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Dear White Colleagues in EM | Becoming Better Allies

November 8, 2021

Written by Eriny Hanna

Spoon Feed
There are specific actions that non-minority providers can take to effectively help combat racism and inequity.

Why does this matter?
Emergency medicine doctors of color (we) have experienced microaggressions, discrimination, and lack of resources. COVID has disproportionately affected Black and Brown populations, a burden that we are reminded of daily. At work and in the community, we constantly experience the burden of police brutality, over-policing, and racist policies. In short, “We are tired.”

Here are ways to be allies and practice antiracism

Educate yourself and change the culture of emergency medicine.

  • Educate yourself on the current state of discrimination. The article provides a table of resources.

  • After that, approach with a humble attitude and ask questions about how you can help.

Change your on-shift culture.

  • If you see an act of discrimination, acknowledge what you saw and ask how you can help. Avoid the assumption that we need you to step in.

  • All members of the department should receive training on discrimination response.

Change your institutional culture.

  • Change the department’s values and goals and use metrics to track progress.

  • Improve education on equity in a holistic way and “pay the majority tax” by leading these sessions yourself.

  • Provide support for the department to attend health equity conferences.

Change the face of emergency medicine.

  • Support pipeline efforts and getting underrepresented students into residency.

  • Remove application filters that disproportionately disadvantage underrepresented applicants.

  • Formalize a diversity committee, vetted with resources, protected time, interview time, and voting at ranking meetings.

  • Apply a Rooney Rule that requires interviewing minority candidates for each position.

  • Provide mentorship, development programs, and protected time for diversity efforts.

Change the voice of emergency medicine.

  • Review promotion criteria using an “equity lens,” and make promotion criteria transparent.

  • Implement small efforts such as asking opinions of those who are marginalized.

Change the strategy of crisis prevention.

  • Implement training on navigating police in the ED.

  • Create policies regarding police brutality management.

  • Write to legislators on issues that matter to us and our communities.

Another Spoonful
For more information, check out EMRA’s Antiracism in EM presentation by Dr. Sadiqa Kendi and ACEP’s Diversity section. MedEdPortal provides an anti-racism collection and Diversity, Inclusion, and Health Equity collection for curriculum ideas.

Dear White People in Emergency Medicine. Ann Emerg Med. 2021 Sep 28:S0196-0644(21)00774-5. doi: 10.1016/j.annemergmed.2021.08.004. Epub ahead of print.

Peer reviewed by Clay Smith. Thanks Dr. Hanna!

16 thoughts on “Dear White Colleagues in EM | Becoming Better Allies

  • Count me in the group of (white) physicians that support your decision to cover this article. Both the content of the article, and the backlash to even discussing it, highlight critical issues that are affecting our colleagues and our practice. I particularly like your follow up comment of “doing what I can to make things right in my sphere of influence”. Keep it up
    – Sam Bores, MD

  • Our work takes humility, compassion and courage. Kudos to you for having both and bringing attention to this important matter. Whatever our race/ethnic background, all of us have room to grow and better understand the world around us. If we don’t realize that, we are fooling ourselves. We are with you.

  • Drs. Smith and Hanna,

    I’d like to thank you for posting this as well. As part of a majority white/male specialty that cares for the most vulnerable people in an increasingly diverse country, we need to talk about how race affects our patients and colleagues in a self-reflective, respectful way. Thanks again for contributing to that dialogue.

    James Sledd PGY-3

  • I just read the Spoon Feed about the comment on this post. The content of the post is great, as much as the DEI training. However, I believe your title did the same thing that much of DEI training does, and that is alienate people from the beginning. Starting an article off with "Dear white people" is antagonistic and is offputting to white people. A better title would have been "How to be Better Allies".

    • I too was initially taken aback and provoked by the title of the editorial. Then I read what was on the inside and found it to have a different tone and thought the information was useful and helpful. I did not agree with everything in the article, but I seldom do. However, there was so much in there that was of benefit, I knew I wanted to amplify this on JF. I agree with you; I think I too would have titled the editorial differently. But maybe it conveys some of the rawness and hurt some of our colleagues feel. I was so moved when I read, "We wear our white coats to drive to work in case we get pulled over. We’ve even taped our hospital badges to our dashboards so we wouldn’t have to reach for them to prove who we are. We have seen what has happened when people of color reach for identification after being pulled over." That was heartbreaking and eye-opening for me. So I just want to give a lot of space and grace. I really wrestled with what to make the title for Dr. Hanna’s summary yesterday. I wanted to convey it was written as a letter from Black colleagues to White colleagues, but "Dear White People" seemed so impersonal. These are not just random "White people." These are valued friends and colleagues. So, I tried to take a middle-of-the-road approach and changed our blog post title to reflect that these are our friends and teammates. We are allies. But we have much work to do to be better, wiser allies. But I hear your critique 100%. Others have privately emailed the exact sentiment. And maybe I should have titled our blog post differently. Thanks again for the thoughtful, constructive comment.

  • Thank you very much for posting this on JournalFeed. Articles like these are often restricted to the echo chamber of those working towards more progressive ideals and don’t reach the audience that the authors are attempting to have a discussion with. Although the negative commentary that you addressed in your e-mail today is disheartening, it is nevertheless a sign that your post is reaching a group of people who would otherwise not be exposed to this. And if you are able to advance the conversation with even one person, then it is worth the discomfort and frustration.

  • I want to add my support here as well. This is such an important topic and we (white members of the medical community) NEED to be challenged to be better. Folks that are upset about being asked to participate in that dialogue are telling on themselves. Parsing the exact language of the title is fallacy that obscures the need to examine the content of the referenced article. I hope the negative reactions of the vocal few will not stop you from highlighting similar content.

    Jason Woods

  • I think the problem I have with this referenced article is not in its intent but in HOW it wants to accomplish the goal of ousting racism. And, I think what bothers me is the difference between equity vs equality; these two words are not the same. The referenced article and the summary by Eriny supports equity rather than equality (neither use the word equality). Equity is further highlighted in the provided resources (Table 1) of the referenced article. My comments below broaden the discussion somewhat.

    Equity strives for equal outcomes.

    Equality strives for equal opportunity.

    Providing equal opportunity will not lead to equal outcomes. Equal outcomes will not lead to equal opportunity. Equity by definition precludes equal opportunity. You can’t have both.

    Equal outcomes lets the less qualified get to the top (e.g. Rooney Rule – based on the color of someone’s skin rather than their ability). Ensuring equal outcomes leads to someone losing when they deserve to be there. I do not want a less qualified surgeon operating on me because he/she got into surgical residency based on their skin color. I want the best surgeon to operate on me regardless of their skin color. Equity means that someone had to work less hard to get somewhere compared to others. Don’t we owe it to our patients to only offer them the best of the best? And if the best of the best means all black doctors, then so be it.

    In 2020, there were ~74% black NBA players and ~17% were white. Equity means that we would need to strive for equal white/black players. That means that a better black player gets left behind in the name of equity so a white guy can play. Ridiculous, right?

    An equitable society leads to competing groups rather than competing individuals. Equity will only further divide us.

    Striving for equity will lead to continued fractionation; what about equity based on being fat, tall, short, your age, temperaments, etc? We would have to dig into a countless amount of fractionation in an effort to achieve equal outcomes. Achieving equity is an impossibility.

    Equity stifles innovation; if we have equal outcomes then why bother striving to be the best at something?

    Equity stifles the American Dream that anybody anywhere can accomplish great things. This country was based on equality (equal opportunity). There are countless examples of black people with significant accomplishments that have risen out of difficult circumstances.

    “I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.”
    ― Martin Luther King Jr.

    If there is a disproportionate amount of black people in certain fields then we need to look at the root cause of the problem by ensuring equal opportunity and not let an unqualified person slip through (regardless of their skin color) because we wanted to ensure an equal outcome.

    • Thank you for your reflection. Everyone has different circumstances and needs differing resources to become successful. Equity is about giving fair opportunities. The article offers suggestions for equal opportunity. The authors suggest that mentoring and pipeline programs are ways to support deserving, talented minority candidates. They identify that mentoring is one such resource that can level the playing field. Someone can work really hard and have the right character, but despite their qualification does not get recognized or promoted because they were not given the right resources or opportunities. The Rooney Rule does not guarantee or force one race to secure a position, rather it allows institutions to consider diverse applicants and to mitigate unconscious bias.

  • What troubles me is If you define racism as make judgements based completely on someones skin color, the article is extremely racist. There is nothing magical about someones skin color that protects them from being a racist, just like there is nothing magical that makes them a racist.

    • The article is suggesting ways that we can be better allies and better work against racism together.

  • Both myself and our residency leadership team strongly support Drs. Smith and Hanna in their efforts to engage in conversation and education on this topic. Our Department values diversity, equity and inclusion in every aspect of Emergency Medicine, and we look forward to continuing to foster open and supportive communication on this topic.

    Erik Hess MD MSc
    Professor and Chair, Vanderbilt University Medical Center

  • To use "titles like this" only creates more division. It sets a tone and this should never have been published like this. If wrote an article and changed one word in the title to a different color it would not have been allowed.

    • Tom and other commenters in this thread,
      I allow anonymous comments on this blog, because I can’t seem to make them work at all when I require an email, etc. Readers, please be aware. Some have not identified yourselves. This is forum for civil discussion. It is mainly written for practicing clinicians. So far, I appreciate that your comments are on point and civil, which is why I have not deleted them. Plus I didn’t establish this as one of the ground rules. However, it is important for the JournalFeed readers to understand we have no idea who you are. If you are going to comment on this blog, you need to identify yourself. I am asking readers to please avoid commenting anonymously until I can figure out how to change my blog settings without breaking commenting altogether. We show clearly who writes each post and consider this a matter of integrity. Readers deserve to know who is writing what they read, and I apologize I am having this tech trouble. I will try to figure out how to change to no anonymous commenting. For now, we benefit from learning from each other and from the discussion. But if you’re not willing to stand behind your comments, should you be making them?

What are your thoughts?