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A Battle Cry for Healthcare: Changing Systemic Bias

Updated: Jun 20, 2023

changing systemic bias

The last 3 weeks have been a rollercoaster of emotions for many of us. Reeling from a pandemic and secondary effects of depression and anxiety, we are now facing one of the most momentous times in history. The heinous death of Mr. George Floyd has sparked a flame that highlights once again the depth of systemic and institutionalized racial injustice, the public health crisis of racially motivated violence, and the need for change at every level of our country.

On a personal level, I’m recalling painful memories of being bullied, being physically pushed, threatened, and scared as a child. One painful memory is a group of fellow 4th grade classmates throwing stones at me along with two other Asian Indian girls, while the yard duty watched on and did nothing. Simply because we were darker and different. I don’t blame those kids now, I blame the yard duty, who as the adult on the playground should have protected us. However, she didn’t and it’s clear in my mind now, she didn’t think we deserved protecting. I know now that my weight issues stem from these adverse childhood events, called ACEs. As you can imagine, countless children face this daily and carry the weight of these traumatic events in their bodies, causing physical disease and mental health issues. In my early childhood years, I wanted to be a pediatrician, to protect and support children as a health professional. As I learned about our health care system, I strongly felt that health care is a right and not a privilege.

Over the last 23 years, I’ve dedicated my time to community health working with women and families, first as a nurse-midwife, and then as a family medicine nurse practitioner. In my patients, I saw the battles I faced, and wanted to support them the best I could. In my career journey, I have faced overt racism, denied opportunities and support, and dealt with many microaggressions. Most of the time I did not speak up, and even if I did, I thought what good would it do. Moreover, it could hurt my career to be seen as an instigator or a rebel. And when I did stand up, I was not supported, or worse, penalized for doing so. Most of the time I did what many Asian immigrants do, try to stay quiet, work hard, and focus on the one-on-one interactions with patients.

Those of us working in community health, especially in a diverse state like California, are well aware of racism in the health system. We see it every day. Unfortunately, systems do not support or listen to health care professionals serving our communities on the ground. And the problems persist. I’m tired of the systemic bias, the inability to make change in systems, and to help my patients. I’ve faced burn out twice working in these environments. I’m not alone, and many colleagues of color are in the same place. It is hard to see our people suffer and not be given the tools and support to make an impactful change.

Therefore, I’m grateful for the outpouring of support from many of the health care professional organizations, with many white colleagues and leaders looking to listen and educate themselves. This once again, highlights the pervasive hierarchy in our society, in which white people are expecting to be educated. I’m remembering my times at UC Berkeley in the 90’s, in which those of us growing up in white dominant culture sought to educate ourselves, knowing that no one would teach us the history of people of color, we had to seek this knowledge on our own to truly embrace diversity and broad thinking. And what comes of reading about a culture or a group of people, is being educated enough to understand the lived experience of another group of people?

Why does unconscious bias continue, because there is an “us”, and a “them”, and never a “we”. To become a “we”, we need to break bread, take a walk, talk, become friends, get to know one another. Laugh together, cry together, be together. Neighbors need to reach out to neighbors unlike them. Then you will understand our differences and our similarities. Then you will advocate for us in institutions and become a voice of reason and change, someone who combats racism at every level, and in every sense of the word, anti-racist. I’m proud that my children know many diverse people in their lives, have spent time getting to know different cultures through history and food, and understand that all people regardless of color, background, and sexual preference are the same. We have the same desires and hopes for ourselves and our families and work hard to achieve them.

Unfortunately, because of the racial discrimination in our governmental, justice, health care, and education systems, some of our sisters and brothers of color, and especially those who are black, are wanting only to stay alive and survive, and cannot even think of thriving.

As a society, it is our call to action to change these conditions in the United States.

As a nurse and health care professional, I can only speak to what I know.

I call on my fellow health care professionals to do the following:

  • Get to know people unlike you and actively understand the lived experiences of those people. Create a “we” mentality.

  • If you are a leader in your health care system, actively seek opinions other than those like your own. Encourage those at the “bottom” of your organization to speak up. You might be surprised how much your organization can thrive by getting your head out of the C-suite and serving your employees and patients. Take a holistic perspective on what the bottom line is, and it’s not just about money.

  • For those not in leadership positions, get involved with leadership in your system by representing those of diverse opinions. Don’t just sit back and take it. Don’t be just a worker bee, be a leader. Be part of the solution.

  • Create task forces at your workplace regarding inequity in the workplace to address racial inequities. Start a committee to improve racial disparities in the clinical setting, use the data you collect already, and actually make small changes using PDSA cycles. The momentum is there, let’s get it done.

  • Pledge to serve underserved communities. This is especially true of health professionals in private practices taking private insurance. Allow for a certain percentage to be pro bono or Medicaid patients. If not, volunteer your time locally. I see many providers glorify their volunteering time abroad in third world countries, but people in your backyard need you.

  • Be a mentor to health professional students of different backgrounds. They need cheerleaders, supporters, advocates, and resources to be successful and continue the good fight.

  • Most importantly, yearly unconscious bias training for all in health care workers should be mandatory. We need to address our own biases, before we can truly be of service to others.

Thank you for taking the time to read this blog, it is a step to understanding and caring.

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