There is no area these days that is immune from charges of systemic racism. The authors of the article below, published in The Journal of General Internal Medicine (JIGM) single out medical education. You can read the article by clicking on the screenshot below, or get the pdf here. Below the first screenshot you can find a precis of the journal article from the Yale School of Medicine website, but it’s not much shorter than the original two-page article, which will be the one I’m discussing and quoting from.
At any rate, medicine may indeed have racists working in it—indeed, there’s some evidence quoted in the article that black patients don’t get treated as well, medically, than white ones, and also some quasi-racist misconceptions about blacks from doctors. But I’m not so sure you’d call that “systemic” racism—a racism imbued in the system.
But never mind about that. Insofar as there is racism in medical education, the question is how to eliminate it. The authors propose a simple solution: keep racists from getting into med school. They couple that with the notion that you’d want to preferentially admit students not just who aren’t racists, but who are deeply committed to social justice. After all, you can not be a bigot but have other interests besides further social justice.
This all raises several questions. Is the ditching of racist candidates something we should be concentrating on?. If so, how do we do it? What degree and kind of racism should keep you out of med school? Will the proposed methods work, or just drive bigotry underground? Is any racism grounds for dismissing a candidate? If a candidate isn’t that committed to social justice, but has other extraordinary talents that are worthwhile (outreach, general empathy, etc.), will those help her? I don’t know the answer to any of these questions, except that the methods proposed are rather authoritarian and would seem to be easily obviated by bigoted students intent on becoming doctors. The set of procedures (there are many) smacks of the approved “diversity statements” that some schools require from candidates for academic jobs—statements that can get you rejected at the outset even without your credentials being vetted (see posts here).
From Yale Medicine, a summary:
The obligatory disclaimer: First, I support initiatives to increase the diversity of medical school students and their teachers, as well as medicine in general. Further, I’m not denying that minority students may face bigotry in medical school, or patients may face bigoted doctors. Nor am I in favor of letting invidious racists into med school when their bigotry is seen as a serious problem for their work. But, as authors like Robin DiAngelo incessantly inform us, all white people are racists to some degree (we have “implicit bias”), so the problem becomes what degree of racism is tolerable in a med school applicant? And that’s where the problem comes in, because the ways these authors suggest for sniffing out the racists smacks of heavy-handed Critical Race Theory. They even mention intersectionality, for you might want to sniff out those who are bigots on several axes.
Let’s review the methods the authors suggest for ferreting out racists who apply to med school. These come after the authors argue that “medicine is a white space” (i.e., it is full of prejudiced white people intent on “marginalizing the black person, actively reminding him of his outsider status to put him in his place”). They cite some evidence of racism, and do note that med schools have tried to dismantle the “white space” with diversity-enhanced curricula and faculty, as well as “education on implicit bias and microaggressions.” But, they imply, this is not enough:
We propose a more direct way to address racism in medical training: stop admitting applicants with racist beliefs.
. . . Medical school admissions and residency programs could build on some of these current modes of evaluation to ascertain whether applicants hold racist beliefs or invalid and fixed views on biological differences between races.
This already raises red flags. How “racist” is “racist enough to get your application deep-sixed?” Since everyone has implicit bias, there must be some threshhold specified that will get your application booted no matter how good your qualifications are. Further, what are “invalid and fixed views on biological differences between races”? This is in fact an area of ignorance and controversy. Certainly there are biological differences between races (I prefer “populations” or “ethnic groups” to avoid the loaded and controversial idea of “race”); for one thing, their pigmentation and morphology differ, and those are biological differences. I suspect there are physiological differences as well, though their size and their relevance to medical care are unknown.
The ways of vetting (all indents are quotes from the JIGM article):
For example, a short questionnaire could be used to flag significantly uninformed individuals who may not yet be ready to care for patients or interact with their non-white peers in a respectful manner. Applicants could be given surveys adapted from studies on implicit and explicit bias.
As far as I know, “implicit bias” tests have been found to be flawed and faulty. But that aside, questionnaires, interviews, and essays will of course alert students who, knowing that even the hint of racism is grounds for dismissal, will do all they can to look like social-justice warriors. Explicit bias tests must surely be easy to defeat, and it can’t be that hard to tweak an essay to look really woke, even if you’re a Proud Boy.
Application essays are also opportunities to understand an applicant’s views on race in medicine. Many medical schools, including Yale School of Medicine, include secondary essay prompts about applicants’ perspectives on “diversity.” These essays could be enhanced to more clearly elicit applicants’ positions on race: for example, reflecting on their own racial or ethnic identity; or responding to selected passages by prominent scholars on race and medicine, such as Dorothy Roberts or Harriet Washington.
Again, if you have any neurons at all, you can simply say what you want the committee to hear. In contrast, you can’t fake your credentials, test scores, or college grades, or (unless you’re Lori Loughlin’s kids) your accomplishments.
Interview questions evaluating applicants’ views on race could be similar to essay prompts or they could be more direct questions, such as “Do you think Black patients are more likely to be poor historians than white people––and if so, why?”
Now what would you say to answer that question if you wanted to get into med school. The right answer is clearly “no”. (I don’t even understand the question, though.)
4.) MMIs. (These are “multiple-mini-interviews––where applicants rotate through several rooms responding to different prompts––to assess qualities such as communication, empathy, professionalism, integrity, and ethical reasoning. My emphasis below
MMI scenarios could be based on discriminatory experiences reported by minority faculty, trainees, and students: a peer implying that an underrepresented minority (URM) medical student was admitted only because of “affirmative action”; a professor suggesting that race is biological; or an attending telling a patient not to take a racial slur “so personally. Due to the intersectional nature of identity, MMI scenarios could be designed to touch on multiple forms of discrimination simultaneously. MMI stations could also ask applicants to respond to a summary of a study on racism in medicine.
This has a bizarre similarity to those “quick dating” scenarios where someone rotates among potential dates quickly, spending a few minutes with each. It also reminds me of rushing at fraternities in college: an experience so distressing, because you knew you were being evaluated quickly and on the basis of a few sentences, that I dropped out after the first day. To me, this doesn’t sound like a good way to vet candidates.
5.) Student-hosted discussions.
Student-hosted discussions of race in medicine could involve students and trainees of color engaged in racial justice work or affiliated with groups such as the Student National Medical Association (SNMA) or the Latino Medical Student Association (LMSA). Host students or trainees could then evaluate candidates’ racial attitudes in a more informal setting.
Given the wokeness of students these days, this sounds even more fraught. One misstep, or one misinterpreted word, and you’re gone. And if you don’t adhere down the line to Critical Race Theory, you’d be toast.
6). Interviews by community members.
Interviews by minority community members could assess applicants’ attitudes about non-white patients. In White Coat, Clenched Fist, Dr. Fitzhugh Mullan described such a strategy. He recounted how parents from the South Bronx formed Lincoln Hospital’s Pediatric Parents Association (PPA) and participated in interviewing residency applicants in the 1970s. Mullan recalled that “mothers from the PPA spoke up right from the start, often asking tough questions about applicants’ attitudes towards blacks or Puerto Ricans.
I’d prefer to leave the professionals—those who work for med schools, do the vetting, especially if the admissions committee is diverse (see recommendation #7). If this strategy was so efficacious, how come it appears to have died in the Seventies.
7.) Diversifying admissions committees.
Diversifying and educating admissions committees and interviewers is essential, because they will be responsible for locating a given candidate on a continuum of racial attitudes which would then be weighed as part of their overall candidacy.
I have no issue with this, though diversity historically has rationales other than sniffing out racists. Rather, on admissions committees it’s a way to ensure that minority candidates get a fair vetting, at least partly from those in their own ethnic group who, presumably, have had similar experience.
As the authors note, these procedures aren’t designed just to eliminate students who are racists, but to “select for students who are committed to social justice.” But why limit these methods to med schools.? Since all areas of academia, especially STEM fields, are said to be “white spaces” and riddled with systemic racism, why limit this kind of vetting to med schools? After all, don’t those fields also need scholars committed to social justice? One might answer that, well, it’s especially important for doctors to treat patients in an unbiased fashion, but biases in fields like STEM are said to cause large amounts of harm, both psychologically and to people’s career prospects. Indeed, this is the reason why schools like the University of California are mandating diversity statements for job applicants in other fields.
Finally, as I noted above, what about those students who are neutral on the racism scale, perhaps showing a tiny bit of implicit bias but with no outright racism, but with a terrific background in other desirable traits, like doing outreach or having terrific lab skills that could make him a great medical researcher? How much racism counts against these other talents? In the University of California, those other talents aren’t even considered unless your diversity statement passes a threshold of acceptability (and that bar is pretty high).
In the end, the authors admit that people can change (then why boot out the purported racists at the outset?), but they don’t use a very good example to show that:
To be sure, people’s beliefs can evolve, especially in environments that strive to change curricula, diversify medical schools, and counteract racism in medical culture. This was the approach taken by the Black Panther Party, which not only rigorously evaluated physicians for their commitment to racial justice before allowing them to practice in their clinics, but then required those physicians to receive a “re-education” on race and anti-colonialism even after they had been accepted as volunteer medical staff.
“Re-education” smacks not of the realization that you could do better, but of an attitude drilled into people through force and propaganda. That’s hardly, I think, what the authors would want to inflict on med students. Or would they? Perhaps!
89 thoughts on “Medical-journal article suggests eliminating applicants to med school if they’re racists”
What these doctors propose borders on an inquisition. I can see rejecting candidates that have openly expressed racist notions or behavior in the past. But, what they want to do is to plumb the deepest recesses of a candidate’s mind. What is important in the medical profession, as in most, is not what the person thinks, but what the person does. Medical schools should stress to students that they must treat all patients with the best care, regardless of race, gender, ethnicity, sexual orientation, etc. If they don’t, the consequences will be severe. What they think or believe is their own business, but their personal attitudes can in no way impinge on their performance.
It made me think of Philip K Dick’s notion of pre-crime.
Pre-crime? You’d need VALIS for that. 😉
if it makes sense to label and exclude racists from admission, it makes sense to expel racists after admission.
more, actually. if someone’s facebook post in high school or college is a sign of racism, objectionable statements from a more mature person would seem even more objectionable.
What the person thinks has an effect on what the person does. Serena Williams almost died because of the type of bias these people are trying to keep out of the profession.
This hue and cry about social justice warriors is infuriating to me, since I’ve been the victim of some white male doctors who should be in some other profession.
Oh wait… she almost died but had good treatment, and then went public about sub-standard treatment for other women. Sorry about that!
Still… lots of women (myself included) have received substandard care due to bias.
The criteria for medical school should be that you’re good at spouting the Left’s party line about things like CRT? This seems like a horrible way of adding selection bias that favors propaganda-spewing followers and discriminates against independent critical thinkers. Great, just what you want in a doctor. Someone prone to jumping on bandwagons who can partner with drug companies to bring us the next opioid epidemic and is easily swayed by powerful interests like HMOs. (Sarcasm, obviously.)
Students who have the background and grades to make it in med school already have plenty of experience giving Marxist professors the answers they want.
I also think it is very unlikely that the current generation of med students are racist by any reasonable standard.
By “racist”, they probably mean “not sufficiently enthusiastic about this week’s obligatory leftist beliefs.
If someone is a racist, they aren’t a critical thinker.
This is true if using the traditional meaning of the word ‘racist’, however, it has morphed so much that now it often effectively means ‘someone who doesn’t share my political views, often involving fad-of-the-day semantics, or controversial political topics’. Doctors recently came together to say that mass gatherings carried out by protestors are ok, essentially because police violence is a bigger risk to minorities than Covid. While I do feel like kind of a jerk pointing this out (I’m not trying to minimize police misconduct when it genuinely occurs,) this is just statistically ridiculous. Covid is a huge risk to minorities. Signing on to such a statement is in fact a sign of following what is popular, not what is objectively true. Medical professionals should be free to voice opinions on both sides of such opinions, not have to toe some party line to become doctors in the first place.
Is geography structurally racist?
But a read of Guns, Germs, and Steel makes me wonder when it will be.
I’d much rather see outreach programs to minority students that ensure, even as early as elementary school, that kids are aware that they could have a future in health sciences. This potentially could lead to a more representative group of medical students (as well as other health students). Yes, it takes time, but the pay off is huge and sustainable.
The number of women in medical programs has steadily risen, and now 50.5% of med students are women:
Yes and I think that was due to concerted conscious effort to recruit them as well as societal changes showing that women had some other options other than the traditional roles at that time. It is essential to do this with minority groups. My medical school where I work has a program that does this with Indigenous kids and they start in elementary school and visit the community. They show there are options. They have been successful in increasing the population of indigenous students in the health sciences which can only be a good thing.
Wow, this is great!
Surely, they’re looking through the wrong end of the telescope – doctors who treat patients in a discriminatory way should be struck off after they have qualified, rather than introducing some dubious pre-emptive process to prevent ostensibly suitable applicants from even becoming medical practitioners?
Why should someone like that take up a spot in a medical program when someone equally qualified who’s not an a$$hole would make a better doctor?
This seems really extreme on the surface. I can see how the level of scrutiny can become a self-fulfilling prophecy when interviewers are actively looking for racism.
But then, I have personally had some humdinger interactions with sexist doctors, and how I wish they’d been screened out before they were allowed to deal with female patients! If you’re sick, or even just going in for routine exams, you don’t want to have to defend yourself.
A year ago our primary provider in our local clinic went on an extended vacation. She was replaced, for a period of two months, by a Catholic doctor who refused to prescribe birth control pills. Patients were told that they could go to another clinic, forty miles away.
Why should half the population have been inconvenienced by one religious bozo? Nobody got a reduction in their insurance premiums because of the reduced services.
So, part of me is kind of sympathetic to preventing, to the extent possible, people of color having to experience the same nonsense.
Yeah I was thinking about my sexist interactions as well and can empathize with people who face racism. Once when I was in the emergency with my mom, who was seriously ill, I was in her “room” which was a curtain because it was the emergency and she hadn’t been admitted yet & I heard an ambulance guy say that he did some work on the reservation. One other guide made a remark about drinking at lunch time and it was a very deliberate racist remark about indigenous people. I almost said something but when I peered around the curtain I couldn’t see who made the remark and I also thought that if I made him angry or embarrassed or scared, perhaps it would affect my mom’s care somehow. So imagine if you were indigenous and you heard that remark? It would be pretty awful. I wondered how he treated indigenous people and what kind of preconceptions he carried around. It really enraged me.
THat’s horrible of course but is “Pre-Crime” type purity tests the way to fix it?
Is there any way to fix it?
I hope your Mom is better now.
It may not be pre-crime but it should be a culture where hearing such a thing is considered so offensive that the person would feel obliged to report it. A person with that type of bias shouldn’t be in health care.
Oh yes, my mom is better now. That hospital was excellent and after receiving terrible care at another hospital this one was far better and she was properly diagnosed, admitted, treated & released.
On a tangent, my doctor retired about six months ago, he sold his practice to a young woman doctor. The first time I saw her was to get a prescription renewed. As I usually do, I took my jacket off because the examination rooms are usually very warm, but kept it with me since I keep all my stuff in it. (Wallet, cell phone, keys, notepad, pen)
I was hanging it on a chair just as she walked into the examination room.
She looked at the jacket and said:
“No need to take your clothes off.”
I was so confused I didn’t know what to say. Now I think she thinks I’m a weirdo that gets naked at the drop of a hat.
On less of a tangent, so far she’s a better doctor than my last male doctor ever was. He tended to assume a great deal, she tests her assumptions.
Ha ha “weirdo that gets naked at the drop of a hat”. It sounds like a Seinfeld episode. It also reminds me of the Adam Sandler song, Phone, Wallet, Keys https://youtu.be/e9N6_Tj9u2U
My best doctors have been women.
re: undressing — it makes me wonder about that retired doctor!
Have you considered that she might have been making a joke to put you at your ease?
That worked. /s
Misogyny is indeed an angle that likely needs addressing in med school, or in med school applications. At least I’ve heard many times of doctors who dismiss female patient symptoms as being ‘all in their head’.
Pre-judging people seems like a fraught proposition.
(Just saying, as people like to say.)
In the abstract of the article, the authors cite “scholarship on the sociology of racialized space” and “personal experience” among reasons for why there’s a “long history and pervasive racism in medical culture.”
It’s difficult to get behind so many of these social justice/activism efforts, since the problems they seek to correct are poorly defined. Do the authors have an adequate sample size of “personal experiences” that help illustrate pervasive racism in medical culture?
Please see my comment above.
From a purely statistical viewpoint, I understand what you’re saying.
But, as a Supreme Court justice once said about pornography, I know it when I see it.
Recently I had a screening appointment with a doctor, who, when I described to him a bad reaction I’d had on a medication, responded by saying, “Well, that’s not on the list of side-effects”. (Here, you dumb woman, let me tell you how it is.) When I told him that it happened, regardless, he responded by saying that he had almost forty years experience in his field.
I won’t bore you with the whole litany of my bad experiences with men doctors, but suffice it to say that it’s extensive.
My doctor said that to me when I told him that Lyrica add me gain wait. He told me that can’t be it. I looked online and everyone said how they gained weight on Lyrica. I stopped taking it and lost all the weight.
It is possible that you have other experiences with this doctor that give you an understanding of his of his bias. However just from what wrote now here, it is not clear for me whether he is misogynist. As far as we can tell he handles male patients the same.
And I also could tell stories where doctors behaved similar ways. Both male and female doctors. And I am male. I once went to a young female doctor with a persistent throat inflammation and she aggressively insisted that I must be an alcoholic. (To the extent that she basically called me a liar when I told her that I rarely drink.) Did she have prejudice against men? Possible, but my working theory was that she is a follower of the “school” that says that pretty much every illness is the consequence of the patient’s wrongdoing and she would probably behave the same way to women.
And then there are male dentists, who use your breasts as arm rests. My latest dentist is my first female dentist. She doesn’t use my breasts as arm rests! I thought they all did that!
Yes, there’s a problem of bias affecting health outcomes and it’s been documented many times.
from ‘american family physician’ a throwaway medical journal that follows me wherever i go
“The authors advocated for the use of race in guiding the selection of antihypertensive medications without acknowledging that race is socially constructed. This perpetuates the myth that people of different races are inherently biologically different and warrant different treatment regimens.
Race is a sociopolitical construct that does not represent shared genetic ancestry. It is a way of categorizing people based on physical characteristics and assumed geographic ancestry, but racial categories are defined differently across societies and have changed over time.”
not much doubt the sociopolitically constructed definition of race is a socio-political construct, or that there is overlap in populations. i’m not convinced that there are no medically significant variations between populations, or that all evidence suggesting this is disproven.
I wonder what AFP thinks about sickle cell disease. Or thalassemia. Or cystic fibrosis for that matter.
I believe question 3 talks of medical history
One must be aware that from the ideological perspective of Critical Social Justice (CSJ), you’re not expected to be a nonracist, because its adherents regard nonracism as a form of racism (following the perverse ideo-logic of “silence is violence”). Instead, you’re expected to be or become a politically active antiracist. What is more, you’re expected to accept and practice antiracism *as defined and controlled by CSJ and its guardian councils*. So you’re either a CSJ antiracist or a racist. According to the CSJ ideology, both nonracism and non-CSJ antiracism are forms of racism. It follows that “keeping racists from getting into med schools” means “letting only CSJ antiracists into med schools”.
“What’s the problem with being “not racist”? It is a claim that signifies neutrality: “I am not a racist, but neither am I aggressively against racism.” But there is no neutrality in the racism struggle. The opposite of “racist” isn’t “not racist.” It is “antiracist.” What’s the difference? One endorses either the idea of a racial hierarchy as a racist, or racial equality as an antiracist. One either believes problems are rooted in groups of people, as a racist, or locates the roots of problems in power and policies, as an antiracist. One either allows racial inequities to persevere, as a racist, or confronts racial inequities, as an antiracist. There is no in-between safe space of “not racist.” The claim of “not racist”
neutrality is a mask for racism.”
(Kendi, Ibram X. How To Be An Antiracist. New York: One World, 2019. p. 9)
I am of an age when I can reasonably expect to have some interesting medical conversations at some stage in the future.
I would as sure as hell prefer to have such conversations with a doctor who had been properly trained to diagnose and treat the medical conditions of real, actual people than one who had been ‘selected for her commitment to social justice’.
Are those two aspects of training mutually exclusive?
Well, I don’t know, and that’s the issue. If my quack got into medical school because she had the scientific qualifications that are normally required, then fine. If she got into medical school because she had the right SJW credentials, I might start to worry.
I subscribed to Discover Magazine for many years.
They have a monthly column called Vital Signs, written by various doctors. One medical school professor wrote a column about students who got into medical school even though they had some pretty inaccurate religious beliefs. Two that stood out for me were the students who got into med school believing that men have one fewer ribs than women, and one who started his gyn residency believing that sex should hurt women.
Oh my. I hope those beliefs were corrected. Incidentally, anatomy isn’t required for all medical programs.
I have colleagues who teach anatomy and they say they run into the rib thing every couple years. I so wish they would ask: ‘Why do the paintings of Adam and Eve show them with navels?’
A white male can count on getting what you have said you want.
Can a woman or a person of color?
It’s very definitely privilege to believe that your doctor will give you excellent care without anti-bias training or screening out biased applicants for medical school. Those people who would not be screened out would not be a problem for you.
It’s not an either-or proposition anyway — a person who is a bigot is probably intellectually lazy, so screening out that person won’t hurt you. And those who don’t have red flags in their background and make it through the screening process will indeed get an excellent education.
Is an incompetent doctor who treats all patients with the same degree of ineptitude better than a competent doctor who only treats some patients with ineptitude?
In reality, of course, it’s more likely that this policy will result in more students dropping out of medical school rather than worse doctors because, by excluding some apples from the top of the barrel, you have to reach further down into it to make up the numbers. It is to be hoped that the course will weed out those people who aren’t good enough.
So is it okay for only some people to get the correct treatment and diagnosis?
It’s better than nobody getting the correct diagnosis and treatment.
It’s a false dichotomy — the difference between two candidates in technical competency will be minimal because medical schools are so selective. Someone with an awareness of their own positive bias will have a larger edge than someone with a teensy bit better MCAT score who is dismissive of the complaints of women or p.o.c., or whose research methodology doesn’t account for differences in sex or DNA.
*potential bias, not “positive” bias. Fingers were on autopilot!
Well you were the one who introduced a false dichotomy. Your previous post assumes doctors are either woke or they don’t treat women or people of colour properly. I was merely responding to that.
In fact my previous post speculated that the quality of doctors would not go down but there would be more drop outs from med school.
It all seems to be totalitarian nonsense to me.
So… you could in future only get a medical education/job if you support the Social Justice party line? Reminds me of only Party members getting plum jobs under Communism in Russia.
Soon to be followed by not being allowed to have quality medical care if you don’t support the Social Justice party line perhaps?
It may strike you as an absurd idea, but look at employment restrictions for federal employees, actors and writers in the McCarthy era, not that long ago.
Oh noes! I’m shaking in my boots!
In the spirit of evidence-based medicine, I would ask for some objective, scientific demonstration that these programs can provide the hoped-for outcomes without more detrimental side-effects before they should be carried into general medical-school practice.
There has definitely been evidence that the problem exists:
I meant evidence that the proposed fixes would be likely to have the desired outcomes.
A young person who plans to someday practice medicine will need to make social media posts that conform strictly to the political standards that will be in effect when they will be applying to their chosen program.
Not many of them post racially biased stuff. I doubt that serious pre-med students post much at all.
This is just a slippery slope argument, which I would not expect to see here.
Like the slippery slope that led from being opposed to racist actions to “silence is violence” mobbing of bystanders in restaurants and physical assaults against disfavored campus speakers?
My observation was sort of sarcastic, as nobody could reasonably predict what sort of beliefs the woke people might be insisting on years in the future.
I have a kid in med school, and he has never expressed any interest in social media. He has no such accounts. Even a review of his emails would reveal only concise messages about his schedule, financial needs, or study arrangements with his peers.
He was admitted to the program because of outstanding grades, as well as working as an EMT as an undergrad.
He is on a military scholarship. The only thing about that process that I had not expected was how focused they were on an applicant’s participation in sports in High School and before. They were looking for him to be team captain or equivalent, which I assume is an indicator of leadership potential.
It is particularly easy to show that a program of screening pre-med students for their Diversity credentials will be more than self-defeating: it will paralyze all college study forever. This follows from 2 points.
(A) All students will soon (if not already) be required to attend “anti-racism” training sessions, replete with expected CRT agitprop.
(B) Pre-med student are particularly skilled at sniffing out and fulfilling requirements to get into med school.
It follows that no pre-med student will dare be the first to stop applauding at the end of an anti-racist training session. They will thus all continue applauding indefinitely, so that the session will never conclude, and so no students will ever be able leave it to study anything.
I agree with anti-racist training (and anti-sexist training) for people who have power to make life-or-death decisions for people who are not similar to themselves.
I have experienced prejudice from doctors, and it affected the quality of care for me. Why in the world would we want bigots in such an important profession?
Will they also be checking on religious beliefs/biases? Will Muslims be checked to see if they have racist beliefs against Jews?
Will Evangelicals be checked to see if they will preach to patients, say, the depressed?
I’ve read story after story of people who are told by doctors that they need to find Jesus to cure their depression.
Actually, that’s a pretty good idea.
The fact that religious bias is rampant isn’t an argument against rooting out racial bias in medicine. It’s an argument for anti-bias screening and training (and continuing education for it, too).
I’d generally oppose ideological tests for most higher ed programs, for these reasons:
-Higher ed tends to liberalize views.
-Meaningful professional and social interactions with the objects of someone’s bigotry is often a great way to reduce the bigotry. Isolation, OTOH, likely reinforces it.
-This will breed resentment and create more separated sub-groups within our population.
-Potential slippery slope issues.
Now, I have no problem with a private school kicking someone out if they’re blatantly racist or sexist in class (want to do a Pence and not touch unrelated women? Off you go). And if a student has pics of himself at a Klan rally or something otherwise beyond the pale like that, then okay. But in general, the long term strategic solution to many such “isms” is IMO to better integrate such people into the larger society, not isolate them from it.
I don’t want a sexist doctor treating me!
No, thank you!
And if I were black, I definitely wouldn’t want my primary care physician to be in charge of my care if he believes I’m intellectually inferior, or better able to tolerate pain, or shouldn’t be breeding.
There are other places in society for those people. They shouldn’t be making life-or-death for the people they are disdainful of.
You can pick your doctor. Letting people go through medical school doesn’t obligate any person to use their services, nor even any hospital or practice to hire them.
When you show up in the E.R., you don’t get to pick your doctor. Also, you can’t screen your doctor for bias, despite some review sites popping up. The only way you know someone only brings their A-game to white males is for someone to make a public statement, or a legal case to make the headlines. Since most malpractice suits are settled and not litigated, how would I know that my doctor is a sexist jerk until it’s too late?
According to CRT, who isn’t “racist”?
Exactly — we operate in a society that was built on European privilege by people who thought they had a right to take land from other people and to enslave still different people to work that land. And then white society has had a tug-of-war between righting those wrongs and clinging to them because the benefits were just too good to give up. If we don’t actively try to rectify things, we permit them to continue. The person who suffers from the persistent inequities of our society doesn’t really care if you or I actively or passively represses them. Either way, they’re repressed.
I had the benefit of a good education thanks to educational funding being based on real estate value, which is based on whiteness (where I grew up), so the poor kids who were black had less funding, bigger classes, older textbooks, fewer AP courses (or none) or extra-curriculars. It’s not fair, and I don’t really have the power to change it except through my vote, so at least I do that.
Maybe the interviewers and diverse admission committees should first submit themselves to being interviewed by members of FIRE and if they exhibit any affinity to Critical Race Theory, they will earn a lifelong ban from interviewing applicants to medical schools.
This journal has an impact factor of 4.606. For comparison, the Journal of the American Medical Association has an impact factor of 45.540 and the New England Journal of Medicine has an impact factor of 74.699.
So… how likely are these people to remain anything but cranks in the minds of the establishment?
But I agree that medical schools should screen for bias of all kinds. I certainly wish the emergency room resident who groped me hadn’t been accepted to medical school, or that the ENT doctor who fat-shamed me rather than treat my condition hadn’t been accepted.
There is data showing that doctors minimize the complaints of blacks and women. A curriculum that promotes empathy (and reinforces it during clinicals) should also be part of their education.
It should go without saying that people with superiority complexes should not be doctors. There should be some humility in any student of any field, but especially medicine.
The impact factor is racist.
How do you even teach empathy? Personality is largely genetic, and the psychological interventions that are supposed to change it (e.g. to make people behave more ethically) routinely fail the null hypothesis.
It is not obvious to me that empathy is positively correlated with performance. Applinats who can successfully pretend to be empathetic in the application process may be charismatic and popular without being especially competent.
You can work on developing and retaining empathy (vs. compassion fatigue), unless the student has Asperger’s or some other issue with theory of mind. But even if the person has blind spots like that, teaching about stereotypes & biases can prevent those things from getting in the way of good care.
It is so frustrating because this has so obviously become a wild moral panic.
It is frustrating because there are REAL biases about and we must work to eliminate them but I wonder about the motivations of some of the people pushing for a lot of these changes and purity tests. It seems very Khmer Rouge to me.
Further, as Bret Weinstein says when you blame white men for *everything* there is going to be a blow back and it is ugly.
Then there are those who are BLATANT bad actors like Linda Sasour (DON’T even start me!) or Robin DiAngelo whose ‘original sin” take smacks of religious fundamentalism and magical thinking. Then there is hilariously stupid “Blackwashing” by mega-corporations – so incredibly insincere.
Then… (and I’m nearly done…) there’s BLM whose “solution” to Palestine (for some reason!) is a very “Final” solution if you get my meaning, who are avowedly Marxist, anti-capitalist folks in the mix.
Where are ordinary people of good conscience to go? Ordinary people of good conscience.
Pardon me, I must go. I’m late for my Struggle Session to apologize for being white and successful and it always takes me awhile to “check my priv” at the door.
David Anderson, J.D., NYC
(big time liberal, Hillary campaign volunteer and donor, former Queens/Mhtn defense atty/writer)
Syndicated article of mine about some recent NYC stuff on this topic:
I would posit that some of the posters here seem to be in a wild panic!
“Do you think Black patients are more likely to be poor historians than white people––and if so, why?”
Ah, Professor, don’t you see? There is no right answer. If you say yes, they will say, “You clearly think black people are inferior.” But if you say no, they will say, “You clearly don’t understand that centuries of oppression have caused black people to suppress and dissemble regarding their lived experience.”
Apart fro the rather sinister tone of the article that would like to weed out candidates of diverse political views, there is a large undiscussed problem: we don’t know how to select medical students that will make “good” doctors. In the past the assumption was that the smartest would be the people we wanted in the job, and MCAT ruled the American med school scene, A-level results that in the UK. It was also the case that a minority of people got in through family connections – a parent had trained there, but they knew more about what they were in for and did just as well overall as the brainy kids. Some attempts were made to manipulate entrant statistics – my class started in 1976 and contained 60% female students, which was unheard of at the time – girls had not then started to outperform boys at school. Nowadays they need no special considerations as they thrive at school whereas the boys seem to languish.
Responding to criticism that doctors needed to be more empathetic, it next became fashionable to examine prospective students’ out-of-hours activities. If you could claim you enjoyed nothing better than going and washing feet at the local homeless shelter it would help a lot, but this was very cynically manipulated by applicants in the know, and turned out to have no effect on the quality of doctors trained.
These days we are quota driven, and explicitly so. In order to be accredited, a medical school or residency program has to show it has appropriate percentages of entrants, or is striving to hit those targets. Yes, explicit equality of outcome. This means that a candidate with a low MCAT score who belongs to a group we need more of for the quota will be given a place over a brighter or harder working candidate who does not. By the way – if you’re dangerously ill, which one would you like to have treat you? Naturally, we all want the best qualified and most skillful. Perhaps worse still is the tendency in Canada to make special programs, or entire medical schools for doctors who will be expected to work in certain places. The North, rural medicine – both have special schools that turn out grads with what is seen as a second-class degree that will make it harder for them to apply to the better residencies or get privileges in prestigious hospitals.
And we still don’t know how to pick a student who will be what we want in a doctor! After a life in the field, I’d say we need variety. Some super eggheads, some ditzy but good-hearted carers, some cold and clinical, some good with their hands rather than their brains. Then let them sort themselves out in researchers, orthopedic surgeons, family docs and pathologists. We need them all and there’s no doubt some people gravitate towards different interests. Medical school is already a sausage machine that tends to turn out grads molded into certain views and attitudes. We might do better if we encouraged variety.
I don’t know that we don’t select well. The medical school where I work is experiential learning. There are no written tests – only simulations. The entire end of year exam is one big simulation conducted across the country at the exact same time (regardless of time zone) where doctors are observed in how they handle various scenarios. On top of that there are clinical placements where preceptors evaluate student doctors. I think there is no better way to weed out bad doctors than these scenarios. I think we are getting better at weeding out bad people as well but we need to improve.
Of course, you could be a doctor who was bottom of the class and only cares about making money….I’ve met those ones. They are usually he clinicians who overbook patients, don’t care about how their staff, probably paid very poorly, treat patients, and are never around if you need them. I really hope competition among docs kills them off but we need to figure out a way to better kill off the careers of these ones.
Another progressive idea is that racist patients should be eliminated, i.e. not treated. While doctors are routinely expected to deal with violent and outright criminal patients, those suspected of thought-crime are apparently beyond the pale.
Not even a joke: notices posted prominently say that any disrespect to staff will result in a refusal to treat. And since all our hospitals share a common administration it is not clear that such a patient will then be accepted elsewhere. Not to mention the extremely shaky legal grounds one would have to rely upon if a patient harmed by such a refusal decided to come after you in court.
Like when Elaine on Seinfeld was known as a difficult patient so then no one would see her about her rash.
Suspected? Where do you get that idea?
If someone commits an act of aggression (for whatever reason), the employee who experiences it has a right to refuse treatment. I haven’t heard of any mind-reading being involved, just actual behavior.
I just hope that all students are subjected to this if anyone is – after all black students are just as capable of showing racist and discriminatory mindsets as any other ethnic group.
Or is that just my own inherent racism, which I deny of course, showing?
I think worrying about the effect on minority med students from other countries where there are significant cultural differences is a very valid concern. Anecdotally, I feel, based on my experience with doctors, that there can be more of a “Pipe down and listen to The Doctor, little lady, they are the authority here and you are the person who needs to listen to the authority.” attitude when it comes to doctors from other countries (and actually, not even one country in particular, this just seems to be a common attitude elsewhere in the world – again, anecdotally.)
And even here, I think there is a trade-off that should not be skewed 100% in favor of the most liberal values. Without getting into gory details, I wrote a letter of complaint to the hospital where I gave birth because the doctor (a woman who was, I believe, from India,) went against my explicitly expressed wishes and consent. But I worried a lot about writing it (even though it likely was chucked by some admin somewhere without a second look,) and consulted a family member who is a doctor first, to make sure this was really out of line stuff – because my son, after a days long labor, was born happy and healthy, and I understand there is a tradeoff between consent and physician efficacy when making calls in realtime. A world where you’re rushed into the ER dying and your doctor is running beside the gurney shouting “Well I don’t know, what do you think? What would you like to happen here? Would you like to read up on it first?” obviously wouldn’t work, ha ha. So you agree to some degree of authoritarianism in that dynamic, and different cultures will frame that differently. I think true diversity is trying to make room for people from those cultures while still saying “Ok, but here are our norms in America, we are going to insist, gently at first and more ardently if that doesn’t work, that you adopt this framework to some extent.”
I think people want hard and fast rules – always respect the attitudes of those from another culture, 100%… no, always insist on the American liberal attitude, 100%, and screen out anyone who doesn’t… etc. – because the tightrope walk that results otherwise is messy and time consuming and often full of disagreements that slow everything down. I get that, I like speed and efficacy as well. But this is part of having a heterogenous population – we have benefitted a lot from that cultural diversity in this country, but those benefits do involve work.
I understand the rhetorical purpose of this interesting point but it provides an amusing angle:
It is the wrong assertion? Are all such assertions valid? Surely there are meaningless assertions.
Genes are immortal? I think they are but they change over the generations in small ways.
All rocks are immortal?