The Intimidating Doctor: Implicit Bias & Physicians of Color

The Evaluation

“I find her to be intimidating and unapproachable.”

This was the first comment on my first evaluation as a resident. The chair of my department sounded confused as she read the anonymous comment out loud in our feedback session.  She laughed nervously. “We both know this isn’t true,” she said. There was a long pause, which felt minutes long even though it was probably just a few seconds. She had a look of regret, perhaps that the comments were not pre-screened. Finally, she broke the silence. “I don’t know. I think this is probably a mistake. This comment doesn’t appear anywhere else in your evaluations.”

We had had a great discussion of my progress and future up until that point. We talked about my goals in dermatology and some strategies to reach those goals. But now, the air was different. As she moved on to the remaining topics of our meeting, I was still. I was confused as well. Was I intimidating? Was I unapproachable? My friends and family would never describe me that way. I am always friendly and smiling. Sure, I am focused and driven when it comes to my career, but I am kind, warm, helpful, and compassionate. How could I have been interpreted so incorrectly?

Focus Meets Form

I grew up in a large family as the second to last child of Nigerian immigrants. Growing up, education was everything. I had my value and self-worth wrapped in it and I needed to do well to feel whole. Friendships were a low priority. Instead, I was singularly focused on my academic achievements. I was also incredibly talented in tuning out distractions—gossip, conflict, and even relationships. This worked for me. I got the grades that I needed and reached the goals that I set out for myself.

Now, I was sitting face to face with what I thought were the results of my years of intense focus. I was a PGY-2 dermatology resident, the first black resident ever to match into my program, on my way to becoming one of the 3% of board-certified dermatologists in the nation who are of African American descent. I had made sacrifices in order to reach a great career goal, but was this the result?

“They don’t know me,” is what I told myself. “I can just show them who I am.” But why was this the burden on me? Why was my default personality (when someone did not know me) an intimidating resident physician?

The Angry Black Woman

Growing up, I was so shy that in the second grade my teacher told my parents that if I didn’t start talking they would give me a failing grade. My teacher was concerned that I was uninterested. In my reality, I had a lot to say, but was extremely terrified about speaking in front of my peers. Throughout the rest of my schooling, my quiet nature allowed other people to fill in the blanks and create stories about the type of person that I was, my interests, and my motivations. I have had my opinions and good-spirited input misconstrued as a dissent and disagreement. When offering similar feedback as that of my peers, I have been told that I just needed to try to “get along with others.” I have been told by another physician to stop asking so many questions and to “stay in my lane.” Slowly, I started to realize what was driving these misinterpretations about me was larger than my own experience—it was common to the shared experience of minority physicians.

My struggle is not unique. For many physicians of color, particularly women of color, the stereotypes of being angry, confrontational, unapproachable, and intimidating, are so pervasive that they can oftentimes be pushed onto us. We carry a daily weight as some of the only people of our gender or ethnic background in the workplace. We are excluded from important conversations. We face microaggressions and talk that is rooted in inaccurate stereotypes. A well-cited 2018 Catalyst report refers to this scenario as an under recognized “emotional tax” that women and men of color pay in the workplace as they are forced to remain “on guard” against any potential biases or discrimination that might be encountered.¹ 

What does this emotional tax equate to? It means that in addition to the daily challenges of our jobs, people of color in medicine, have to face the additional work of warding off discrimination whether we choose to or not. I have started to open my eyes to the implicit biases around me and sadly it is everywhere. I’ve started to try to understand how the inaccurate expectation that I will be angry makes me “unapproachable” and “intimidating” from another person’s vantage point.

My mother once told me, “People will judge you. People will try to write your story for you. Don’t give them that power. Write it yourself.” I didn’t realize the power of those words at the time, but now I remind myself of these words almost daily.

Storytelling

So, what do we do from here? I don’t think these workplace challenges can be solved by one person in one day. All I can tell you is what I have started to do. I’ve started to share more of myself in an effort to counteract these stereotypes, confront implicit biases head on and write my own story. I realize, however, that this is not enough.

The most impactful thing that can be done is education and partnership. We need to both educate our colleagues and ourselves. We need to become allies in these efforts. If you are in a position of power or influence or if you have a role on a committee with a voice, I strongly recommend that you advocate for implicit bias training in your hospital or workplace. In addition to helping all physicians deliver better care by helping them to understand their patients, it will help physicians understand their diverse colleagues. Training of this nature will also help increase job satisfaction and retention of physicians of color at the highest levels of leadership and academia. The responsibility to push for progress in the workplace should not fall completely on physicians of color, but we can all work to start the conversation.

Reference

¹ Dnika J. Travis and Jennifer Thorpe-Moscon, Day-to-day Experiences of Emotional Tax Among Women and Men of Color in the Workplace (Catalyst, 2018).

Dr. Caroline Robinson is a dermatologist in Chicago, IL. She received her undergraduate education from Cornell University and her medical degree from University of Louisville. She completed her dermatology residency at Southern Illinois University serving as Chief Resident in her final year. She is clinical faculty at Northwestern Medicine and Director for Diversity Initiatives for the Department of Dermatology.