Response to Racism in Medicine Article
A wider discussion on the perceived impact of racism in medicine
Doctor Stories
July 8, 2020

A response to Medworld's Racism in Medicine article, posted 10/6/2020.

“Let’s step up the discussion on racism in medicine and let’s move the profession forwards. If you’re a doctor with expertise and experience in this space and you have an event or report you’d like us to share, get in touch.”

Racism in Medicine Article

Dear Sirs and Madam,

I would like to join this discussion with what I believe to be a widely held but infrequently expressed set of positions. First and foremost, racism, in the true sense of the word, is to be condemned at every opportunity. It is a grave and serious issue which deserves thorough discussion and respect. However, the discourse surrounding the issue in recent years has degraded to such a degree that those writing on the issue no longer notice the logical non-sequiturs and sophistry which they reproduce without scrutiny. The term “racist” ought to be used by any individual or organisation which treats individuals differently due to their external racial characteristics. This is an irrational form of discrimination which ascribes to the individual the generalised attributes of a group, in this case a race. However, increasingly the term “racist” is used to describe anyone with an opinion which differs from an extremely narrow viewpoint. This modern version of McCarthyism targets those with mainstream opinions, suppressing their right to voice those opinions, and truth is the victim.

I have selected a few excerpts from the article as talking points, to which I shall respond. I would encourage others to offer their own unique opinions, so that we may hear as many different opinions as possible.

“In order to achieve true health equity, there can be no racism in our health systems.”

Racism in Medicine article

Defined as parity of outcome for all, equity has a certain superficial utopian ring to it. Those who use the term typically use to in terms of equity between different groups, often racial. However, upon further analysis it is demonstrably a concept which is fundamentally flawed. Firstly, it sets up race as the primary determinant of an individual’s behaviour, choices, and treatment. It fails to account for the confounding influence of the infinite number of ways in which individuals can differ which have nothing whatsoever to do with race. Therefore, any attempt to create equity between racial groups pays no heed to the goals, ambitions, and choices made by individuals. As discussed earlier, the ascribing to an individual the attributes of a race is an irrational form of discrimination, even when it is done with the best of intentions. Equality, often defined as equal opportunity for all (rather than equal outcomes) is a far more just, rational, and achievable aim than equity. Not everyone wants the same thing; compelling them to have equal outcomes is paternalism (or perhaps maternalism, but this is a discussion for another article).

To demonstrate this point, consider that cultural attitudes may influence an individual’s behaviour, as alluded to in the Racism in Medicine article. If measured on a population level this would be observed as a racial difference, as race and culture are correlated, but are not the same thing. Consider also that there are cultural groups which are opposed to vaccination, and as a result are likely to have poorer health outcomes as a group independent of their race, sexuality, or any number of other demographic attributes. As mentioned in the recent article Racism in Medicine, handwashing is a cultural attribute, one which is typically taught at a young age by one’s parents. I was fortunate that the importance placed on hand hygiene by my parents growing up was such that I will happily queue at a sink for an unreasonably length of time to ensure that I have met my own hygienic requirements. Could the same be said of everyone in our society? And might this cultural practice differ between people who grew up in an environment with virtually unlimited access to clean water, and those who did not?

“In Australia and Aotearoa New Zealand, cultural barriers lead to unequitable healthcare for indigenous peoples”

Racism in Medicine Article

There are a few issues with the above statement, which is one often repeated but rarely interrogated for fear of being maligned as a racist. However, it is far too important an issue to not discuss openly, honestly, and factually. While I agree with the sentiment of the sentence, in isolation it implies that cultural barriers are a primary determinant of health inequality. In the contexts in which it is usually used, it also implies that it is the healthcare system’s fault, and therefore responsibility. Aiming for equity between two groups separated by largely arbitrary demographic categories is irrational and is based on the fundamentally racist assumption that race is the primary determinant of an individual’s place in the world. It fails to consider, for example, that certain individuals may not wish to engage with healthcare, and that this attitude may cluster within certain cultures. Furthermore, constantly referring to cultural barriers will add credence to the attitude that healthcare is a force for segregation and oppression.

Culturally or behaviourally (which are very similar concepts) hostile attitudes towards healthcare systems are not exclusive to Indigenous peoples. Consider, for example, the experience of the average patient in a public hospital. The sick patient arrives, and is put in a noisy, brightly lit room on an uncomfortable bed. They are ordered out of their own clothing, and put in a rather undignified, but practical, hospital garment. They are poked, prodded, stabbed, and irradiated. Any human being in this situation would develop a distinctly hostile attitude towards healthcare. The solution which has been proposed in most developed societies has been to engrain in our children that doctors and nurses know best, that they mean us well, and that their advice should be followed. Until recent decades, that was an accepted truth in the minds of many Australians. However, many indigenous Australians have been taught a very different attitude, creating a problem exacerbated by constant references to racism, barriers, discrimination, and gaps.

Secondly, implicit in the above statement is that being culturally different from healthcare providers is an acceptable objection. We are taught that Indigenous avoidance of healthcare on the basis that healthcare workers are members of a different race is logical and inevitable. I wonder who would be as charitable if a white patient were to avoid treatment by a doctor or nurse from Asia, India, or Africa? Could it be that we afford specific races immunity from bigotry? The justification that is often provided is that the Indigenous peoples of the world have historically suffered injustice. But what of the suffering of the Jews in the 20th Century? What of the persecution of Tibetans, Uighurs, and Hong Kongers which continues to this day in the world’s second-richest country? Even the British were slaves for centuries under Romans and later Danelaw. No one race or culture has a monopoly on suffering, nor immunity to bigotry.

“Viral social media posts have encouraged pākehā/white Australians and New Zealanders to get better educated on the complex problem of racism”

Racism in Medicine article

Sadly, when we divide a nation based on its racial and cultural groups, instead of treating them all as individual Australians (and New Zealanders) with their own autonomy, we can only worsen divisions. Instead of including everyone, by these means we can only marginalise everyone. Particularly if we continually single-out one race with our accusations of racism, and reply upon the toxic platforms of social media to dictate our social agenda.

“Undeniably, people tend to trust those who are from their same country, practice the same religion, come from the same social class, have the same ethnicity and share similar physiological features. It is more difficult to create a warm and comfortable environment, a better connection and a more intimate relationship with someone from a distinctly different cultural group.”

Racism in Medicine article

The obvious and immediate flaw with the above excerpt is the use of the word “undeniably”. There are very few undeniable truths in this world – even its spherical shape is denied by some. Stating that your own views are undeniable, without providing primary literature, is the antithesis of robust debate and cordial conduct. But I digress.

Once again, I am somewhat sympathetic to the broad statements made above. However, the flippant conflation of religion, colour, culture, and physiological features is erroneous. For instance, I have warmer relationships with many dark-skinned, short, female, foreign-born colleagues than I do six-foot tall white male Australian colleagues, yet I would fit into the latter group. The reason for this is that one cannot tell everything about an individual by assessing their demographic profile. In fact, one cannot even tell a tenth of a person’s attributes from such features. I believe, left to their own devices, Australians judge people by the content of their character, not by some arbitrary physical feature.

Conflating race with behaviour was the error made by much of mankind in the 19th and early 20th century. In the end it led to genocide, war, and tore nations apart. If we continue to state that poor race-relations are inevitable and “undeniable”, we will ensure that they always are. Whatever problems Australia had with race-relations, a brief perusal of the historical headlines from elsewhere in the world during this period will convince you that we did very well, all things considered.

This is not to say that I have not witnessed racist language and behaviour in this great nation. I myself am the target of frequent racial abuse, largely from Indigenous Australis, as I walk down the high street of Australia’s towns and cities, typically after refusing to support an individual’s smoking habit by the loan of a cigarette or lighter. However, in this instance and in all of the other instances that I have noted, race is never the primary reason for the abuse. I’ve seen an Indian nurse falsely and rather rudely accuse a patient of lying during a home visit, which received a few choice words from the patient, some of which referred to the nurse’s race. I’ve also seen an African doctor whose communications skills were very poor completely fail to gain proper consent from a patient for a simple procedure, and upon attempting to commence the procedure received a stern but racially-phrased rebuke from the bewildered patient. And I myself, after insisting that an Aboriginal patient be admitted during an acute myocardial infarction, received a reference to my whiteness, which was conflated with a desire to lock people in institutions. In all of these examples, what causes the outburst is not the race of the assailant’s interlocutor, but rather the latter’s behaviour as an individual. The use of racist language is lamentable, however the condemnation of the language without addressing the motivation does very little to improve relations – in fact, censoring a person who feels wronged is a guaranteed way of creating resentment and prejudices.

“Recent events have again highlighted that racism is common in institutional organisations – to devastating results.”

Racism in Medicine article

This is a very popular statement on social media and in certain circles. However, very few reliable facts are reported. I can only assume that the death of a counterfeiter in police custody on the other side of the world, and the subsequent rioting, are the “recent events” referred to in the excerpt above. As tragic as these events were, one death in a nation of 330 million people does not demonstrate that racism is “common” in institutions. It is worth remembering that 93% of black murders are committed by black murderers – it is difficult to believe that these murders were racially motivated. It is also worth remembering that 70% of Aborigines in custody committed violent crimes against close family members – perhaps endemic violence in Indigenous communities is what is common “with devastating results”.

However, there was one event much closer to home which was a very clear example of an institution behaving in a racist manner. Multiple members of the Australian Senate declared, one after another, that “black lives matter”. There was then a motion inviting members to vote in favour of the statement “all lives matter”. Almost all the Senators voted no. Are we to conclude that the Upper House believes that black lives matter, but it isn’t quite so sure that the lives of other races matter? Now, Australians are not thin-skinned, and they rarely take non-binding motions in parliament seriously. But there is another insidious influence at play here. The Government is charged with taking care of the most vulnerable – children, the elderly, the disabled – those who cannot take care of themselves. Should the Government become the patron of a specific race, it will deprive them of self-determination, and they will cease to be masters of their own fate. As we have seen thus far, $35 billion of patronage has yet to make any measurable difference, and the victimhood narrative has only entrenched a sense of entitlement which has deprived many Aborigines of the dignity of aspiration. Could heavy-handed affirmative action be the instrument of oppression favoured in the 21st century?

“In New South Wales an Aboriginal person was denied testing because priority treatment would only be offered to “real Aborigines”.

Racism in Medicine article

The above excerpt is fascinating. A specific race is entitled to priority treatment before other races, but it is the healthcare worker who requests proof of membership to this race who is committing institutional racism? It is perfectly possible that the nurse in question has seen fraudulent claims of Aboriginality in the past from patients seeking the same priority treatment. If you are wondering whether it is justifiable to give priority treatment to Aborigines, I would suggest imagining another race receiving preferential treatment – would this sit well with mainstream Australia?

“In Aotearoa New Zealand, almost half of practicing GPs will retire within the next decade. We’ll soon have a dramatic ‘changing of the guard’. Now is the time to encourage and enable more young people from diverse backgrounds to join the profession.”

Racism in Medicine article

I may be old fashioned, but I believe that a doctor should be hired based on the content of their resume, their clinical acumen, and their interpersonal skills, not based on the colour of their skin. Being a member of a specific race is not a virtue, nor a skill, nor relevant in medical practice. If we begin to hire doctors because of their race, then we will have created true institutionalised racism.

“The goal is the detection, prevention and eradication of racism at all levels of the health care system.”

Racism in Medicine article

The difficulty with racism is that is means different things to different people. To some, it is treating individuals differently because of their race. For others, it is failing to go out of one’s way to help and understand people of other races. For others still, it is failing to declare one’s own internal racism and privilege, and questioning any policy whose stated aim is to redress inequity. If we are to use words such as “eradication”, it is essential that we clearly define what is it that we are eradicating. It is also important to remember that anyone who has tried to eradicate anything has thought that they were doing the right thing, but history rarely applauds their efforts.  

Article by
Dr Edmund Locke

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