I spent the evening of the 2016 presidential election and the morning after on an emotional rollercoaster. It began high and then descended into shock, disbelief and grave concern about the future of our country. Now that we have selected a candidate who intends to take the country in a radically different direction, and I worry about the consequences of reversing the Affordable Care Act, reversing economic assistance programs, and dramatically shifting our position on the international stage.
Yet I have friends who had the exact opposite experience. Initially prepared for the seemingly inevitable defeat of their candidate, they are now elated at the prospect of the new administration. Despite our wide differences of opinion, what we can readily agree on is that there is a deep divide in our country. This divide is reflected in the paralysis of our governing bodies and the vitriol of our rhetoric. I believe this divide is rooted in the lack of meaningful interaction among individuals from different social circles. In the absence of such interaction, our voices reflect inside our own echo chamber, and we fail to acknowledge the validity of other opinions.
Our professional and life experiences are what shape our beliefs and core values. They also give us to ability to empathize with and understand other viewpoints, if we allow ourselves to. As physicians, our patients allow us a window into their lives, unlike any other profession. And we have a responsibility to work hard to overcome our own biases and differences in order to provide the best care we can. In recent days I’ve explored how my own experiences have shaped my views and how I can work to engage outside of my comfort zone with understanding. I hope a window into my experience will help you do the same.
Two years ago I ran a sexual assault clinic and spent one morning each week seeing patients for HIV post-exposure prophylaxis. After my patients filed police reports and visited the emergency room, I was often their first point of contact. My patients were diverse, from college students and professionals to laborers and the homeless. What was painfully consistent was the emotional devastation that comes with sexual assault. I was present at the beginning of the tailspin that one’s life enters after such a violation. When I heard our president-elect boast about sexually assaulting women, with no fear of consequence, I was taken back to the countless mornings in clinic spent with tearful men and women coping with the shock of a recent assault. Had my life not intersected with these patients, would I be as outraged about these comments? Would I be so inclined to think less of those who now support the president-elect?
I am also a black male professional who, like many of my black male colleagues, knows that my professional status does not shield me from suspicion and the risk of police-initiated violence. When videos of black men being shot and killed by police became national headlines, I tried my best to bury my sadness and anxiety and focus on my patients. But I was caught off-guard one day while performing a lymph node exam on one of my black male patients. The silence of self-preservation was broken when he looked directly at me with tearful eyes and asked, “Are you OK, Doc? You know, with everything going on?” All of a sudden we were grieving together, our respective roles as patient and healer suspended by shared fear. We both had sons who were toddlers at the time. We talked about how we wanted to extend their care-free childhood for as long as possible, knowing that their transformation from innocent child to a perceived threat would happen far too soon.
When I heard our president-elect talk about the need to strengthen and expand the controversial “stop and frisk” program in New York City along, other with racially tinged comments, it took me back to this moment with my patient. It made me anxious about the day when I will have to teach my son that he will need to learn how to interact with authorities to preserve his safety. If I were not a black man in the United States, would I take such exception to a president-elect who so easily endorses sacrificing my Fourth Amendment rights for the purported sake of the greater good?
Many argue that the so-called “wedge issues” — such as race, gender, and class — classically employed in elections were not the primary concerns of voters who supported our president-elect. Rather, they were motivated by a hope to revive declining industry and a way of life that is currently unobtainable. I grew up in poverty and know all too well the feeling of hopelessness that comes from living in an area where the quantity and quality of available jobs do not match up to the needs of the community. Many of my friends — both black and white — lived in unemployed or underemployed households. When lack of opportunity is so pervasive that it begins to cut across generations it elevates to the level of a crisis. And, often, the only appropriate solution to crisis is radical change. My own radical response to poverty was to apply to college, despite the huge financial risk and my fear of failure. The radical response of many in our country was to elect a candidate representing a radical departure from normal politics.
How would I have responded to the president-elect’s speeches about reviving our economically depressed areas if I were living in a declining area, past the age of radical reinvention, without hope for myself and my family, yet unsaddled by the baggage of my skin color and professional experiences? Would I have been willing to put aside any disagreements with his personal conduct? Would I have been willing to support someone so radically different?
As physicians, we have the honor and privilege of protecting the health of individuals and populations. Our work has the ability to cut across race, gender, socioeconomic status, immigration status, religion, and all of the other factors that so often lead to divisions within our society. Through our patients, we are afforded glimpses into lives often very different from our own. Our responsibility is to use these glimpses to challenge the social undercurrents that inform our own implicit biases. Though this election cycle has polarized our nation, we must cross this divide — from whatever side we’re starting from — for the sake of our patients. This is our duty, because our assumptions about others have the ability to cloud our professional judgment. To begin exploring your own biases, I encourage you to take one or more of the Implicit Association Tests developed by Project Implicit, an international collaboration of researchers interested in social cognition. We must reverse our crisis of misunderstanding and empathy to strive for unity. And it begins with each of us, right now.
Taison Bell is an internal medicine physician.
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