I love writing and often jump at the chance to have my words read by others. So, I was pretty excited when I received an email request to write an op-ed from my hospital’s public relations team, especially since I was only a fellow at the time. They had read some of my previous work and I felt honored they wanted me to represent the hospital in such a meaningful way. Yet, once I saw the topic, I was taken aback. They wanted me to write an op-ed for a suburban newspaper encouraging teenagers to refrain from posting racist content online so they would not get in trouble at school.
After the murder of George Floyd in 2020, and more widespread awareness of systemic racism in America, schools were instituting stronger surveillance and discipline of racist statements. High school students were suspended or lost college admissions offers following racist actions. The racial dynamics behind the request seemed so obvious to me, and yet, others were oblivious. The hospital’s white public relations team wanted me, a Black woman and the only Black physician in the adolescent medicine division, to tell teens in the predominantly white suburbs to not share racist images or statements to avoid consequences. Their request felt offensive, and I was appalled that they could not even see their own error.
Black, Indigenous, and people of color in healthcare already bear the burden of educating our predominantly white colleagues, hospitals, and training programs about racism and ways to intervene. We are called upon to provide education, often without compensation, that takes time away from other pursuits. It can be emotionally draining. This phenomenon is so common that it is referred to as the “minority tax.” I could have just said “no” myself, but I hoped the fellowship program that promised to support me would understand the burden this education and these types of requests have on me, and offer to intervene on my behalf. I reached out to my program leadership for help. They responded, but only to offer a space to brainstorm how I would respond to the newspaper. I quickly declined. I knew I could respond, but I felt I should not have to. I wanted their advocacy, not their advice.
I never wrote that op-ed, and my requests to change the topic to a more appropriate one were declined. Yet, that experience sticks with me because it is reminiscent of so many interactions that I and other healthcare professionals from marginalized backgrounds experience. We are drawn to universities, training programs, and hospitals in part because of promises of support and allyship for our marginalized identities. We see diversity statements on hospital websites, Black Lives Matter signs in offices, and rainbow flags on name badges. All these gestures aim to signal that we are welcome and safe here.
Yet, I and many others have found these exact spaces — from medical schools, to fellowship programs, to hospital settings — to fall short of the support we need. When students, trainees, and staff from marginalized backgrounds report discrimination based on that identity, they are often met with troubling responses: confidentiality breaches, unwanted advice on how to fix the problem themselves, reassurance that the person who harmed them has “good intentions,” denial or minimization of their concerns, blame for causing the problem, or even retaliation for raising the issue. Some of these responses are well-intentioned, and some are malicious, but all serve to silence and isolate the person experiencing harm and destroy their sense of belonging at the institution. “It’s not about intent, it’s about impact.”
How can allies respond to discrimination in healthcare with a positive impact? As demonstrated in a qualitative study of medical students by Justin Bullock, MD, and colleagues, there is “no one size fits all” approach. People have different preferences and one person may even prefer different responses to differing situations. The study’s findings suggest two important points for allies: prepare for when, not if, discrimination occurs and talk about preferred approaches to issues beforehand.
My advice to healthcare supervisors, faculty, and program leadership on allyship is five-fold. First, seek out accurate education. The ability to combat racism and other forms of discrimination must start with a common language. Develop and strengthen your institution’s educational initiatives so everyone has a baseline understanding of historical context, terms, and why these issues are so important. Second, notice how those around you are treated. Pay attention to language and gestures made by patients, families, and providers. Regardless of intent, recognize the harm in their actions, including the consequences for mental and physical health.
Third, listen. Let anyone you supervise or work alongside know that it is safe to bring concerns to you. Explain guidelines for confidentiality in advance and your desire to address concerns. Fourth, give affirmation. Once harm has been reported to you, acknowledge it without questioning or minimizing the situation or defending the person who caused the harm. Finally, address the issue following the reporter’s lead. Offer to intervene on their behalf, but only with their permission, and develop a plan for who the issue will be reported to and how it will be handled.
Power dynamics are always at play, both in the healthcare workplace and far beyond, yet they can often be ignored by those in the most privileged positions. When my program leadership only offered me a space to brainstorm my response, they did not acknowledge how intimidated I may have felt to communicate my true concerns. They left me in a position of vulnerability to tell older white women with established relationships at the hospital that I, a Black, temporary trainee, felt their request was not only wrong, but racist. I feared the consequences of speaking up. Allyship is not just offering a safe space to vent, but standing up and offering to advocate for those in healthcare with marginalized identities when discrimination occurs.
Rebekah Fenton, MD, MPH, is an adolescent medicine attending at a federally qualified health center and school-based clinic in Chicago, and an adolescent health advocate with a health equity lens.
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