The Daily Micro- And Macroaggressions Of Being An Underrepresented Minority In Medicine

I sat in a crowded auditorium listening to an attending at a renowned medical institution give a lecture. I didn’t know the answers, and shrouded in imposter syndrome, I avoided eye contact. The visiting medical student from Mexico answered the question, and the attending moved on. Another question came. Again, the medical student from Mexico answered. The attending chuckled and said, “OK, Cinco de Mayo,” an exaggerated emphasis on the Anglicized pronunciation of the 5th of May in the middle of winter. I opened my eyes wide, surprised that this could happen, and glanced at the student, then sat in silent witness as the aggression led to his deep and crimson blush. The lecture continued. I never answered a question posed by that attending because my last name had rolling Rs, and my faint accent was a subtle but ever-present reminder of my difference. Years later, I still remember this as my shame. I should have spoken up.

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The lady who asked me, a nine-year-old, to stop speaking Spanish. The person who said I, of course, got into medical school only because of my last name. I swallowed my perfect scores, top grades, championships, and volunteer hours and looked ahead. The radiologist who, reading a gallbladder ultrasound in the darkroom as I sat behind him observing on my radiology rotation, laughed and said, “Look at all those stones and fat. I bet her name is Maria, and she’s got 10 kids.” I shrank into myself. The attending who, exiting an uninsured patient’s room, said, “Why don’t these people just learn to buy insurance?” Time had passed, and each prior episode weighed on me so that I tried to speak up and said, “If they’re choosing between groceries and insurance, they have to choose groceries.” He laughed and said, “It’s Taco Tuesday. Go get some tacos to calm yourself down.” My cheeks burned, and I looked away. And so on. And so on. And so on. The daily micro- and macroaggressions of being an underrepresented minority in medicine sought to subtly diminish heritage and bleach roots. And unconsciously, I contributed.

The effort to soften the accent, what my sister calls my “white voice,” and carefully enunciate when speaking in a professional capacity. The subsequent occasional, “Wow, you speak well.” Why would you assume I don’t? The reminder to my three-year-old daughter to speak English in public. Unconsciously, unwillingly, frequently unknowingly participating in the perpetuation of bias in medicine as I went through my training learning and using calculators that gave different outcomes for vaginal births after cesareans or different glomerular filtration rates depending on race because I didn’t know enough to stop, pause, think and do otherwise. I didn’t know how to do better. The memories of all the times I watched and shrank and did not speak up all proof of how I contributed.

In a state where, for years, ubiquitous “No Mexicans Allowed” signs were hung near entrances to public places, I trained to care for all people. Where “We serve whites only, no Spanish allowed” shown brightly, I trained to help the sick. Where Mexicans and Mexican-Americans were killed at the hands of Texas Rangers because of who they were, I trained to be a physician. I entered an arena where people like me were few and far between and where I had to prove I was enough, quietly moving past and looking away from the aggressions because all that mattered was not differentiating myself further and arriving at the degree that would be concrete proof to the white world of my worth. Now I care for people who look like me, whose names sound like mine, and I wonder why they don’t trust the system – the one that once lauded killers as heroes, oppression as positive change.

Slowly things have changed and today, I sit through a medical education conference learning about the problems and perspectives of the underrepresented in medicine. Hearing how we can help our students handle the aggressions faced daily, the scenarios ring true and seem to be directly taken from my personal experience. For once, I feel heard. I feel seen. I feel strong as I dwell on my difference from the majority and experiences as a female, Mexican-American, and highly trained physician. I feel purpose as I familiarize myself with tools I can use in the future and pass on to the students who are sure to encounter similar experiences to mine in their career.

To all the ones who asked how I pronounced my name before continuing to mispronounce it, thank you. To all the ones who stopped and addressed the inappropriate, shining light on bias, thank you. To all who came before and stood up and spoke out, thank you. To all those who unite to change the face of medicine, culture, societal norms, our nation, thank you.

To the rest of us, may we continue looking, remembering, representing, and learning that our differences make us shine brighter. That our roots and background will, in fact, benefit patient care and outcomes in medicine and we have valuable contributions to bring to the table. That we’ve got such a long way to go, but we’re starting the journey of bias recognition and action. That we, who are in a position of possibility and opportunity, must make it our priority to listen to those who are not in the same position, who are underserved and under-represented, to bring their needs forward with our time and advocacy and words of encouragement. That the time for change and for representation is here.

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