“Wow, you don’t have an accent at all!”

From Charlottesville to NFL stadiums, conversations and controversies surrounding race relations have seldom felt more heated. These events challenge each of us to consider how racial issues intersect with our daily lives, as OHSU emergency physician Esther Choo notably did in a now-viral tweetstorm about patients refusing care from providers of color.

The reverberations of these seismic disruptions in our social consciousness have, naturally, stirred discussions in our medical school’s classrooms and clinics: how we’ve felt impacted, how our patients have been affected, and how we can root out structurally-ingrained racism in our local environments. And while I can’t claim to understand or have experienced the unique challenges my black or Latino colleagues encounter, these conversations have raised common threads of reflection among my Asian-American peers about the micro-aggressions we navigate while learning medicine in the ‘buckle of the Bible Belt.’

Thankfully, the experience of being verbally confronted or having my services refused on the basis of race isn’t something I’ve had to handle—for such overt hostility, the New England Journal of Medicine has an excellent primer on “Dealing with Racist Patients.” Instead, my brushes with “lowercase-r” racism have been much more subtle, and often unintentional.

“I know a Dr. Patel; he lives in North Carolina? Do you know him?”

Funny; I know a Joe Smith in Edison, New Jersey. Do you know him?

“Where are you from?”

New Jersey.

“No, where are you really from?”

I promise, I am really really from New Jersey.

“Where are your parents or grandparents from?

[Groan.]

“Wow, you don’t have an accent at all, and your English is great!”

Well, I scored 5’s on my AP English exams and an 800 on my SAT verbal, so I’d say I’m pretty decent at English, yes.

“You moved here when you were two months old? That means you’re almost one of us!”

Thank you for letting me know that, though I’ve spent 99.3% of my life here, completed 20 years of schooling here, renounced my Indian citizenship for a U.S. one, and consider myself as deeply immersed in your sports, music, and pop culture as anyone else, that you still think of me as less entitled to the privilege of being “American” than you are.

If you’re not convinced, Buzzfeed has some delightful examples, too.

I came to Tennessee (which is 1.8% Asian) from a university ranked #1 for race-class interaction, and before that, a minority-majority hometown where our high school cafeteria resembled the United Nations. It felt entirely foreign, then, to transition to a setting where most of my patients not only didn’t look like me, but had often lived for decades in rural communities where everyone looked the same, sounded the same, prayed the same, and voted the same. It was a rare experience to feel hyper-aware that I was different, which was only heightened by my patients’ comments and curiosity questions. These bigots, these ignorant rednecks, these deplorables, I fumed internally.

With time, though, as I grew to better understand my patients, my exasperation softened to empathy. Through brief interactions at the bedside, I came to see my patients’ “political incorrectness” not as ill-intent, but inexperience. If you live in McMinnville, Tennessee, you might believe that most towns, like yours, have only one South Asian family, and intuit that these dispersed Desis find and know each other. You might only know of South Asian culture through the pop culture vignettes of Simpsons or Slumdog, so that when you encounter an Indian American medical student, your conversational instinct is to ask about accents, bindis (“dots”), the caste system, or arranged marriages. Maybe that is bias or racism, but it’s a curious naivete that’s infinitely harder to hate or look down upon than a tiki-torch mob.

Acknowledging that naivete, I no longer get frustrated or angry. Instead, I teach.

“I know a Dr. Patel; he lives in North Carolina? Do you know him?”

“No, I don’t. There are 4 million Indian Americans across the U.S., so it’s hard for all of us to keep in touch! “Patel” is also as common a last name among Indians as “Smith,” “Jones,” or “Johnson” are here. It’s like asking if you know my neighbor back in New Jersey just because he has the same last name; I’m guessing you probably haven’t met!”

“Where are you from?”

“I’m originally from New Jersey, where my family still lives.”

“No, where are you really from?”

“Well, I was born in India, but moved here when I was two months old. I’ve completed all my schooling here, gone to college here, and consider myself culturally American with Indian roots. Most people tend not to remember much from the first two months of their life, so practically, my life here is all I’ve lived and known!”

Likewise, acknowledging my limited insight into the lived experiences of the South, I learn. I ask my patients what it’s like to live in rural Tennessee or the ‘urban underserved’ areas of Nashville. I ask about the factors that promote or impair physical and mental wellbeing in their communities. I ask about their beliefs, values, and goals, realizing that their social contexts might frame these perceptions to be drastically different than my own precepts or presumptions. As I realize that I understand their lives and backgrounds as little as they do mine, it becomes harder to cast judgments or throw stones.

Of course, not everyone’s experiences might be as benign as I’ve been fortunate to have, or as amenable to resolution with casual conversation and cross-teaching. Medicine has much self-reflection and work to do regarding racial disparities—certainly, among others—in our physicians’ demographic composition, in our patients’ health outcomes, and in our interpersonal interactions in clinical practice. That’s a much larger matter, and I’ll table it for a more seasoned expert’s commentary.

But, for immigrant medical students and physicians, I offer this advice: the next time you encounter an off-putting or politically-incorrect remark, consider where it’s coming from, and the contexts and experiences which frame that person’s viewpoint. Consider the positive impact you might offer by deferring confrontation for education. And most critically, consider your own biases or presuppositions before judging or critiquing someone for theirs. Shared understanding isn’t always the solution, but it’s often a worthwhile start. Give it a try; I promise your patient interactions (and cortisol levels) will be all the more better for it.

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Chugging Along

It’s the morning after Election Day, and the world still has a sort of surreal quality to it.

I awoke this morning with a sense of fear. Fear for my own safety, and the safety of my loved ones who fall beyond ‘standard’ templates of race, faith, nationality, gender, or sexuality. Fear for the stability of public discourse and debate in the coming days and weeks. Fear for the legacy of the last 8 years—and the last 240 years, really—which today seems more vulnerable than ever.

Somehow, I got out of bed, took a shower, got dressed for school, packed a lunch, and drove to school, all the while feeling anxious to discover what a “Great Again” America would look and feel like.

And then I reached the hospital. Here, it doesn’t feel like the morning after Election Day; it’s Wednesday, November 9th, and just that. Doctors are taking care of patients. Residents are scurrying about, completing their usual errands. Patients are being seen, heard, and cared for, just like any other day.

One of medicine’s most beautiful qualities is that, whatever the turbulence beyond the hospital, the essence of the patient-provider interaction and the bedside encounter remains a familiar constant. Today, my fellow healthcare providers will head to work carrying the weights of their emotions and thoughts, but once we walk into that exam room, nothing else will seem relevant but the needs of the patient before us. Even if that patient is wearing a “Make America Great Again” cap, and even if he holds an ideology that considers my kind an outsider or a threat, we’ll look beyond that. We’ll resist the temptation to see a ‘deplorable,’ and challenge ourselves to see someone who needs our guidance, compassion, and care. A patient—nothing less, nothing more.

That’s not to suggest at all that medicine occurs in a vacuum. As physicians and physicians-in-training, we now face an uncertain future that could well profoundly affect the way we practice. Our patients will face renewed challenges to receiving accessible, affordable, equitable health services. The health and wellbeing of marginalized populations, such as women and LGBT individuals, will be more vulnerable to the whims of partisan policy than ever before. Gun violence will, once again, fail to receive its due recognition as a public health emergency.

These are important matters, and as educated experts who navigate these issues in the trenches each day, our voices will be critically important to these conversations. We cannot let our commitments to advancing the health of populations waver in the face of adversity. The path forward will be harder, and so our convictions must be even stronger. That conversation begins tomorrow.

But today, when it seems like the rest of the world is standing still, and when it feels like a future with a President Trump is too painful to even imagine, I take comfort in the assurance that ours is a profession that, despite our emotions and adversities, keeps chugging along, changing the world one patient at a time.

White Coats for Black Lives? Prove It.

When it comes to advocacy on matters of race and social justice, medicine’s C.V. is, at best, mediocre. 19th century medical students learned their craft by dissecting the grave-robbed cadavers of African Americans, immigrants, and the poor—the bodies that wouldn’t be missed or spark protest. Decades of translational research relies on an immortal cell line extracted, without consent, from African-American Henrietta Lacks in the 1950s. And, of course, there was that clinical experiment for “bad blood.”

Which makes it all the more fascinating, then, how medical students nationwide responded to the recent controversies surrounding the deaths of Michael Brown and Eric Garner:

On one level, it’s incredible to see medical students taking a stand, making ripples nationwide, and letting all our patients know that we stand with them. The white coat—even a short one—lends reputation and gravitas, and #WhiteCoats4BlackLives proves that if we stand (or die-in) together, people listen. As tomorrow’s doctors, we should be inspired from these events to capture that attention and guide public discourse on society’s leading issues: access to care, women’s health, medical errors, gun control … the opportunities are immense.

And yet, on another level, it feels somewhat hollow to die-in together, to call our campuses to attention with powerful gestures, to feel the pride of a national movement … only to return to clinic or class an hour later, ready to resume our usual routines. We have the public’s attention, but now I’m tempted to follow up with a question I encountered too often as an Indian-American liberal arts major: “What are you going to do with that?” If social media is any indication, we grabbed the microphone for a moment, dropped it, and walked off the stage. That’s not social advocacy; it’s feel-good activism.

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In the days to come, we have to remember that raising awareness is a means to an end, but not an end in itself. It’s imperative that our objective is continuity, not complacency. We’re entering a discipline where our black and white patients’ life expectancies differ by five years. Where blacks have the highest rates of cancer, but the lowest rates of clinical trial enrollment. Where six percent of our colleagues are black. Where 70% of the applicants for NIH funding are white, and 1.4% are black. If we want to take action—to not just “raise awareness” of problems, but solve them—the social agenda practically writes itself.

As medical students, we chose this profession to help others—to make a difference. So let’s challenge ourselves to go beyond the “social activism” of fighting a disease by wearing pink, pouring ice water on ourselves, or sprawling out on a sidewalk. Let’s challenge ourselves to identify matters of race and social inequality within our communities, in our medical institutions, and at the bedside of each patient we meet. Let’s challenge ourselves to not simply “raise awareness” of the issues that are already trending in the media, but to take real, directly measurable actions to make these social inequalities artifacts of history.