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It’s the story I hear the most from medical students/residents/staff: “I was on a rotation/in the reading room/<insert location here> and my preceptor/attending/manager said something racist/sexist/homophobic, etc. I had always thought about how I would react in the moment — and even practiced it — but when faced with reality, I didn’t say anything. I just froze.”

When asked for tips on what they should have done or said, most are surprised by my response: “You did the right thing. You shouldn’t have said anything.”

Fact: Our healthcare system is flawed on many levels. It is built to perpetuate the hierarchical status quo, which allows discrimination and exploitation to perpetuate. Our system is not designed for upward feedback, especially when it comes to complex issues of diversity, equity and inclusion. Calling out a supervisor can lead to retaliation and, in truth, I don’t believe there is ever going to be a completely anonymous way of reporting discriminatory behavior. I have heard too many instances where information regarding the reporting party was directly passed on to the person in question. One provoked supervisor can torpedo your chances of getting into that competitive residency you’re eyeing/finding a job in your subspecialty/getting that faculty promotion. Our relatively subjective system of evaluating subordinates in medicine leaves plenty of room for retaliation under the guise of subjectivity. Understandably, there are few academic reports of documented retaliation, which quickly become a human resources or legal matter; however, studies have shown that concern for retaliation or reprisal shapes trainees’ willingness to speak up [Binder 2018; Gianakos 2022]. One does not need to look much farther back than the COVID-19 crisis to see several examples of managers demonstrating such retaliatory behaviors [Gross 2020].

Speaking up comes with risks and can have a profound impact on your career. People love to talk about “getting in good trouble,” but I would argue that at the time those “good troublemakers” were just seen as “troublemakers,” and for every person who was later celebrated for taking a stand, there are many who suffered grave consequences and were forgotten by history. Furthermore, the causes and freedom-fighters society chooses to lionize do not necessarily reflect our better ideals. For example, Martin Luther King Jr., was despised in his time and the current popular understanding of his legacy has been sanitized to the point where it promotes the very things he fought against [Dyson 2000; Alridge 2006; Berry 1996; King Jr 2010].

So, what do you do? A friend and mentor of mine told me you can’t back every cause, and you need to pick and choose your battles: pick the ones you can win so you can fight another day. For him, that meant keeping his head down and abiding by the politics of the workplace. This strategy has served him well as he has risen through the ranks and has been able to make meaningful changes to the system. I, on the other hand, have backed the lost causes; from trainee exploitation and unionization to ageism in the workplace. We’ve both had wins, losses and dust-ups. I don’t know the right answer, but I do know that you — medical students — can change what healthcare looks like in the future; you just need to survive our broken system first. It is vital that we work to fix our hierarchical system and create one built on mutual respect of all healthcare workers focused on continual improvement.

Bibliography

Binder, R., Garcia, P., Johnson, B. and Fuentes-Afflick, E., 2018. Sexual harassment in medical schools: the challenge of covert retaliation as a barrier to reporting. Academic Medicine, 93(12), pp.1770–1773.

Gianakos, A.L., Freischlag, J.A., Mercurio, A.M., Haring, R.S., LaPorte, D.M., Mulcahey, M.K., Cannada, L.K. and Kennedy, J.G., 2022. Bullying, discrimination, harassment, sexual harassment, and the fear of retaliation during surgical residency training: a systematic review. World journal of surgery, pp.1–13.

Gross, D., 2020. What happened when medical residents asked for hazard pay. The New Yorker, 8.

Dyson, M.E. and Jagerman, D.L., 2000. I may not get there with you: The true Martin Luther King, Jr (Vol. 233). Simon and Schuster.

Alridge, D.P., 2006. The limits of master narratives in history textbooks: An analysis of representations of Martin Luther King, Jr. Teachers College Record, 108(4), pp.662–686.

Berry, M.F., 1996. Vindicating Martin Luther King, Jr.: The road to a color-blind society. The Journal of Negro History, 81(1–4), pp.137–144.

King Jr., M.L., 2010. Where do we go from here: Chaos or community? (Vol. 2). Beacon Press.

This article represents Dr. Chonde’s individual views on the subject matter and not the views of the 黑料网.