The interview is divided into two parts. This part 2 will cover Dr. Freeman’s views and experiences regarding equal opportunities and diversity in the healthcare system in general. The part 1 covers her story and her work with the “Tour for Diversity in Medicine”. You can find the part 1 here (English) or here (German). Diesen Teil vom Interview können Sie auch auf Deutsch lesen.
Polina: How exactly do racism or discrimination impact students or potential students during their studies or their application to the medical school in the U.S.? What do you think are the most important factors?
Dr. Freeman: I think one of the things that I often talk about related to this question is the fact that institutional racism affects people all along the pathway, not just at the entrance point to medical school. I’m a paediatrician, so I think about that kind of life course you could see it going back to the opportunities that children have in preschool or nursery school. Thus, if you don’t have the opportunity to learn and thrive at your best even early on, then you won’t do well when you get to kindergarten which makes it harder for you to do well in elementary school and then high school. If you’re not doing well in high school it makes it harder for you to do well in college, which makes it much harder for you to get into medical school.
When we look at applications, we look at the activities that students have done, the research opportunities, their letters… And there can be areas, where discrimination and racism impact application. For example, a student didn’t get an opportunity to do an internship because there was bias on the part of the person selected for that. And so that internship made someone else more likely to get into medical school. Another example is how someone writes a letter: there has been a lot of data recently that people from minority backgrounds (women, ethnic minorities, racial minorities) are described with different words. Meaning, there can be words that are not as favourable in terms of what someone is going to be, evaluating any in an application. This is the case when someone is describing a white male one way, and there are these really excellent words, and then they describe a black female a different way. It makes the white male look stronger when they actually might be the same. But someone’s bias is making them describe this person a different way.
It’s hard to pinpoint one thing because there are so many different factors and so I think it’s really important for us to work on understanding bias across the life course, understanding the kind of distance travelled and the educational opportunities that people have. We have to look at it in a multi-dimensional way. We can’t just look at it in one dimension because we will not see all of the aspects that are supporting or have contributed to a student’s story.
Polina: What do you think is the main factor for discrimination in health care? Not just for medical students but also for the patients or nurses?
Dr. Freeman: I think one of the things that contributes the most is people’s bias. Where they don’t recognize that they have something called unconscious bias or implicit bias that has them make assumptions about a person because of attributes that they’ve drawn conclusions about without actually getting to know the person. There was a study in the US that actually indicated that medical students at a school in the United States thought that black people did not feel pain the same way. It was one of those things where somewhere along the way they had had this belief system that for some reason they thought black people were less susceptible to pain and they didn’t need pain medicine. There are all sorts of things that can come up whether it’s seeing someone who has a lot of tattoos and assuming that they are from a certain background or certain socio-economic status or seeing a type of insurance that someone has and assuming something else. And I think one of the things that are really important for us as physicians are to recognize that you can’t assume anything by looking at someone.
There are two types of thinking systems: one is fast, one is slow. So we often depend on our fast thinking, and we needed in some way (if you had to think about every step that you take, you would never get anywhere), but there are other things that especially in patient interactions where we can’t assume just by walking in a room that someone is this or that. I think it’s really important that we work on understanding bias: how it impacts the decisions we make and how it impacts those we interact with.
Polina: 2019 and 2020 were remarkable years in the history of the fight against discrimination because of such movements as Black Lives Matter, Red Handprint and Stop Asian Hate. Did these movements somehow impact your work? Were there more students that reached out to you?
Dr. Freeman: I think in some way it did. All of us were personally impacted by that. and I think in the pandemic people could have lost motivation because there’s just too much going on. I think it was one of the things that really kept us motivated: “We need to do this and it’s really important to continue to push and pursue the goals of the organization!”. We’ve never actually asked students if they reached out more because of what was going on. But it was definitely something that motivated us to keep going in the midst of everything else.
Polina: I can imagine that some students that need the help your organization offers are scared to show it. So, what would you say to medical students worldwide that struggle with it? Why is it okay to ask for help and to reach out for a mentor?
Dr. Freeman: One thing that I have learned while working with pre-med students, medical students, residents, is that (especially with residents) if you are not willing to ask for help, you will kill somebody. It is a very important skill to be able to recognize when you need help and being willing to ask for it. I ask for help all the time. You need what is best for every patient, even if it includes you telling the patient and your colleges that you need to get one more opinion. We think that physicians know everything. No one knows everything. And those who think they do probably kill people. So you should always remember that we are not Gods, we are people who learned information and are applying it to take care of other people.
Polina: Thank you for the interview, Brandi! It was amazing to have you here.
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