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Black feminism describes that Black women are inherently valuable and the specific liberation of Black women is necessary in its own right. It parses out these political identities and desires to have true humanity for Black women -- arguing that it is impossible for there to be bondage of any other group when we liberate marginalized genders and Black people, as these populations are seen as the .
Medical culture is in almost direct opposition to Black feminism. There can be many positive aspects, such as focusing on promoting evidence-based approaches to care and centering the patient in the care process. However, medical culture often does not promote collaboration between team members, is hierarchical, and punishes people for "stepping out of line" when someone who is perceived as being less important steps outside of their defined role by questioning care and management.
Rather than taking the time to even consider the possibilities of there being teaching opportunities or even considering the possibility that others are right, medical culture and training promote trauma and identification with one's abuser for medical trainees, as trainers at many levels and the entire medical system are traumatic and abusive. There is glory in insomnia and failure to eat and seeing patients when we can no longer take care of ourselves, and not seeing our families and refilling our own cups. This glory comes in the form of promotions and awards for working excessively. Consequently, we fall into a trap where we lose our empathy, families, and health. This burnout at many levels leads to poor patient outcomes, such as longer discharge recovery and lower satisfaction.
This culture also does not promote motherhood or childbearing and increases dissatisfaction with work and burnout in medicine. This is clearly harmful to both male and female physicians at multiple levels. This does not promote men being active fathers in their children's lives or having healthy personal and professional lives. This culture promotes alienation from family and mental illness, which is increasingly harming Black people who more commonly experience racism and an absence of support in their work.
Medicine is clearly necessary, though oppressive and abusive. However, understanding the need for liberation of Black women and freeing all marginalized people will allow political, social, and economic freedom. This understanding will improve: 1) the care any patient receives; 2) how medical professionals at every level experience their work; 3) how patients present to medical care; and 4) health disparities in medicine.
To inherently improve the care patients receive, we must understand that this framework will first and foremost allow professionals to see the true disparities in medical care. These professionals will begin to address the real processes that lead to poor outcomes in patients due to the medical systems. We will see how we fail to listen to many patients and fail to diagnose them because we view some people as inherently less credible than others and destroy that experience. We will begin to approach care with patients from a place of love and understanding. Using both a lens of understanding and applying science and pathology to come from a place beyond care and respect, but actual love, will transform our relationships with patients and their outcomes.
To improve the experiences of medical professionals at all levels, we will understand that every single person on our team, regardless of their race, gender, cultural background, or status in this system provides a valuable contribution.
This means inviting everyone directly caring for a patient consistently to rounds to discuss the patients. This means open lines of communication between all team members who should feel comfortable approaching any person on the team about a problem. This means taking on licensure-appropriate responsibilities for others on the team when they may not be able to perform those tasks. This means recognizing the burnout that others on the team are experiencing, offering to help, conveying our vulnerability, and asking for help from others on our team to help ourselves and our patients. This means clear accountability from everyone on the team, but clear forgiveness and moving forward when a mistake is made. This also means that team leaders set the tone and expectations of equitable care for every patient, and challenging biases from everyone.
In trying to decrease health disparities and improve presentation to medical care, using a Black feminist perspective will allow us to recognize the cause of the disparities and promote taking specific and helpful action steps in decreasing these disparities. Rather than only engaging in implicit bias training, we should discuss inherent connections between slavery, sexism, incarceration, and the medical system, and have clear steps to reduce these in each respective health system.
It means understanding patients' experiences and believing these experiences are real, and reducing the poor experiences and outcomes that patients experience. We also must believe that there is value in reducing the trauma patients experience, having clear and honest conversations with patients, and providing quality care to each patient. Using this specific framework, we can implore understanding from each patient, each team member, and truly improve the experiences of every single person.
For decades, professionals have discussed the toxicity of medicine. However, there has been limited change in culture shifts in medicine. It's time to try something radical to change medicine drastically for the better.
Micaela Stevenson is a medical student.
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