Month: September 2017

Through no coordinated efforts on our part, 3 graduates from my high school arrived in New Orleans, LA to attend Xavier University of Louisiana.  When I describe my experience at Xavier to other people, I describe it as the first time I could be unapologetically myself.  It was so empowering to look out on the yard on any given day and feel empowered by people who looked like me striving toward higher education and positive service toward others.  Those four years became more important when re-entering the “real world”, remembering the support and guidance there, helped during the days when I was made to feel less than or underprepared or undervalued.

The fight for equality has been ingrained into my being for as long as I can remember.  My grandmother was not shy in sharing her experiences growing up and prepared me for what we now call micro-aggressions when I started elementary school.  I have no doubt this part of my informal education led me to medicine and then to public health, searching for my own way to level the playing field.  With the current events that have engulfed our country over the past several weeks, I have been struggling to articulate my thoughts and feelings as it relates our country and our profession.  Those feelings that range from anger to disgust to disappointment to despair.

My high school and college classmate, Ashley Harmon, a psychiatrist, made an eloquent statement the other day.  She captured some of those feelings.

“No one ever speaks to the complicity within the medical community that tolerates racism. Do my peers understand what it means to be called a Nig–r while providing care to patients? Do you know how it feels to be seen as subhuman and still provide excellent care? Do you understand how I have to remain silent and continue to be unbiased? Do you understand that because I am the defacto leader that I have to provide an example at all times? Do you understand how traumatizing that is? Do you know that medical schools do not teach people of color how to defend themselves? These institutions also do not teach our white peers to defend us either. Administrations look past the person and to the bottom line. Racism and bigotry scream silently down the halls of medical institutions. And we wonder why there are health disparities? The medical community has not even developed a coherent response when one of their own is harmed. How then could the medical community protect others?”

I asked Ashley if she would mind sharing more on this subject today.

1. Tell us about yourself.

My name is Ashley Harmon and I am a board certified geriatric psychiatrist. Most recently I have been working at a VA on an inpatient unit as an independent contractor but will be coming into the VA as a full-time physician in the fall of 2017. I have been quite mobile since graduating from my fellowship at University of Rochester in NY. I have been blessed to work in several different health care settings including nursing homes, assisted livings, inpatient psychiatry and emergency psychiatry.

2. What led you to the field of Psychiatry?

When I entered medical school, I initially thought I would pursue neurology since I had a fascination with the brain and how it functioned after working as an aid at an assisted living facility. I will never forget an elderly resident that I took care of. She was a God-fearing woman who never forgot her evening prayers, but she was heartbreaking because she forgot her children’s names. I also could not reconcile how this praying woman could become irritable in a moment’s notice and be an adept thief that could rival any professional. We often retrieved resident’s belongings from her purse. I wanted to understand what was wrong with her brain, and why she lost her memory. But as soon as I stepped onto a psychiatric unit during my clinical rotations, I was hooked. It astounded me that someone’s brain was powerful enough to shape their perception of reality and it was wonderful learn about the person behind the illness once their symptoms resolved. I felt that through psychiatry, I would work with the young and old, including those with dementia and try to improve their quality of life.

3. Can you elaborate more on your comments above?

The day I wrote this Facebook post I was quite frustrated and dismayed at the racial tensions and violence that were displayed in Charlottesville and the days after. I was especially alarmed that white supremacists had become so emboldened that they were proudly spouting their ideas and vicious rhetoric. This made me reflect upon the times, in various settings in which I had been called the n-word or my patients of color had to manage knowing another patient was using racist language. Though I deal with emotionally unstable patients, the majority will adhere to social norms despite their illness. And, the majority of cases where I had encountered racist language were not in the midst of psychosis or delirium. It reminded me of instances where even inside the walls of a hospital, a supposed place of healing, racial tensions could easily bubble to the surface. It is always below the surface, unspoken. If racists can proclaim their beliefs loudly in the streets, why must I remain silent in the halls of healing? Prior to taking a sabbatical from the VA, my team was dealing with a man who made racial slurs in front of others. Fortunately, this program had a policy in place to manage incidents like these so there was a feeling of empowerment. This is not the norm. But this made me think of other facilities where policies are not clear and in fact give no recourse for those who would be aggrieved, either patients or staff. And does this not reflect on the way we deal with race in a broader context? Essentially, what I have seen is the policy of reprimand without consequence. This can foster a sense of helplessness which can produce apathy. There is also an ethical argument to be made about not refusing to care for those who believe differently from you. But what if those beliefs could be harmful to others? I think this question becomes even more complicated when dealing with mental health. Ultimately, I believe health institutions encourage the silence because this is a difficult situation and hope it “goes away” along with the discharge of the patient. It is also true that this is the easy way out. But the experience never truly goes away for those who experience the insult. How do I protect my patients? How do I protect myself? Is no place sacred? Even in this place, where my patients of color are trying to obtain stability and healing, they had to deal with someone who thought of them in vile terms and less than human. Daily they had to interact with a person who speaks about them in vile terms, smile, and be appropriate, and all because this person hid behind the cloak of the name “patient”. And I realized that I have been taught to do the same. In all of my education and training, these issues had never been addressed in a formal manner or treated with any consistent seriousness. And I saw myself in the same boat as my patients. The ways in which we address culture and race can significantly impact patient outcomes or minority participation in the health care field. As providers, it can significantly impact our health and our spirit. So what are we to do?

4. How do you see change happening regarding racism in the medical profession?

Medicine tends to focus on patient outcomes (rightfully so) and there is a focus on racial/cultural health disparities. There is little in the medical literature that focuses on the experience of minority physicians nor is there much guidance in how institutions should instruct their providers to empower themselves or their colleagues in this matter. But if we are to truly address these concerns, they must first be discussed. They cannot be swept under the rug since it is indicative of a larger problem.  In medicine, we are taught that to address a problem, we have to first correctly identify it. We have to acknowledge that our peers and colleagues of color have experiences which can be emotionally unsafe and at times traumatizing. I believe we should begin to document the experiences of physicians/practitioners in terms of racist interactions so that we know how prevalent this experience is. Unfortunately, I believe that this experience is quite common and occurs at least once during the career of a practitioner of color. Once we catalog the frequency and quality of these experiences, we can begin to develop an appropriate response. Medical students should have appropriate training and enter into their careers armed with tools and confidence to take care of themselves and others. Though we may not be able to refuse care to patients, we should have a coordinated and consistent response across facilities that lets patients know that this behavior and rhetoric is not acceptable within healing institutions. Our brethren should be empowered alongside us so that we carry a forceful message that will scream louder than the silence of racism.

5. As you know, outside of large cities, some of us may be the only face of color in the department or in the office or hospital.  What advice do you have for our colleagues, those who encounter racism or witness racism in the work environment?

For now, I encourage my colleagues to consistently document these encounters and keep a log. Out of sight is out of mind. I believe that our counterparts may not actually believe that this occurs regularly and therefore does not warrant a coordinated response unless we have the data to prove it. Begin to approach administrators and ask them about what policies are already in place and gauge if they are open to improving these policies and re-educating staff on how to deal with these patients. We will be the only ones to bring this issue to the forefront. We will need to be the champions not only for ourselves, but ultimately for the ones we serve.