Being Aware of the Invisible
A letter-testimony by a medical student
19 Dicembre 2022 – USI, NarrazioniTempo di lettura: 12 minuti
19 Dicembre 2022
USI, Narrazioni
Tempo di lettura: 12 minuti
Dear reader,
First, I would like to introduce myself to you: I am a medical student, currently in the last year of the master programme. I was born and raised in Switzerland and Swiss German is my native language. I went to school in Switzerland, I went to high school in Switzerland, and I am studying at a university in Switzerland. And these are some of the questions and comments I am faced with at lectures, at clinical courses, hospital internships, or simply right after meeting new people:
«Where are you from?», «Where were you born?», «You speak German very well», «Your name must be very complicated».
Now, why do I keep getting these questions and comments about my identity, while most of my colleagues from med school, who share all the facts mentioned above with me, do not have to go through this “interrogation”? You might have already guessed it by now, the fact that I didn’t reveal about myself in the introduction: I am a person with brown skin.
In this article I want to address implicit bias and implicit racism and I would like to share some of my experiences and the consequences these seemingly simple and harmless questions can have on a person. The questions I mentioned above are examples of implicit racial bias, but what does that mean?
Implicit biases are unconsciously held associations (implicit prejudice, implicit stereotype) towards a person or a group based on (irrelevant) characteristics such as skin colour, gender, or sexuality. This can lead to negative evaluation of a person/group and can cause individuals or institutions to unknowingly act in discriminatory ways. Treating someone differently, without being aware of one’s beliefs influenced by stereotypes and biases, can undermine someone’s identity. While for example questions about someone’s identity may not be born out of malicious intent, they can have serious consequence on the people they are directed towards.
Let me jump back to the first question: Where are you from? Of course, it depends always on the context, but sometimes I notice that people want to hear only one answer and it’s not the one where I say: I am from Bern. This will lead to follow-up questions like «where are you originally from?» or «where are you really from?» until the response is satisfying enough for the one asking. But why is it a problem to ask where I am originally from? Why is it a problem to point specifically at me and make sure that I understand or speak German? It is a problem, because over time these seemingly harmless questions can evoke insecurities, feeling of otherness, exclusion, and the sense of not belonging. I can confirm that in these little moments I felt exactly like that – like I don’t belong. I have to be honest with you, strangely, I got used to these situations and even normalize it. Being accompanied by questions about my identity throughout my entire life, I started to accept that this is something that just happens every now and then.
Still, I cannot deny the impacts it had on my thoughts and behaviour. To make it easier to imagine what I am talking about, these are some thoughts that go through my mind from time to time at work: How do I make sure that my competences are seen for what they are and that my abilities are not minimized? How do I make sure that the patient knows that I am academically equivalent to my (white) colleague next to me? Summarized: How can I actively take away the chance for other people to reduce my identity to my skin colour and take away the unconscious bias or prejudice that might be coupled to that?
Now, in the hope that this example gave you a better idea of the impacts some actions and words can have, how can we act on implicit biases? The first step is to acknowledge that unconscious biases exist everywhere and that everyone has them. Repetitively checking in on our own thoughts and actions can help to reflect the situation, which might have caused harm.
Second, we need to talk more about bias, racism, and discriminatory behaviour. For example, it would be very encouraging to create a safe space at university or at work, where people can openly talk about concerns and feelings with others who might be experiencing similar challenges. Finding the words to describe the impacts of implicit (or explicit) biases and being understood helps to recognize that one’s feelings are justified and should not be trivialized.
So far, I have given you only examples from my perspective, from the perspective of a medical student/health care provider. But also patients are victims of biases (misconceptions about patients’ character, pain tolerance, or perception of symptoms) with the consequence of not being treated adequately or symptoms not taken seriously. Therefore, there is a need for more education about unconscious bias and cultural sensitivity to unmask discriminatory attitudes. This would bring us a step closer to recognize preconceptions that get in the way of providing the best possible care for a patient and to create good relationships with co-workers and colleagues. Cultivating awareness to these issues would facilitate and encourage affected people to speak up, as there is oftentimes the fear of being misunderstood or fear of negative consequences. Implicit bias education and learning strategies on how to confront injustice might help colleagues to speak up for each other and to support one another, even when not affected personally.
Being close to the end of this letter, I want to thank you for staying with me and reading this far. I hope I could stimulate your thoughts on implicit biases and encourage you to be more mindful about it. The goal of this letter was to shine a light on the importance of biases, discriminatory actions, and the harm inflicted by them. Finally, what can we as individuals do to empower more unbiased thinking, equity, and inclusiveness? I want us to consciously treat everyone equally, while being aware of diversity. I want us to reflect, uncover, and admit our own biases and preconceptions, even if it makes us feel uncomfortable. I want us to ask ourselves: did I act in a hurtful way because of unawareness of these biases and how can I change that? When witnessing discriminatory behaviour, I want us to recognize it and to ensure that the feelings of the ones who were treated unfairly are listened to – I want us to offer understanding and support. I want us to make the invisible biases visible.
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