the AAFP has and those it is developing to help all of us do better. The Academy is holding an all-member event that will focus on racism at 7 p.m. CT on June 22, 2020, and will remain available as a video on Facebook and YouTube.
Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is a member of the AAFP Board of Directors.
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