Last night, in the middle of reading news articles about the Baltimore riots and catching up with social media coverage of events on the ground, I received a Facebook chat from a med school friend with a link to an article defending the rioting, quickly followed by a long message that began, “I’m mad….” “I’m furious” was my reply. And so began our conversation about police violence and rioting — and about the responses to issues such as these within our med school.
Since starting medical school, I’ve had numerous conversations about racism and other forms of oppression with my classmates, many of whom are like-minded friends. These discussions usually occur privately on walks home, in study rooms, and online in private messages. And for the most part, the most open we are about issues of social justice is on Facebook, where we post articles and videos of current events like Ferguson, Staten Island, and now Baltimore and just let it be. (I, for one, do this often because it’s the easiest way to air my opinions without having to actually spell it out in my own words.) Outside of those spheres, however, there is relative quiet in the medical community.
The silence within medical institutions is something I’ve noticed since starting medical school this fall. The weekend before my med school’s orientation for first year students began, Mike Brown was shot and killed by a white police officer in Ferguson, Missouri. Little did I know then that Brown’s name would become a hashtag, that people would march to demand justice — not only in Ferguson but across the country, and that discussion of these events would be, by and large, absent from my medical school community in the months to follow.
I recall spending the first several months of med school feeling like I was in a bubble. On campus, there was no outrage, no public discussion, and almost no acknowledgement of what was going on “on the outside”: the militarization of police in Ferguson, the series of black murders at the hands of white cops, and the significant and largely nonviolent marches and die-ins happening in various cities. Leaving the bubble was an altogether different story. I would sometimes walk home with a couple of classmates (who quickly became friends once we realized we had a passion for social justice in common), and we would discuss current events and felt free to express our outrage at racist systems. Upon arriving home, I would check social media to see what I had missed during the day and would find my Tumblr dashboard absolutely flooded with text posts and screencapped tweets that provided updates from the ground in Ferguson or signal boosted incidences of police violence that mainstream news sites would either not cover or brush under the rug in favor of more “clickable” news items.
The difference between on-campus and off-campus was stark. On-campus, people were radio silent on these issues; off-campus, there was considerable and justified raging against oppressive systems.
I thought that perhaps the lack of discourse on campus was due to the fact that we were new students, still trying to figure out the lay of the land — who our friends were, how we fit into the medical system, and what sorts of things we could and could not do. Now, eight months later, I’m not so sure that the silence on social issues — particularly issues of race and police violence — is because we’re new students. Rather, silence seems to be the norm.
To be clear, I’m not saying that medical students aren’t engaged in social justice; on the contrary, I have found an amazing network of people both at Penn and at other med schools who care deeply about justice and take action accordingly. What I’m suggesting is that public discussions of things like Ferguson, Staten Island, and the Baltimore uprising that is currently taking place do not occur in medical schools. At least, that’s not something that happens naturally, and I’m curious as to why that is, and it’s something that I’ve been discussing with my peers.
The best we can come up with is that medicine, like nearly all of society, is hierarchical. Although we are taking steps to move away from that structure, it remains deeply embedded in medical culture. It’s very clear from the moment when you first don your white coat where you belong: As a first year medical student, you are at the very bottom of the totem pole; your job is to listen, to absorb, and to regurgitate. And from what I hear from older students, it doesn’t get much better once you start rotations. Calling out a resident or an attending for an insensitive remark, for example, just doesn’t happen.
The problem of silence in medicine then isn’t that medical students are quiet. It’s that we’re taught to be quiet because that’s what we’re supposed to do as medical professionals. In the medical hierarchy, we are taught not to offend. We are taught not to make waves. We are taught that we cannot voice potentially unpopular opinions aloud, save in private conversations and behind closed doors. We know this because our attendings, our professors, and our institutions are quiet too.
In the months following Ferguson, my friends and I waited for public statements by our medical schools, our hospitals, and professional medical associations to at least acknowledge what was going on outside of our halls. They said nothing — not until medical students started taking part in protests, from attending marches in our white coats (I see you, New York friends who went to the Millions March!) to demonstrating in die-ins on our own medical campuses. Once students pushed the conversation on racism, police brutality, and medicine to the forefront, physicians started addressing the issue publicly. While I’m quite encouraged that discussion is starting to take place in spaces like NEJM, the larger culture of silence still predominates.
Institutional silence teaches us that professionalism in medicine is maintaining the status quo. It also means that we are taught that, on issues of race, we cannot be honest about harsh truths. We are not allowed to talk explicitly of white supremacy — and are barely taught about white privilege — when we have discussions of race and health. We are told that we should not say #BlackLivesMatter, as if affirming the value of Black life somehow implies a simultaneous devaluing of other lives (more on this in a future post). We are given the message that the role of the physician is to quietly practice medicine and not lend their voice in protest against a system that actively harms their patients — and colleagues — of color.
I’m not suggesting that med students and physicians alike need to come out to protests or participate in direct actions or anything of that nature (although that would be awesome!); I understand that that sort of activism isn’t for everybody. But what I am hoping for is the space to dialogue honestly and publicly about these sorts of issues. Speaking up and out about racism or other forms of oppression should not be something that we leave for our social medicine courses. It should not be controversial or “risky” to take a stand for justice within medical circles. And at the very least, talking about these issues should not have to happen only among like-minded friends. These are public issues; they deserve to be discussed publicly.