EMS brings in a critically ill patient and begins to transfer the patient to the gurney. The lead EMT, a White woman, looks to the White man medical student who is standing in the back and says, “Ready for report, doc?” You are aware that the senior resident, Dr. Massey, a Black woman, who is also standing near the gurney, is the person running the resuscitation.
- Impact: How might this interaction affect the individuals involved? Who might it harm? Why? Why does this matter?
The Black senior resident likely feels that the EMS assumed the White male resident was in charge, and that she was not, due to a combination of her race and gender (i.e., racism and sexism). She may feel that her expertise and role as a doctor has been dismissed. She may feel that she has to work harder and be more assertive such that her role is not undermined in an important professional setting like this. This sort of role confusion – someone assuming that someone else is the doctor or assuming that you are not the doctor – unfortunately is a fairly common experience for women and Black doctors in our system. How it impacts her will of course depend on who she is as an individual and how she has learned to cope with these sorts of experiences. In general, such an experience – combined with other insults and slights that accumulate over time – may contribute to higher burnout, less feelings of inclusion and belonging, stress, depression, and lower levels of job satisfaction.
- Intervention: If you were to intervene to address the potential harm caused…
- What might you do or say?
- You could say “Excuse me, but Dr. Massey here is in charge.”
- You could turn towards Dr. Massey and say, “Yes, Dr. Massey, please tell us what’s next.”
- You could approach Dr. Massey afterwards, tell her you noticed the slight, and ask her if she would have liked you to speak up. You could provide her with some validation that such experiences are unfair and possibly exhausting, and you could offer her your genuine appreciation for her as a doctor and person in charge.
- You could approach the EMS afterwards and explain their mistake to them.
- What obstacles might get in the way of you intervening?
- You may feel that the incident happens too quickly for you to figure out what to say or do. Then it becomes awkward for you to say something.
- You may be unsure what Dr. Massey would want you to do. Maybe she does not want you to intervene on her behalf? In this case, you could still talk to her afterwards, ask her what she would have wanted, and offer validation.
- You may wonder if Dr. Massey has asked the medical student to take the lead as a teaching opportunity. In this case, you could wonder this out loud, “I’m sorry, has Dr. Massey asked that the student take the lead?” or “I thought Dr. Massey was taking the lead?”
- You may not want to interrupt or distract from the urgent clinical care of the patient. In this case, you could still talk to the individuals involved afterwards.
- You may not want to embarrass the student. In this case, you may speak up, and state that you understand this mistake is not the resident’s fault.
- What might you do or say?
- Repair: If you are the “offender”, how can you apologize or accept feedback?
- You may say, “Oops. I’m sorry, I made some biased assumptions there for a minute. I’m sorry, Dr. Massey.” We include this option because such an apology would likely be received as a very meaningful and authentic, although we also recognize that it would be hard for an offender to recognize and admit to this bias so quickly. There is a skill to apologizing that is hard for most of us to achieve. The best apologies are ones in which the offender takes direct responsibility for their behavior that caused the harm, as in this example. For more information on apologies, consider this excellent book.
- You may say, “I’m sorry Dr. Massey, that was wrong of me to assume he was in charge.”
- You may discuss this privately with some colleagues, recognizing that your assumptions were based on harmful stereotypes about who is likely to be a doctor, and ask for help improving.
- Other comments and background information about this scenario:
- This scenario may bring up important discussions about the need to better establish roles and clear expectations of residents and interns.
- This scenario may also bring up discussions of intersectionality. Intersectionality is a framework used to understand how a person’s experience is a unique combination of their social and political identities. This combination can be both privileged and marginalized at the same time. In this case, although Dr. Massey holds a privileged role in the system’s hierarchy as a doctor, she experiences the insult specifically as an invalidation of that role due to the intersection of her marginalized racial and gender identities.
- Although this may feel like a minor insult, it is important to understand the long and ugly history of medical education that made it very hard for Black individuals, and women, to become doctors. See here for a quick history of this at UW Medicine: Blog Post Draft Black Doctors.docx
