Dr. Tamika Cross made national headlines two years ago when flight attendants on a Delta flight from Detroit to Minneapolis didn’t believe she was a doctor after she responded to their call for a physician to help a passenger having a medical crisis. They demanded her medical credentials and asked her if she was an “actual physician.” As a female black physician, she was barred from helping a fellow passenger in need.
Miles away, Dr. Fatima Cody Stanford read about it, and as another black female physician, she thought about how, if this happened to her on a flight, she could try to prepare. She tucked her medical license into her wallet and started carrying it around with her.
It’s not common for doctors to carry their medical license in their wallets. But even when Stanford presented her card on a recent Delta flight from Indianapolis to Boston, flight attendants repeatedly questioned her credentials when she began helping a passenger near her who was having a panic attack, the New York Times reported. “Are you a head doctor?” asked one flight attendant. “So is this your medical license?” asked another.
For Stanford, being an obesity medicine specialist at top academic medical institutions including Harvard Medical School wasn’t enough to convince a flight attendant that she was qualified enough to help a passenger.
(According to Delta Airlines, the flight attendants were employees of Republic Airline, a Delta Connection carrier. Delta company spokesperson Anthony Black told me: “We thank Dr. Stanford for her medical assistance onboard Republic flight 5935 IND-BOS, and are sorry for any misunderstanding that may have occurred during her exchange with their in-flight crew.” Jon Austin, a spokesperson for Republic Airline, said: “Delta changed its policy for providing medical credentials in 2016, and we are working with all of our connection partners to ensure their changes and actions align with ours.”)
This sort of treatment isn’t new for Stanford. Since childhood, she had been asked if she wanted to be a nurse instead of a doctor, and throughout medical training, she was subjected to various microaggressions. In medical school, her neighbor couldn’t believe that she, a black woman in a largely white neighborhood, was studying to become a doctor. When the neighbor saw her at a fast-food restaurant later that year, she assumed Stanford had dropped out of medical school to work there. In residency, while Stanford was attending to a mother and her newborn, the mother continued to tell the nurse that she had not seen a doctor, even in front of Stanford, who — wearing a white coat and physician badge — had repeatedly told her she was her doctor.
“In most situations, I do try to keep a license with me because I think there are different reasons people think I don’t look the part,” Stanford told me in an interview. “I will be 40 on my birthday but somehow people think I’m 20-something, and then I’m black and I’m also a woman, so I think that combination, that trifecta, doesn’t play out well.”
Stanford’s story is commonplace for physicians of color — especially women and underrepresented minorities. As a fourth-year medical student, I see this bias frequently. Though so much effort goes into our medical training, I believe institutions and medical education organizations should also prioritize creating a hospital environment where perpetuating discrimination against either physicians or patients is not acceptable. Otherwise, bias against minority physicians will continue to harm the well-being of both doctors and patients.
How medical school prepares students for racism and sexism
When I was a first-year medical student, we had a class to introduce us to interacting with patients called “Introduction to Clinical Medicine.” One by one, each of us would talk to an actor pretending to be a patient in front of our small group, and the other five students and one faculty preceptor would observe and provide feedback at the end. During one such session, the “patient” lobbed racial and gender stereotypes at us; to me, he made comments about Indians and insisted that he couldn’t trust a woman to do his upcoming surgery. He wrongly assumed a classmate was Mexican and made derogatory comments about Hispanics and Mexicans. To our white male classmates, he had nothing offensive to say about their identities.
At the end of the session, we learned that the point of this exercise was to prep us for treating patients who would offend us. We were taught that we needed to maintain our composure and redirect the conversation to patient care, and that we must avoid getting upset or getting into arguments.
At this, I couldn’t help but laugh. Women and people of color have been dealing with stereotypes their whole lives. We don’t need a test kitchen to learn how to do our job in the face of discrimination — we need this behavior to become less acceptable.
Psychiatry resident Jennifer Adaeze Okwerekwu, who wrote about race and medicine for Stat News, told the story of being called “colored girl” in medical school by a patient three times in front of a supervising attending physician. Not once did the doctor correct the patient or even acknowledge the incident with her after the fact. Okwerekwu wrote, “Despite all the other positive interactions I had with this teacher, her silence in this circumstance diminished my presence. I wondered if she thought of me as a ‘colored girl’ too.”
It’s interesting to me that medicine, with its protocols, pathways, and years of training, has no blueprint for supervising physicians on how to address inappropriate comments toward the people training under them. This reluctance to address the existence of bias in a health care setting hurts patients because it perpetuates a culture of silence — or worse, denial.
It’s better to have training for physicians on how to alter the medical environment to stop perpetuating bias against physicians and fellow colleagues, rather than training physicians how to bow their heads in the face of racism and sexism. We have much to learn about the long history of sexism and racism in medicine and should receive presentations from those impacted by it on what they think could be improved. We should have training on how to listen when you are in a position of privilege.
Medicine continues to be an old boys’ club
Part of combating this bias includes changing the racial and ethnic makeup of the physician workforce. Many medical institutions use the term “underrepresented in medicine” to encompass a group including African Americans, Hispanics and Latinos, Native Americans, Pacific Islanders, and some Asian subgroups whose proportion in the physician workforce is less than in the population, and promote efforts to recruit underrepresented students. However, in 2015, only 6 percent of medical school graduates were black and only 5 percent were Hispanic or Latino, numbers not significantly different from the entire physician workforce.
(I also receive a certain amount of privilege in a profession where Asians as a large group are overrepresented: 22.6 percent of the physician workforce, though 5.9 percent of the overall working population. I have personally never been mistaken for support staff or encountered disbelief that I am a physician-in-training.)
Though women now make up 36.8 percent of the physician workforce according to 2016 census data, they still may encounter disbelief of their profession. Despite this lack of recognition, according to recent data, the elderly patients of female physicians fare better in terms of mortality than those of male physicians.
That patient actor exercise, though misguided, was certainly a harbinger of experiences to come. But it wasn’t a solution. People of color and women learn how to deal with these situations as best they can. They carry their medical licenses; they study extra hard to do well on exams and prove their capability; they dress nicer even in casual settings; they learn how to wear their knowledge on their sleeves; they become overqualified.
But at the end of the day, it is also the responsibility of their privileged allies to step up. It is up to the male fellow, resident, or medical student to redirect the patient to the female attending. It is up to the airline company to come up with an unbiased protocol with which to solicit and accept medical help on an airplane and then follow through on it. It is up to medical schools and institutions to train and hire more physicians of color and female physicians across training programs, to break down old boys’ clubs, to decide if they will have a zero-tolerance policy for bias. To make it easy for physicians like Dr. Stanford to simply do their job.
“If I were to be angry at this situation, I would be angry all day, every day”
We are increasingly realizing that racist and sexist bias against patients is a pervasive issue. But what about bias against physicians from patients, from bystanders like those flight attendants, and from fellow medical professionals? They are symptoms of the same disease — a reluctance in medicine to take a stand on issues of social justice and equality, and an idea that caring too much about equal treatment gets in the way of practicing the science of medicine.
Stanford said she has been struck by the outpouring of support for her, from both the American Medical Association, in which she is an active member, and white male colleagues who have reached out to say that this has never happened to them and that they are outraged.
“A lot of people are asking me, am I angry?” said Stanford. “And I say no, and they say, why are you not angry? And I say, because I experience so many things almost every day of my life that if I were to be angry at this situation, I would be angry all day, every day.”
Vidya Viswanathan is a fourth-year medical student and aspiring pediatrician and writer at the Perelman School of Medicine at the University of Pennsylvania. She is also the founder and president of Doctors Who Create, an organization encouraging creativity in medicine. Find her on Twitter @vidyavis and read more of her writing on her website.