The consciousness of racism is something many develop over time if they have grown up in a country where it is not as prevalent. This is exactly the realization Melanie went through when she moved to the United States to start her medical degree. Today Melanie joins me to share some of the history behind the racism we see today and explain the burden so many black people carry simply because of the color of their skin.
Listen in as she explains where racism really comes from, as well as some extremely informative articles and books that will help you understand the extent of the deep-rooted racism this country was built on. You’ll learn how we can be allies to the Black community as white individuals so we—as a country and the world—can move toward a more diverse and educated future.
Katrina Ubell: You are listening to the Weight Loss for Busy Physicians podcast with Katrina Ubell, MD, Conversations About Racism in Medicine Part Three.
Welcome to Weight Loss for Busy Physicians, the podcast where busy doctors like you get the practical solutions and support you need to permanently lose the weight so you can feel better and have the life you want. If you’re looking to overcome your stress eating and exhaustion and move into freedom around food, you’re in the right place.
Oh, hey there, my friend. Welcome back to the podcast. Welcome to part three of the series Conversations About Racism in Medicine. Thank you for coming back. Thank you for listening. I did want to encourage you to share these episodes, this whole series, with your social networks, with your friends, with the people that you work with, whether they are doctors themselves, or working in health care, or really anybody who you think is interested in learning more and is interested in progressing themselves further, and just hearing different perspectives. I think one of the things that I’m learning is just how … I mean, of course we know everybody’s different, but everyone is so different and their experiences are so different. The way that you find out for a specific person more about them, more about what they go through, and more about what their perspectives are is by asking them and talking to them, and even when that’s kind of uncomfortable, even when it’s really uncomfortable. And, of course, it depends on what your relationship is to a certain extent, but it is totally okay and encouraged to find out more. That’s an action of caring my just discovering more and learning more.
Today, I have another one of my amazing clients. This is Melanie. She is a complete badass. Just trust me on that. She is. She has just some really, really good information. She talks about a number of resources. We’re going to put all of those in the show notes page, which you can find on my website, going to katrinaubellmd.com/podcast. You’ll be able to find it there. She just has, like everybody, just her own unique perspective that I thought was so interesting. She is so articulate. She is really able to explain what’s going on. She also has the experience of not only being one of very few minorities in her specialty as a whole, but also one of very few women. So her experience has been unique to her. And, of course, when you don’t have many minority women in a certain field, there aren’t going to be many of them to be able to talk with the experience is like.
So, please listen, learn. Just take it all in. Then, please share this. Please share this with anybody, but particularly on your social media streams. It’s going to help so many people to just know, hey, this is a good episode to listen to in this whole series. All right. With that, I bring you Melanie. And I’ll be back again tomorrow with another conversation. Hey, Melanie. Thank you for joining me today.
Melanie: Hi. How are you?
Katrina Ubell: I am super glad to be talking to you. Thank you for agreeing to have this conversation with me.
Melanie: Yeah, it’s my pleasure.
Katrina Ubell: All right. I have learned recently that before we start talking it is okay to ask how you like to be referred to. So, do you prefer Black? Do you prefer African-American, person of color? What do you prefer?
Melanie: I prefer Black.
Katrina Ubell: You prefer Black. Okay. Thank you. So I usually start off by asking people to just kind of give us a little introduction of themselves. So, if you wouldn’t mind just telling us a little bit about yourself.
Melanie: So, I’m actually not American, so that’s why African-American necessarily fit. But, most people don’t know that, and most people don’t assume that, so I live the African-American experience. But, I’m actually Canadian. I’m from an immigrant family, so I’m the first generation. I actually grew up or spent most of my formative years outside this country in the Caribbean and in an all Black society. So I started in this country in undergrad in a historically Black college and university. So I was really insulated and protected. And even though when I went to medical school, there were probably a dozen of us who would identify as Black, we all knew each other, and we all stuck together and formed a pretty tight-knit community both within our class and within the other classes ahead of us. So that was my group of people.
So again, a lot of us had gone to the same undergrad and we all knew each other, so there wasn’t necessarily from that kind of social structure exposure to the wider community. But, we were aware that we’re a minority, and certainly the lack of diversity was present. Then, I went to my residency, and then I was aware that I was in a minority minority, and really felt it.
Katrina Ubell: Yeah. You felt things significantly for yourself.
Melanie: Yeah, yeah. I really felt it. Because then, it was just me. I was the only person of color. But, actually, I was the only Black person in my program for four out of the five years. And while we had brown individuals, there were two Latinos, and we took about six residents a year. So, it wasn’t a small program. So the consciousness for me has been something that I’ve developed over time. It wasn’t something that I was raised with because I wasn’t raised in this country, and so wasn’t necessarily aware of the ongoing and just kind of constant struggles that people go through.
One of my parents is a professional. The other’s been to graduate school. And for much of my … I can understand why people couldn’t just go to school and work hard because my immigrant parents came from some place else with nothing. I mean, they came from houses where they had no running water or that sort of thing and came to … My mom was educated in this country. She went to Howard and were able to put themselves through and achieve. So, it seemed to me not to be that difficult. I’m guilty of being one of the privileged Black people who separated themselves from the poor Black people, and why can’t these people just work hard. I think that’s a lot of the attitude that people have, right? It’s like, “Well, if they only ate better, they wouldn’t be diabetic. And if they only took their medicine, their blood pressure would be under control.”
And I didn’t necessarily really link how I was treated differently to being black because I didn’t want to make it about race. I wanted to work hard and not use that as an excuse, so to speak. So, I wanted to prove myself on my merit and not acknowledge that race could be a problem because then it wasn’t something that I did that I could fix. And I was very conscious and very kind of committed to pushing through, and working hard, and proving myself, and so I did. But in retrospect, as I look back, I’m like, “Huh. Well, maybe you weren’t quite …” Then, is it my race, or my gender, or is it both?
Katrina Ubell: Well, and without exposing exactly what field you’re in, women and minorities are massively underrepresented-
Melanie: Oh, absolutely.
Katrina Ubell: … in your specialty.
Katrina Ubell: Like ridiculously underrepresented.
Melanie: Yeah, absolutely. I mean, so is it … Which one is it? And one never knew. It was probably both, frankly, so it’s a little bit hard to separate. But, just in feeling the isolation and being the only person of color and feeling uncomfortable in spaces where why shouldn’t I feel comfortable was one thing. The other thing, too, is I ended up reading in The Atlantic called the Case for Reparations, which I think everyone should read who doesn’t really understand that racism is not an individual action but it is a system. It is a well-worn and well-structured system that ensures that people of color will not succeed in this country and will never succeed enough to threaten the power of those who benefit from their subjugation.
So then, the idea of, well, I’m Black and my parents are Black, and they worked hard, and we worked hard, and we did this just didn’t really hold true anymore. Because the reason there were only 7% of African-Americans in my medical school class is that no one else really stood a chance, right? If you were coming from a failing elementary school, you don’t stand a chance.
Katrina Ubell: No.
Melanie: It’s not going to happen.
Katrina Ubell: It’s so hard for baseline if you don’t have that kind of support from early on your host. Yeah, it’s not going to happen.
Melanie: I mean, and so I’ve chosen to educate myself about the country that I live in and understand why people who look like me who I thought I was different from but I’m not have a very different experience and can’t see the world in terms of opportunity because that has been stripped from them a long time ago. Another book by Ta-Nehisi Coates, he wrote the first article is Between the World and Me. It’s a very poignant expression and a very poignant kind of look at how the hope and any sense of the possibility of opportunity is stripped away at a very young age. So if you have no hope for the future, then what is the point?
Katrina Ubell: Right.
Melanie: And the systems that exist take that hope away, and so here we are.
Katrina Ubell: So here we are. So it sounds like over the last however long, you have been educating yourself more and understanding things more.
Katrina Ubell: How has that changed your perspective in general, in all of those?
Melanie: Well, I mean, it’s changed my perspective in that I realize that, number one, my education and relative privilege do not protect me at all, and that it doesn’t make me any better or any different in that to the extent that I’ve succeeded, what can I then do to help my fellow person. And that becomes a bigger challenge. I think I fall victim to that same it’s too big a program for any one person to fix. Maybe I just focus on practicing medicine. But, I think there’s something that everybody can do, even just in terms of recognizing what role you as an individual may play as part of a bigger system or as part of a way to change a system. A system only exists because the people who benefit from it continue to perpetuate it.
Katrina Ubell: Well, I was watching a video where the woman said, “Listen, if you go out to brunch, then you can make a difference. If you’re sitting at a table with three other people, you can make a difference.”
Katrina Ubell: It’s when you’re aware of the systematization of it, you can have an educated conversation. You can call people out. And that doesn’t mean in an aggressive attacking sort of manner necessarily, but not just letting things go, even being aware that there is something happening that you’re letting go. That already is huge.
Melanie: Yeah. I mean, even just the awareness that things are … For example, you’re on rounds with a medical student, or … I mean, I’ve been asked to empty bedpans more times than I can count, right?
Katrina Ubell: I bet. Yeah.
Melanie: You go to a patient’s room and you’re wearing a white coat that says Dr. So-and-so, and they ask for the doctor like several times. And you introduce yourself as that and your name badge, and they’re like, “So when’s the doctor coming in?” You’re just, “All right.” And you just let it go. But, where those sorts of things are witnessed, say … Just kind of calling them out and showing that, number one, that the person who is facing these sorts of … They’re not even microaggressions. It’s the implicit bias kind of that is in all of us, so calling it, and naming it, and not being afraid to have the conversation, saying we’re afraid to talk about it.
Katrina Ubell: Oh, totally. I was thinking like, “What else are we so reluctant to talk about?” And the only thing I could think about was sex.
Melanie: Yeah, pretty much.
Katrina Ubell: Right?
Katrina Ubell: It’s like where it’s just like people just are so ridiculously uncomfortable discussing it, do not want to have that conversation.
Melanie: Yeah. And it’s for the same reason that it’s the vulnerability and the risk that is associated that there might be an instance in my past or my present where I might’ve said or done something that might be racist. And there’s so much resistance to that because then it’s like, “Well, I’m a good person, so how could I possibly be racist and be a good person?” So we immediately shut that down because it brings shame and shame brings hiding. We want to hide. Then you don’t have the honest conversation and-
Katrina Ubell: And you don’t education yourself, right?
Melanie: Yeah, you don’t. Absolutely.
Katrina Ubell: You’re not reading books. You’re not listening to podcasts. You’re not watching movies. You’re not doing anything to learn more.
Melanie: Because it’s not my problem, right? Because I can exist-
Katrina Ubell: And you just don’t want to feel bad, you know?
Melanie: Yeah. I mean, I can exist-
Katrina Ubell: Like I was saying …
Melanie: Go ahead.
Katrina Ubell: Oh, I was just going to say that my son has been learning about the Holocaust. And my husband and I have said on at least three occasions, “You know, we really need to watch Schindler’s List with him. This is required. This is part of his education is to watch this movie.” Except, literally, what day are you like, “You know what I feel like watching tonight? I feel like watching Schindler’s List,” right? You never ever … You’re like, “I Was kind of hoping for something more lighthearted.” Like something like that. You got to gear yourself up for it. But then, that moves on to … Right, just move towards the discomfort. I needs to be done and do it. And just allow yourself to be with that for the growth that comes from it and the conversations that come from it. That kind of thing.
Melanie: Yeah. Because then it no longer becomes … Because there’s an inherent defensiveness against being … When the conversations come up in … I find the white individuals in whom that’s come up, and I don’t really engage like that because I don’t … I don’t know. Maybe I’m not enough of an optimist. But, I think people change when they’re ready to change, and they’ll seek out what they need to seek out to be able to educate themselves and see a different perspective. So the conversations usually are white individuals trying to defend who much of a good person they are. But, they don’t ever stop to think about how they really have believed the lies that have been told over generations that there is a difference between people because of the color of their skin. There is not, right?
Katrina Ubell: Yeah.
Melanie: The concept of race was not a part of the founding of this country. It came directly from the need to separate the poor whites and the poor Blacks so they would not band together and pose a threat to the rich white land owners. So then you create the idea of race, and you tell the poor whites that they’re better than the poor Blacks. Then, you can divide and conquer, and now you also have a cadre of people who can help to suppress that other cadre of people to keep your economic machine running. So that’s where race really comes from. There is not race. And we know that because the Italians and so have all now merged into what is now known as white. So it all kind of is fluid. It’s all a construct. It’s people’s thoughts that they’ve believed over and over again. Sorry.
Katrina Ubell: Right. No, but it really is true. I was ready something about that, too, just there really is no race. We think there is because that’s what we’ve been taught, but it’s just not true.
Melanie: Yeah. So then, there’s really no difference, right? What is the difference? It’s not an inherent difference. You look at COVID and you’re like, “Oh, well, the reason these Black people, they’ve got all preexisting conditions.” No, not really. I mean, maybe they do, maybe they don’t. But, they’re also poor and they have to go to work. There was a Detroit bus driver who is on driving his bus and a woman’s on there coughing. Why is he driving the bus? Because he’s poor. He has to drive the bus, right?
Katrina Ubell: Right.
Melanie: He died of COVID because that’s how he has to survive. You know, I think that there’s a lot of the reasons we blame the victims for their plight that aren’t true.
Katrina Ubell: Yeah, totally. Totally. I am curious about your experience within medicine in terms of how you’ve been treated. I know you’ve had a career that’s been split. You’ve had experience in the academic side. You’ve had experience on the private practice side. I’m curious just what your experience has been, like stories to share. I don’t even know necessarily what to ask. I mean, I can imagine things that could’ve happened, but what have been some experiences where you’re like, “Seriously? What is happening right now?”
Melanie: Yeah. I mean, I think, as I alluded to earlier, it was … A lot of my training, especially was in an area where it was hard to kind of parse why you were being treated the way you were being treated. Is it just the universal just kind of environment of the place or … But, I think for me, one of the key things that I look at is that finding mentors who believed in my success and were invested in my success have been few and they’ve come great. I’m one of the percentage of people who went through … came in as assistant professor. Then, when you look at minorities, women were not. There is a big drop off from the assistant to the associate professor level, and it’s because of …
There’s not really overt racists acts where it’s you’re being yelled at or called the N word or so. It’s just the implicit assumptions that are made about your ability to succeed, number one. Number two, it’s the willingness of someone to stretch themselves and mentor you because it’s a lot easier to bet on that winning horse who looks just like you because then that inherently makes you look good because then you can then just show this thoroughbred off and be like, “Well, of course I mentored and trained this-”
Katrina Ubell: Take all the credit.
Melanie: “… bright young man,” right?
Katrina Ubell: Mm-hmm (affirmative).
Melanie: So that opportunity does not exist for those which don’t look like the people who have the power to not only mentor but sponsor, right? Because sponsorship is how you get ahead in academics. So that, I’ve been fortunate in that I’ve actually worked with people who are not like that and who have been very supportive. So that’s been a benefit, but it came late. And I think because it came late, it still wasn’t enough to erase a lot of the self-doubt and the constant fatigue of knowing that you have to prove that you belong, prove that you’re good enough, and the fear that any time something doesn’t go quite right are they then going to say, “Well, of course it wouldn’t go right because she’s …” Whatever. Woman, Black, whatever. Carrying that kind of cloud over your head and shoulder is exhausting. But, it’s real because you know that you’re not looked at the same way, and so you have to be perfect to be perceived as being just as good as someone who doesn’t look like you.
Katrina Ubell: Yeah. I also want to … I don’t think I’m overstepping my bounds by saying that having coached you it’s easy then to make that mean something really negative about you, like there’s something wrong with me and that’s why … I didn’t push hard enough to find the mentors, or I didn’t … Like it’s your fault, right? Yeah.
Melanie: Yeah, exactly, whereas maybe it wasn’t. But, you can’t really see that when you’re just trying to just prove yourself good enough to do this thing that you really believe in doing and really believe it’s your calling to do and are actually good at and have to just kind of believe that. Yeah, so that’s been my experience. I mean, I’ve had patients ask … say they don’t want a Black doctor.
Katrina Ubell: Oh, have you? Yeah.
Melanie: Oh, yeah. Absolutely. I mean, just in both academia and private practice.
Katrina Ubell: Private practice.
Melanie: I mean, that happens. You’re just like, “Well, now, you’re the only person I call today.” I’m sorry, you know?
Katrina Ubell: I just remembered this story just as you were saying that. My dad had prostate cancer many years ago. It was actually when I was in residency. I was able to get a week … Or, I don’t know. I somehow got off and was able to go to be with my family to support him during his surgery. He had been connected through a family friend with the head of the urology department and that this academic place. He was all in on this guy, and this was going to be so great.
It was where I went to medical school, so I knew the area some. We sent him off on his way to go back, have the surgery, and they said, “Oh, it’s going to be a number of hours. Why don’t you guys go and get some breakfast or something?” So, we did. And, of course, I knew a good place to go to. We’re relaxing, me, my brother, and my mom. We come back, check back in, and they’re like, “Oh, yeah. We tried to call you.” And we’re like, “Wait, what? What happened.” Well, it turned out … I don’t even remember the specifics, but that doctor couldn’t do the surgery that day. There was something that happened and super last minute he couldn’t do it. They couldn’t reach us to ask us whether it was okay whether another doctor did it. And apparently, they had already sedated my dad, but they woke him up and asked him if it was okay, which, of course, he didn’t remember at all afterward. We’re like, “Are you allowed to do that?” I don’t know. That was a little weird.
Melanie: Yeah, once you’ve gotten sedation, you can’t consent.
Katrina Ubell: Technically, I don’t think that was supposed to happen, but whatever. But, anyway, so it ended up being a Black woman urologist who did it. I was just inside I was like, “Yes!” Please, I mean, she did an excellent job. He’s been cancer free for decades now. But, I was just like-
Melanie: He probably got a technical surgeon than you would have-
Katrina Ubell: Maybe.
Melanie: … from the department chair who doesn’t-
Katrina Ubell: Sure.
Melanie: … technical operate that much is flying around the country giving talks, right?
Katrina Ubell: Yeah, yeah, yeah. Exactly.
Melanie: Just saying.
Katrina Ubell: I’m just thinking I don’t know if someone had referred my dad to her if he would’ve really been like, “I’m all in.” I want to think yes. I don’t know if that would’ve been the case. But inside, I was like, “That’s right.” I’m just like, “Yes. Yes. That’s so great.”
Melanie: I mean, and to the extent that that exists, it exists. I think we do the best job we can. We put our patients first because it’s really about them and getting them through. I think as minority physicians, we don’t necessarily bear or own … We don’t go to work thinking about this every day because that’s not why we’re there or what we’re doing, at least for me personally. And I guess it’s good and bad. It allows me to function, do my job well. And if and when someone wants another physician, it’s like, “Okay, fine. Whatever,” and then move on. But, then I don’t really necessarily stop and process it. So after a while, you really-
Katrina Ubell: Right. It’s just kind of this collection vessel and there comes a point where it’s full. Yeah.
Melanie: Yeah. So I think just with more awareness of processing these things when they happen. I mean, you process it and you move on, and you kind of look at where there can be change in the system, where that awareness is going to come from, and hope that that awareness happens. And I don’t know. I think now it may be a little bit of … I don’t think it’s a 180 turning point, but I think there’s at least a little bit more of a shift, hopefully in the right direction. Because even compared to 20 … I think it’s 2014 when the Michael Brown incident happened. I don’t think there was quite as much of a broad based conversation in multiple different areas. It was still the same pattern over and over again.
And when the George Floyd thing happened, for the first few days, I was just like, “Whatever. I mean, what’s going to change, right? Black person gets killed by police. Police get off. It’s going to happen again.” So that was phase one. Maybe that was denial. Then, I went into-
Katrina Ubell: Well, maybe just not wanting to even get your hopes up, right? Because how many times-
Melanie: Yeah, yeah.
Katrina Ubell: … have they been dashed and nothing changes?
Melanie: Yeah. Then, that and then Ahmaud Arbery who was essentially lynched in Georgia. Hello.
Katrina Ubell: Yeah, yeah.
Melanie: So, then I went into kind of anger. Upset and anger for a few days. Then, just the weight of the overall lack of regard and the fact that a Black body means nothing and that a white person can do anything they want to do with it. I made the mistake of watching a Central Park video, and that angered me even more because those are the … I know what it’s like to be in those spaces and feel like you’re not supposed to be there. It’s a little safer for me because I’m a woman and I’m not seen as a threat. I’m just seen as why are you here, whatever. But for him, I mean, that was a potential life and death moment. That woman could’ve killed him. And to see the intention with which that act was done, knowing the power of her color to potentially destroy someone because you’re not doing what you’re supposed to be doing is beyond words. But, that’s just kind of the way. You kind of have to prove you belong in the spaces. I spend too much money when I go shopping because it’s like I belong to be here, and I have just as much money as anyone else. So, you know?
Katrina Ubell: Yeah.
Melanie: Which is a little counterproductive, you know? But, it’s like I’m like, “They walk in. You walk to the store, and they just kind of look at you. They’re just like …” So I carry my Louis with me. It’s like a fucking shield. Excuse my French. I carry my Louis with me like a shield, and it’s real. It’s not a counterfeit I got from a trunk in the hood, actually. Because I’m aware that as I move in certain spaces I’m initially looked as someone who doesn’t belong there.
Katrina Ubell: And I think that’s where people like me, we just don’t even … That’s where we don’t even see our privilege. I go into the mall, and that’s just not a concern. I mean, if I had gone into a very, very ritzy, super high-end boutique or department store, I have felt the like, “Are you supposed to be in here?” a little, but that’s just the tiniest little sliver of that, right?
Katrina Ubell: That’s just the tiniest little step dipping my toe into that experience and not even knowing, not even being aware that that’s just the regular experience, and so on.
Melanie: And there’s little things that you do to always carry your receipts with you. If you buy something, don’t just put it in your bag. Take a store bag and keep the receipt with the store bag with it just because you don’t want to necessarily have to end up in an uncomfortable situation. I mean, this is how we live every single day.
Katrina Ubell: I’m just curious, have you ever had any interaction with the police that was…
Melanie: I mean, I’ve pulled over for speeding. Now, was I speeding? Yes. So although the last of the … I was pulled over like three times in a short period of time. I was like, “Really.” I have a short haircut, so I was like, “Okay, really?” The last time I wasn’t driving that fast, I don’t think. I was just going about five over common speed … I personally haven’t really … They pull me over for whatever, and I always get ticketed though. People think-
Katrina Ubell: You never get the warning, the like, “Hey, next time-”
Melanie: Recently, in this town, I have. But I’m not in a relatively liberal college town where I’ve not lived so before so I never … Yeah, it was always side eye and a ticket, and it doesn’t really matter. I mean, I’m careful. I’m not trying to flout the law or anything like that. I don’t mean to say that speeding’s okay, but some of us have a lead foot, and you know?
Katrina Ubell: Right, right, right. Exactly. What have you seen in terms of patients, Black of African-American patients, being treated maybe in a way that they shouldn’t have been treated? What have you observed?
Melanie: Well, I think it’s a general attitude of blaming the victim for their disease and for their lack of having the resources to take care of themselves. So our systems don’t or medical systems don’t make it easy for our African-American and the poor really to navigate through. They got find their way to their own appointments. We’re calling them. They may not have phones. We don’t have other ways to reach out to them. We’re not really trying to expand our … Or for example, who’s your five people who I can reach out to as opposed to just the one persons so that I can make sure that we get you in? Are we really making sure that we explain why these things are important? Do we acknowledge the mistrust that exists in the health care system for the—not necessarily…
So there is mistrust in the African-American community against the health care system. And we know that exists with good reason, and the Tuskegee experiment and all that. People know that. So rebuilding that trust I think is something that we haven’t done a good enough job about. And I think that’s going to require us to, number one, acknowledge that it’s real and that it exists because every institution has … None of the institutions with which Black people interface work for them at all, like none. Health care, education, criminal justice, housing, none, right?
Katrina Ubell: Yeah.
Melanie: So that’s the backdrop that which people are coming into our health care system. And health care systems are hard to navigate for anyone, right? Much less someone who doesn’t have the resources and is poor.
Katrina Ubell: Totally. What do you think white people in medicine can do to be an ally? Awareness, educating themselves?
Melanie: I think there’s a lot. I think there is a lot. One is awareness and educating themselves. That education can be painful because then you may have to face and realize that there have been times where you might’ve done or said something that perpetuated the implicit bias that is part of the foundation of the racist systems that then sew. They’re individual acts in systemic … in systems, and I think it’s a combination of both.
One is education and awareness, understanding and recognizing the privilege that comes with being white and looking like you’re supposed to be a doctor, recognizing that your minority trainings may need a little bit more support and mentorship, like real mentorship. Think about the way you were mentored and think about are you willing to provide that same mentorship to somebody who doesn’t look like you and who may not have that same he’s-a-superstar type of promise, so to speak, that we were granted. Reaching out to … The pipeline is where in medicine our workforce is suffering, right? Because people can’t get into medical school if they can’t get into college. They can’t get into college if they can’t graduate from a decent high school. And we all know the inequities and education are vast. But, there are high schoolers who make it out, right?
Katrina Ubell: Mm-hmm (affirmative).
Melanie: And those are ones who actually think about the possibility. Because people don’t think about the possibility of I could actually become, and they’re not exposed. But, you take a bright kid from any background and you expose them to something that interests them and that ignites their passion, they’re going to succeed. They are going to succeed until we tell them that they can’t.
Katrina Ubell: Yeah. Do you think that that message is just surrounding them all the time? Not necessarily explicitly you can’t do this, although that may be part of it, but just kind of maybe … A white kid goes, “Hey, I think I want to be a doctor,” and people are like, “That’s amazing.”
Katrina Ubell: Then, a black kid says, “Hey, I think I want to to be a doctor.” You think their reactions-
Melanie: That doesn’t even …
Katrina Ubell: That doesn’t even happen?
Melanie: They don’t even think that. Yeah, yeah.
Katrina Ubell: Okay.
Melanie: And that’s the difference. The difference is that thought doesn’t even-
Katrina Ubell: Doesn’t even occur.
Melanie: That thought won’t occur. Because they look around their circumstances and that’s not even a possibility. It is for some, but I think for the great majority it is not. And that is where the change needs to happen, but I think … And then recognizing that we exist in medicine but medicine is not separate from society, and the two interface very closely. We live in our communities, and the people we see, our patient population is a direct result of socioeconomic factors, factors of the community in which we work.
Katrina Ubell: Just kind of on maybe a lighter note, not even really, but just if you could just have white people’s ear for a second, what are some things-
Katrina Ubell: … that you’re like, “Listen, just you need to know this. Stop doing this,” or, “Start doing that,” or, “You think you’re doing the right thing here and you’re really not. Please don’t do that”?
Melanie: Our hair is not a curiosity, and never touch it. Don’t. It’s just hair. Just don’t. Just don’t. Just don’t.
Katrina Ubell: Is it okay to comment on it if you like it?
Melanie: Yeah. I guess, but-
Katrina Ubell: Okay.
Melanie: I don’t know. I have to think about that because sometimes the comments are like, “Oh, it’s different.” Yes, it’s different. And? I think it’s okay. I mean, I think it depends on kind of your relationship and whatnot. But, the hair is just … But, never touch it. Just don’t even ask.
Katrina Ubell: Got it.
Melanie: I think don’t be afraid to talk about race. It’s there. We know it’s there. It’s the elephant in the room, right? Don’t be so afraid of maybe acknowledging that at one point you might’ve said or done something that was racist. It doesn’t mean you’re a bad person. And that’s where that connection is. We know. I mean, I think that people are intrinsically good and want to do the right things. But, I think there’s just so much ignorance around this. Education yourself. Read. There are so many resources out there to really understand how the systems were built, even policing.
I was listening to a podcast called Throughline yesterday. They have an excellent episode about the history of policing and how the police forces in the South, in the North they were a little bit different, originated from slave patrols. That was the first police force in the South, a slave patrol. So then you’re going to wonder why African-Americans don’t trust the police. Think about that.
Katrina Ubell: Right, right.
Melanie: I mean, come on. You know?
Katrina Ubell: I just watched 13th with my family, which everyone should watch, it’s on Netflix, last night with my son and my husband. And it was just I learned … I mean, it was like a masterclass in an hour and 40 minutes.
Melanie: Because this isn’t taught in schools.
Katrina Ubell: No.
Melanie: The education that you get in schools isn’t … You don’t learn the history of what actually happened. You learn the history that will allow the lies to be perpetuated.
Katrina Ubell: But, I also think, too … What I noticed was … I mean, I went into college thinking I was going to be an engineer. And, of course, I chose the most difficult type of engineer that the school had-
Katrina Ubell: … with lots and lots of requirements. Then, midway through that I decided I wanted to go to medical school and I didn’t want to take longer than four years. So then I had additional things even on top of it that I had to do terms of credits and things like that. So did I take a few liberal arts classes? I did, but it was very much like, “Well, what kind of grade can I get on that one?” Because I was already taking such hard stuff.
Melanie: Oh, yeah.
Katrina Ubell: I needed anything that could help me to increase my GPA. I don’t know if there were any easy A’s where I went to school, but easy enough-
Katrina Ubell: Easier maybe. And does it move me along toward my greater goal? So I didn’t really feel the luxury to take a bunch of college classes and explore. We were talking about just the idea how you can audit college classes just to … I was thinking. I was like, “I’d love to … Here are the lectures, and read, and have discussions, but I don’t want to write any papers or take tests.” That part I want to skip.
Melanie: Yeah. Absolutely. Absolutely.
Katrina Ubell: But, I think that can be part of it, too. I think that’s the … Not everybody. There are plenty of people who are liberal arts majors who became doctors, but just recognizing I learned about a whole lot of things in my upper education, higher education experience.
Katrina Ubell: And a grand total of zero of them had anything to do with race, race relations-
Melanie: No, no.
Katrina Ubell: … like anything, anything at all.
Katrina Ubell: Right?
Melanie: We don’t teach it in medical school. Then, in certainly postgraduate training there’s no real discussion about why the outcomes … And I think doctors … I mean, I think medicine in general is just struggling with this as a whole.
Katrina Ubell: That’s why I want to have this conversation.
Melanie: It’s interesting because I was on Twitter and I saw a post from one of my training programs where the chair put out a more comprehensive statement than I’ve seen from other organizations coming out and blatantly calling out racism and calling out for the department to participate in the kneeling yesterday. I was literally with my jaw on the floor for a good five minutes because never in my wildest dreams would I believe that that would’ve been possible, but it is. And all it took was for a change in culture and one person who is a leader to say, “Yes, we’re going to have this conversation, and this is what we’re going to stand for.”
Katrina Ubell: Yeah. And it’s okay to be that person. I mean, I think so much of what I try to do with my own work, right? I mean, you know me. I’m always like, “Great. Yes.”
Katrina Ubell: “We’ll get you to lose weight,” but that’s … I’m least interested in that, actually. We’ll do that. That just comes from us doing all this other work of getting your brain to a place where you are actually able to step forward and lead.
Melanie: Yeah. So getting there is … I think that the brain mental part of it is key on both sides because I think for African-Americans getting over kind of the mental stress and that constant feeling of being under attack, I mean, you can’t really … When the body and mind are under attack constantly, you can’t think, and grow, and explore, and be creative. You can, but it makes it a little bit harder. And on the converse side, when one is in denial about the obvious things around it, then you can’t really acknowledge, face them, learn, grown, and change. So, it goes both ways.
Katrina Ubell: Yeah, yeah. Do you have any ideas for somebody who is a white person who works, let’s say, in a hospital setting or in a clinic setting … What should they be on the lookout for? Or what should they be thinking about?
Melanie: I mean, I think one is to do implicit bias testing. There are websites on there if you look for implicit bias testing. So do the test and expose what your implicit biases are and acknowledge them. Because if you don’t, then there’s no fixing them. So, do that, and then see-
Katrina Ubell: I have not even heard of that test, so I will be doing that for sure.
Melanie: There’s a implicit association test. Because when you hear certain words, you think certain things. So learn about where those implicit biases are. They exist for gender. They exist for race. For everything. So, that’s the first step that I would say.
Then, in your patient interactions, look for where you are applying those implicit biases. Do you think Black noncompliant? I don’t know. Maybe.
Katrina Ubell: Maybe.
Melanie: But, do you—
Katrina Ubell: The way you’re going to find out is by doing something like this. Yeah.
Katrina Ubell: Well, that’s what it’s like. How do you see the thing that you can’t see? That’s what we have to figure out is how to … And it sounds like this test could be really helpful, too.
Melanie: Yeah. Then, as I mentioned, resources, really looking at sort of … If you have a patient who’s got uncontrolled diabetes and you can’t reach them, maybe there’s a different way to go about it. Maybe if that person’s living in a food desert, has no access, or is poor, and the most affordable foods are foods that are keeping their hemoglobin A1c up, maybe there’s a different way to go about it. Then, that may require … But, that’s hard work, right?
Katrina Ubell: Yeah.
Melanie: That we don’t reimbursed for. And we’re already burnt out.
Katrina Ubell: Yes. But, a lot of that burnout is … You know my opinion on that.
Melanie: No. Yes.
Katrina Ubell: There’s a lot of factors that go into it.
Katrina Ubell: And a huge part of it is our own brains burning ourselves out.
Katrina Ubell: So when we manage our brains a little and stop feeling like we’re the victim of our day.
Melanie: Yeah, exactly.
Katrina Ubell: And now I’m expected to help this person who-
Katrina Ubell: … is noncompliant?
Melanie: You know, I mean, how is …
Katrina Ubell: Right, right. It’s like, “Hold on a second. Let’s clean that up.” I’m like, You spend five minutes of clean brain energy on how to help that patient, you’re probably going to come up with something rather than all the time you spend thinking about how it’s you’re being punished because you have to deal with whatever-
Melanie: And maybe you spend your first few visits just building a relationship with that person so that it’s not you’re coming from a place of mutual trust.
Katrina Ubell: Yes.
Melanie: And they’re like, “Oh, yeah. Dr. So-and-so’s a good doctor. I trust him. He wants me to do this.” So then maybe you can get somewhere and make a little.
Katrina Ubell: Yeah, yeah, yeah. Totally. I think that’s so powerful. All right. Well, as we tie things up, any final thoughts, final experiences you want to share?
Melanie: I mean, I think the key is open and honest conversations, open and honest introspection, and holding ourselves accountable, holding our medical system accountable, holding our medical education system accountable or leaders. I mean, there has to be accountability that is real or there will be no change. The powerless have been trying for decades and generations, and it’s going to take a little bit of more of a collective effort to make that real change happen, but I think it can.
Katrina Ubell: Yeah, yeah. Oh, I love that. I love that you have optimism about it, right?
Melanie: Well, you have to. I mean, things are not as bad as they were 100 years ago. Is progress as fast as we would like? No. But, I think especially this moment gives me a little bit more optimism than I probably would’ve had maybe even a week ago, so we’ll see.
Katrina Ubell: Well, Melanie, seriously, I appreciate you so much. Thank you for agreeing to come on and have this discussion with me. I know it’s going to help so many people. I learned so much. So, a huge thank you to you.
Melanie: No problem. Thank you for having this conversation.
Katrina Ubell: Did you know that you can find a lot more help from me on my website? Go to katrinaubellmd.com and click on Free Resources.