This Point of View piece was written by Dr. Hassan Masri, an intensive care specialist in Saskatoon.
“Is there a doctor from here that I can ask for a second opinion?”
The question surprised me. I was struck by how my patient seemed to think it was a reasonable demand.
It was 2013. I was in my first year of medical training in Baltimore.
I had always assumed that my fair skin, red beard and male privilege would protect me from such questions. I forgot that my name tag had HASSAN MASRI written in threatening capital letters.
To be clear, this patient wasn’t asking for a second opinion regarding some complex medical mystery. It was solely because of my place of birth and the name my parents gave me.
This experience was not unique to this one patient in Baltimore. It has reoccurred many times in my career, including in both Toronto and Saskatoon.
Those interactions are not common, but they are also not rare. They trigger a war in my head between my commitment to professional treatment of all patients and my commitment to always speak up against any actual or perceived racism.
They are also a reminder of a larger system of inequality that harms the overall quality of health care delivered in our country.
Where I belong
I was reminded again of this way of thinking by a protester at a rally in front of our Saskatchewan legislature building.
“I have a message for Scott Moe and what’s that, what’s that public health minister’s name…” The speaker went on to intentionally mispronounce chief medical health officer Dr. Saqib Shahab’s last name and make other racist comments.
These comments shook me to my core. They showed how a top-ranking health official and physician can easily be attacked simply for having a name that is not common. His academic brilliance, leadership and jaw-dropping resume aren’t enough to make him belong.
When I post on social media, I am regularly told by those who may oppose my views that I should take my opinions and thoughts with me and return to where I belong.
In my mind that place where I belong is Mississauga. It’s where I grew up, where my parents live and where a lot of my memories are made.
In their mind that place is some imaginary third-world country with corruption and no resources.
Preconceived ideas in medicine are damaging. The mere appearance of a man or woman can affect the trust a patient has in their health care providers.
Immigrants are at Canada’s core
According to the 2016 Census, about 20 per cent of physicians in Canada are immigrants. That means about 28,000 people here are immigrant physicians. Those numbers are even higher in certain rural areas in Saskatchewan and many big hubs like the GTA.
Immigration and immigrants are at the core of who we are as Canadians. Cities, communities and industries were built by the hands of hard-working immigrant Canadians who brought with them a wealth of culture, ideas and knowledge.
Being a male physician comes with an incredible amount of privilege that can at times be blinding. This includes an assumed role of leadership in my community, a large degree of financial independence and a lot of respect from the people around me.
These privileges, at times, make me forget that I am vulnerable to the same comments made to me back in 2013 in a patient’s room in Baltimore.
Positions of power go to those ‘from here’
Racism in medicine is not rare.
Positions of power in hospitals and organizations are often filled with people “from here.” Assumptions are often made that physicians “from here” are superior in their approach and training to those who have uncommon names, even when in a lot of cases their training was the same.
This reality is extremely harmful to the delivery of care in our country. In a nation where health-care delivery is filled with inequalities, the lack of representation leads to further inequities and worse outcomes.
Health-care policies and the overall strategies of delivery of care are made by those at the top of the helm. The obvious absence of true representation leads to unintended consequences where patients who are not “from here” are forgotten or ignored.
COVID-19 further highlighted this unpleasant reality in many aspects. Recommendations to go home and isolate alone at home when sick with COVID-19 showed a clear lack of understanding of some people’s realities.
Many immigrants live in multigenerational homes. To go home and isolate alone is simply not physically or financially possible.
People from the city of Brampton, with its large population of immigrants, were accused of being reckless and not staying apart from each other. Assuming that those patients are reckless may lead to a bias when treating them, when in fact those patients are doing their best to stay safe within their means.
We should be better
Countless research papers and studies showed that unfavourable biases by health-care providers lead to worse outcomes for patients. I don’t claim that more representation among the high ranks of leadership in health care would fix this problem, but it certainly appears to be a large part of the solution.
Those lacking understanding of the realities and cultures of immigrants are less likely to provide meaningful solutions to their unique challenges.
These experiences are certainly not the majority of our reality in medicine, but they are common enough to be noticed.
A nation built on immigration and immigrants can be better and should be better. Immigrants in general and in medicine deserve so much more.
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