Whiteness is the root of all evil.
Just ask the British Medical Journal, or BMJ. They can explain to you that doctors burning out from long hours, grueling work, high stress, and patient ingratitude can all be laid at the feet of white supremacy. Excess paperwork, dealing with insurance, too many patients…those are insignificant compared to White people existing, apparently. If White people went away it’s all good.
Ah yes, white supremacy, the new end all ubiquitous source of all that is wrong and evil in the world, not to exclude whatever trivial malady or misstep that may afflict you — or today’s special…career fatigue. pic.twitter.com/W0VRxtkX3u
— SilverPatriotRedux (@ReduxPatriot) December 1, 2022
The article is a peach, using every possible buzzword you can find to explain how all bad things in heaven and Earth can be laid at the feet of White people.
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention.
However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine’s whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training’s hidden curriculum. We argue that ’ungaslighting’ the physician burnout discourse requires exposing the history giving rise to medicine’s whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
Frankly, my first and rather uncharitable reaction is that if they hate White Western medicine so much then get the hell away from using any of it and refrain from practicing medicine. If it is oppressive, then don’t be around it. See how you like it then when you need heart surgery or cancer treatment. I hear that some shamans have herbs they can burn to help you out.
That is my very uncharitable reaction, which of course wouldn’t be politic to express. And if I am anything, I am both very politic and very charitable. So I will refrain from saying any of those things. Ignore that I did.
Systems of oppression—such as racism—are the historical, organised patterns of mistreatment cemented into culture, society and laws, and subjugating marginalised social groups while elevating dominant ones (National Museum of African American History & Culture 2019). They overlap, exacerbating one another, and compounding discrimination, a phenomenon called intersectionality (Crenshaw 1990). Medicine’s own intersecting systems of oppression represent an abusive system of power in which the domination, idealisation and normalising of white able-bodied cisgender, heterosexual men depend on the subjugation, pathologising and exploitation of all others (Hooks 2010; Boyd 2019). Medicine’s toxic power dynamics and steep professional hierarchy shaping training and clinical care perpetuate marginalisation while bolstering its intertwined matrices of oppression, including ableism, cissexism, classism and sexism (Vanstone and Grierson 2022). While acknowledging them, this paper highlights the trauma medical students and residents experience when forced to assimilate into medicine’s white supremacy and related white supremacy culture.
There’s lots more bullsh*t where that comes from. It is a total piece of crap, and needless to say plenty of people are crapping on it for obvious reasons. Their analysis is really enlightening, so here is just a bit of their brilliance to appreciate.
MEDICAL TRAINING AS ASSIMILATION TRAUMA
Indoctrination into the medical profession is a socialisation process mediated through the hidden curriculum, which is intimately intertwined with white supremacy culture (Gaufberg et al. 2010; Brooks 2015; T Okun, 2021). This surreptitious process begins early when caregivers expose children to narratives glorifying medicine’s social status, heroism and financial security.
As a result of this grooming process, pre-med hopefuls invest exorbitant amounts of time and money to secure medical school admission (table 1), a highly competitive process that fuels a narrative of exclusivity (Lanning 2018). Not surprisingly, the majority of medical students worldwide come from affluent and elite educational backgrounds (Shahriar et al. 2022; Steven et al. 2016; Khan et al. 2020). Class privilege facilitates their admission and endows them with white supremacy culture’s most valued skills.
Classism, thus, primes affluent students to acculturate to medical culture more expeditiously, while further marginalising students from more impoverished backgrounds (Beagan 2005). Medical school commences with senior personnel transmitting the hidden curriculum of saviourism, perfectionism and submission to hierarchy through social activities, like the white coat ceremony (Mahood 2011).
The last thing any of us could possibly want is to have medical students at the beginning of their training to believe that they should pay attention to and learn from their experienced teachers. This is dominance culture. Learning should be collaborative, where the doctors pay close attention to the opinions and feelings of their students, who bring a medical wisdom all their own into the learning environment. Perhaps an experienced endocrinologist could learn about manipulating chakras from a student if they would only listen and learn!
Dialogue about medicine’s interlocking systems of oppression and the hidden curriculum as a conduit for white supremacy culture is noticeably absent. The honeymoon period ends as the taxonomy of value based on students’ ability to achieve white supremacy culture’s ideals emerges (Gaufberg et al. 2010; Brooks 2015; Okun 2021).
Students embody its toxic and divisive power hoarding and competitiveness, sense of urgency and obsession with scientific objectivity—all in order to survive (table 1) (Okun 2021). This acculturation process constitutes an assimilation trauma, one devaluing the pre-medical school identity to embody an idealised identity imposed by medicine’s dominant white supremacy culture (Berry 2015). The so-called ‘imposter syndrome’ that most medical students experience may more accurately reflect the distress stemming from changing identity, repressing personal values and striving for unattainable perfection as part of this assimilation (Martinek 2021; Rosenthal et al. 2021).
Damn! And I keep being told that Science™ knows all. Now I get told that science is White Supremacy and should be tossed aside. It is hard to keep up, BMJ! I cry for mercy. Just tell me what to think and keep it straight.
Frankly I want my doctor to strive for perfection, precision, and all those values that these guys take a crap all over. An unkind person might suggest that they should get off their lazy asses and do the work. Nobody said Med School would be easy, and nobody but these guys wants it to be a lot less exclusive.
The medical training process is notoriously unforgiving and stressful, and very few people who have paid attention to its problems denies that it needed reform. Much of that reform has already taken place. Forcing interns to work 90 or 100 hour weeks is hazing, not educating. As I understand it the profession has been addressing the worst parts of the medical training process.
In fact, this article is a response to those reforms. Basically their argument comes down to this: you can’t make the profession less taxing because it is White supremacist. So get rid of science, perfectionism, obsession about being on time and respectful to those who actually know things. You get the drill. Quit being Western.
That is BS.
It’s not like doctors in 3rd world countries are any less overworked or stressed out, and I guarantee that few American doctors of any color are desperate to move from here to practice elsewhere. The migration appears to be the other direction, where doctors from around the world flee to work in the United States. We get some damn good doctors that way. Two of my doctors have immigrated from India, for instance, and they are excellent.
“Toxic Whiteness” is crap. It’s not that the US and Europe aren’t plagued by cultural problems in all sorts of ways and in all sorts of professions. Of course we are. And we’d be idiots not to learn from others when we can. But our problems are not “white” problems, and being non-white certainly hasn’t demonstrably shown itself to lead to better results.
The fact is that modern medicine is an Anglo-European invention, and bitching about that fact isn’t productive or fair. If you want to be a doctor who uses Western medicine, then you must learn how it is done. If you don’t want to learn how it is done, then don’t.
But there is no chance in hell you are going to get the same results with a vastly different system. You don’t have to be of European extraction to be a great doctor, but if you object to working in an environment that is dominated by Anglo-European values and techniques then medicine is not for you. And if you want to treat patients, do acupuncture or witch doctoring or something other than Western medicine.
Get a sociology or literature degree. Become a guru or an artist. Maybe if stress bothers you so much become a meditation counselor or something. But surgery is stressful. You are cutting into people, so if somebody is demanding perfection from you there is a damn good reason for that. Try doing anesthesiology without being a perfectionist. There is no oops in that.
You can reform the system where it is failing. But something tells me that when you are doing nuclear medicine, heart surgery, brain surgery, or anything complex you want the best and brightest who have undergone very rigorous training that isn’t about how oppressive Whiteness is. You want a doctor, not a sociology major.
At least I do.
I don’t care about the race or sex of my doctors. I have quite a few, unfortunately. They include males and females, white, Indian, Asian, and Blacks. As long as they are good at their job I couldn’t care less. But I want them trained to Western standards. Very high standards indeed. And I don’t want to hear one word about racial issues when I am in a robe with the back open for the world to see. I want my pharmacist to know chemistry and my doctor to know anatomy.
I wish I could say that I am shocked that the BMJ is publishing such drivel, but I am not. Our society is collapsing under the weight of whiny entitled people who scream “oppression” any time they are unhappy.
If you don’t want to meet the standards of being a doctor, then don’t. But if you want to be a doctor don’t complain about how oppressed you are when you are forced to learn organic chemistry or something. Suck it up.
If we want to eliminate burnout in doctors–which is huge problem–the best way to do so is to reduce the burden of paperwork/makework. Doctors’ time is taken up with endless work that has nothing to do with healing people–and healing people is the reason people went into medicine. Better support structures to help doctors focus on what they do well is the first thing we should do to help them out, not send them to DEI lectures.