Anti-Asian racism and how bystander intervention training can save a life [PODCAST]

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“Doctors undergo mandatory training sessions in medical school to prepare for unexpected medical emergencies. Health care workers are mandated reporters who have to undergo specific training for the purpose of identifying child and elder abuse or neglect. Bystander intervention should also be on that continuum of responsibility and training.

I urge bystander intervention training to be widely adopted by health care workers, professional workplaces, and the broader community to end everyday harassment and racism, for microaggressions and violence, alike. In medical simulations, health care professionals are always taught to ask two questions first that can be useful to keep in mind in any situation: 1) Is the scene safe, and 2) Should I call for help?”

Michelle Lee is a resident physician and can be reached on Twitter @MichelleLeeMD.

She shares her story and discusses her KevinMD article, “Bystander intervention training can save a life.”

This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Applications close on July 22.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Michelle Lee. She is a radiology resident, and she wrote the KevinMD article “Bystander intervention training can save a life.” Michelle, welcome to the show.

Michelle Lee: Thanks for having me here. I’m so excited.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Michelle Lee: I’m a native New Yorker. I was born in Queens, I went to high school on Long Island, and I went to medical school in Manhattan, at Cornell medical school. Then I did an internal medicine year at Sinai, where, you know, it’s a very demanding intern year, especially during COVID, and I kind of started realizing my identity as a resident trainee. This was also, you know, with the escalating anti-Asian hate crisis, especially during COVID. I became a community activist for the AAPI community, the Asian American Pacific Islander community, and during my advocacy work for the community, I realized how important bystander intervention training can be, and also saving a life. So I wanted to share a little bit about my experiences and also what I learned from the process.

Kevin Pho: Can you share some stories and experiences of being an Asian American, especially during the pandemic?

Michelle Lee: You know, I’m a first-generation college student, and for most of my life, I feel like I’ve always been trying to get here, which is being a doctor. That’s something my parents always told me, because they were not college-educated. They’re like, “You know, once you become a doctor, things will become easier.” And I’m really quickly realizing that, as awesome and incredible as this field of medicine is, there’s so much I have to learn, but also how much power I have within the white coat. And I realize a big part of reaching that American dream is not just becoming a doctor but really giving back to the community.

When I was an intern in internal medicine, I was frankly pretty burnt out this time last year. Then, when the COVID pandemic hit, I felt, really, a call to arms. I felt the need to serve my city, and I was in the trenches with so many incredible people and helped other fellow health care providers. We were not seeing our families for nine months, and I felt like that was a true creation of my doctor identity within that COVID pandemic. I think these stories were not covered very often in mainstream media, but, you know, burnout, and frankly how traumatizing that experience was, and I think more and more of us are just finally starting to process that.

But I wanted to also talk about a different perspective as an Asian American in New York City, because I’m a native New Yorker, and I’ve realized the city was really changing, because there was an increase of violence against the Asian American Pacific Islander community. I was noticing that even as a doctor on the front lines, because I would hear about a fellow co-resident who was assaulted on the way to work. She was clearly grabbed, and she was going to actually treat COVID, but people were scapegoating the Asian American community as harbingers of disease and the virus. So whatever trickle-down effect from political rhetoric is unfortunately kind of playing out and putting members of my community into the hospital, or these acts of racism, I wanted to raise awareness that racism is a public health issue.

I think more and more of us are realizing that, especially after George Floyd and the wave of political activism afterwards. In New York City in particular, the rate of violence has increased almost over 200 percent. So this last year, it wasn’t just the COVID pandemic, but it was also the anti-Asian racism that was a huge stress to Asian American health care workers within the city. So I wanted to raise awareness about that.

Kevin Pho: So tell me some of the things that you did to raise awareness about the anti-Asian sentiment that was going on.

Michelle Lee: So after the Atlanta shootings in March, in which six of the eight victims were Asian American women who were targeted because they were working at massage parlors, there was a lot of outrage. When I was at Cornell medical school, I was a part of White Coats for Black Lives. Even as an intern, I would march after a night shift to protest George Floyd’s murder. So I realized we need to finally advocate for our own community. I rallied the first white coat front line for the Asian American community. We had over 100 health care workers come out to Columbus Park. It was the largest AAPI rally. I was able to speak on the same stage as Senator Chuck Schumer, mayoral candidate Andrew Yang, and a BLM activist.

I also used my platform to actually amplify a story about a Sinai medical student [name removed by the editor], who’s Thai but was actually assaulted, like beat, on the way to the hospital because she was called “Chinese virus.” I think a lot of Asian American health care workers have been reporting instances of harassment even when they’re wearing scrubs, just because of that scapegoating and racism.

So I did a lot of work, not just community activism, which was rallying, but also within the hospital, which is educating NYP, NewYork-Presbyterian, GME. Luckily, AAPI Heritage Month was shortly around this time, so the hospital was very willing to actually give me a platform. I was able to speak at NYP diversity meetings and also talk at Stony Brook, and also at a medical school, Mercer College of Medicine in Georgia.

An outside gig of mine is actually writing, and I’ve been covering the Asian American community in New York City for like eight years now, just as a side gig. I finally realized that my role as a doctor is not like my parents said, which is just study and make it. It’s really so much more than that. It’s realizing the power you have, even as a trainee, to advocate for a community, and using that voice and that education, which is so hard-won and built on immigrant sacrifice, to actually give that voice to the immigrant community who are unable to advocate for themselves.

So it was an incredible journey. I was able to write so many articles on behalf of the community, including the KevinMD article. I interviewed Stop AAPI Hate co-founder Dr. Russell Jeung, who is an Asian American professor and department chair at San Francisco State, and I asked, “What are six things we can do to help the Asian American community?” With my writing skills and my education, I was able to write an NBC article, among others. I think this is my coming of age as a resident trainee, and realizing there is so much work to be done in terms of community activism that as doctors we should really start to get involved with.

Kevin Pho: Now, for physicians who want to become more of a voice, who want to participate more in activism for a variety of causes, a lot of physicians don’t have a lot of training when it comes to this. How did you learn how to write, how to amplify your voice, and how to do the activist things that you do? Where did you learn how to do all that?

Michelle Lee: Honestly, it’s fascinating, because now there are anti-racism and diversity fellowships that people can do. It’s becoming more and more of a recognized issue, like diversity and inclusion in medicine, and they’re doing increased training. I honestly didn’t get much training from that, except for just going to Cornell and being around like-minded students who are passionate about social issues, who sometimes feel too scared, either career-wise, or overwhelmed with the actual medicine part, and feel like they don’t have time to make this a priority in their training.

But I think for me, I’ve always covered that. My family are Asian American immigrants, and they have a store in Koreatown. They’re local business owners. I’ve always written just kind of as a stress relief for me. But it was truly the Atlanta shootings, where it was local, hard-working Asian American immigrant business owners, and that just really struck a really personal note. I think that’s what really, like many of us, many of us go into medicine because of our personal experience or encounter. I think it was that particular news, and then opening up so many news articles and realizing they were not covering my community in a holistic manner. They even hesitated to call out racism as a key motivator in this, and I realized, you know, how are we supposed to treat instances like this if you don’t properly diagnose them? So I realized calling things out and recognizing racism, and getting professional organizations to also denounce it, is very critical in making members of the community feel heard and their concerns taken seriously.

For me, honestly, frankly, I think it’s just being in New York City, where there’s so much high density and so many instances of this, and hearing these stories, and simply amplifying them in the way I knew best, which is covering them and writing about it and publishing and sending it to places like KevinMD, who will give a platform to physicians who want to share these stories that are not often heard.

Kevin Pho: So let’s transition now into your KevinMD article that you wrote. It was written back in May. It’s titled “Bystander intervention training can save a life.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Michelle Lee: Yeah. So I decided to write it because there was a heavily publicized, at least in New York City, hate crime committed on a medical student. I reached out to her immediately, and I said, “Are you OK?” I’ve been kind of her mentor, and I helped mentor her on some pieces in media as well. The one thing that stuck out to me when she told me her story was she’s like, “There were people around, but they didn’t know what to say. They didn’t intervene.” She was really severely beat, to the point that she had to take time off school.

Similarly, we kept getting a deluge of anti-Asian hate crimes in the New York City media, including one of them, Vilma Kari, who’s a Filipina woman who was just walking to church in broad daylight, literally 10 blocks from the hospital I used to work at for intern year. It caused a lot of outrage because she was beaten to the point where she had her pelvis fractured, she got a concussion, and it was outside of a luxury building, and security guards just closed the door on her. They didn’t call for help.

So, you know, as a medical provider who would probably see the downstream effects of this, like either I would be reading her film, I felt like it was also part of my doctor’s duty to educate people on simple bystander intervention training. That’s something that secondary professional organizations have already been doing, but I think it’s a good thing to educate the mass public about it, because it’s very easy, and I can go into it specifically in a second. It’s very easy, and it could really truly save a life, especially as, unfortunately, with a lot of economic displacement from COVID, there has been an increased crime rate, not just in New York City but nationally.

So the whole idea of bystander intervention is to acknowledge and also potentially intervene to help a person in need, and that goes for not only hate crimes or any kind of crimes, but also when they’re in medical duress, and also in cases of, you know, even a woman, gender-based discrimination.

So my article was simply, you know, it’s kind of like in basic medical training, when you’re learning to run a code, and during it, they tell you to first assess: Is the scene safe? And so if it’s obviously too dangerous for each intervener, and you think you’re going to be put at risk, you obviously don’t need to intervene. But one of the critical things about the security guards at that luxury building, and I was involved in a lot of the rallies and peaceful protests that happened in front of that building, was actually just simply educating bystanders, who simply aren’t trained, and it’s not truly their fault, which is: Even if it’s not safe, you can always call for an ambulance. You can always call for help. If you see someone being attacked, or you see someone potentially having serious medical repercussions, in her case with a fractured pelvis, a head concussion, and a contusion, then we should simply call for an ambulance. That’s something that’s very simple and something that we can do. Call 911. Don’t just walk by.

And bystander intervention is actually a larger topic. My favorite one is from iHollaback. After hearing about a lot of these instances, I took a training course with them, and they call it the 5Ds of bystander intervention, which I really like. Basically, the first of the 5Ds of bystander intervention is potentially distracting the person, which is just trying to de-escalate the situation, but of course, just check that the scene is safe for you, and do whatever you can to help the victim get on their way to safety.

That can be delegating, or calling, or making eye contact with another person in a public setting and saying, “Can you call 911? Are you able to go and help the victim if you feel unsafe? Are you able to direct the police car to here, if they’re able to?”

The third one is to document. Of course, it’s not safe to document if you feel like you’re going to disempower the victim, and you should obviously not post anything if it’s going to disempower the victim, without the person’s consent. But you can document an incident, and maybe that will help that person. For instance, if you see someone acting in a way that you’re unfamiliar with, maybe they’re having a seizure, simply documenting it and just showing it to the medical provider might help them later on.

Fourth is to delay, which is, if you notice someone being harassed or being a potential victim of any sort of harm, you can potentially try to delay the perpetrator. And then, of course, the last one is going to be directing, which is, once the ambulance or the police force gets to the area, you can just direct them to the victim and get them to safety in whichever way you can.

So I think that’s something that I learned that was very helpful. You know, even New York City just isn’t as safe as it used to be, because the city is still recovering, but it’s still pretty empty, and there has been increased crime. So I think about these 5Ds whenever I take the subway or bus to work.

Kevin Pho: Now, with your interaction with the medical community, what’s their level of knowledge when it comes to bystander intervention? Do you feel like they can use more training, or do you find that a lot of physicians kind of already know what to do?

Michelle Lee: I think a lot of physicians need training on it, and I’ve had a lot of diversity chairs reach out to me about bystander intervention training, especially during AAPI Heritage Month, because a lot of even Asian American health care workers were unfortunately being assaulted just taking the subway to work. I talked to a nurse who was punched in the stomach, and it happened so quickly, and they just want to move on with their life, so they rarely report it. So a lot of these things are underreported. But bystander intervention training is something that a lot of people are interested in, because it’s something that we can simply teach, and it can make people more aware of their surroundings and potentially help someone.

Because it can be very disempowering for a health care worker, you know, and that’s why I felt like it was important for me to speak up. I had busted my butt during intern year, right? I was working around practice, socially distancing from my family, and yet I was seeing my community being scapegoated. So I felt like it was very ironic. And especially if you are a health care worker who doesn’t feel safe going to work, or you have been a victim of either verbal or physical harassment or assaults, then, you know, it can be very disempowering and very demotivating to go to work and bust your butt and yet feel not safe when you’re outside the hospital.

Kevin Pho: And if people want to find out more information on bystander intervention training, where can they look that up?

Michelle Lee: One would be the KevinMD article, because at the end, I link iHollaback, which is one of the many, but one of the best I’ve found. It’s very quick. It’s a one-hour training, but they also have pamphlets and very easy pictures, like for the 5Ds.

Even in New York City, there are a lot of local community organizations. For instance, there’s a cafe called Cafe Maddy Cab. She’s just a local business owner who felt unsafe going to work and felt like that was a very common concern within the Asian American community, so she raised over $200,000, and then she reimburses cabs for local New Yorkers simply going to work, and many of them include essential workers.

The biggest takeaway I learned from the last few months is you always make a difference. I think when you’re undergoing a lot of hate or difficult circumstances, I think education, and just simply being caring and empathic, and doing whatever small difference you can, can actually make cumulative, big differences in the overall picture for the community.

Kevin Pho: We’re talking to Michelle Lee. She’s a radiology resident, and she wrote the KevinMD article “Bystander intervention training can save a life.” Michelle, as part of your story, you mentioned that you’ve been covering that intersection between Asian Americans and medicine for years now. Now that you have a platform here, what would you say is the biggest misconception about Asian Americans in medicine?

Michelle Lee: Asian Americans on the surface seem overrepresented in medicine, and that’s as a result of the 1965 Immigration Act, wherein the U.S. specifically selected for high-achieving STEM, and many of the Asian Americans we see in medicine today are a result of that. However, the biggest misconception is that Asian Americans are a model minority and that they’re monoliths. In fact, in medicine, there are very certainly many Asian Americans who are underrepresented. I would say Southeast Asians, Hmong, Cambodian, Filipinos, many of those Asian Americans are actually underrepresented significantly. And it’s that Asian Americans are the fastest-growing but also the most economically divided racial group.

So the model minority, which is, you know, from that 1965 media, you know, that was perpetrated by a very specific kind of white male media outlook, which is that Asian Americans are quite hard-working and high-achieving, they don’t experience racism, they don’t have any difficulties, and they technically made it. That’s completely untrue, because Asian America in 2021 looks very different. We have Asian Americans from over 30 different countries who speak very different languages and also have come from very different socioeconomic backgrounds. Certain Asian American groups, like Chinese and Indian groups, their average income may be six figures, but Southeast Asians, their average income might be $30,000.

So a lot of Asian Americans, even within medicine, the admissions criteria have not been really truly disaggregated. That’s something that I hope to raise awareness for, which is that Asian American groups are considered on the same playing field as others, and that’s not really the case.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Michelle Lee: My typical message is that even if you’re a resident trainee just trying to figure things out, you can always make a difference, and no matter how busy you are, it doesn’t take much to advocate or speak up for your community, because it does make a big difference.

Kevin Pho: Michelle, thank you so much for sharing your time and insight, and thanks again for being on the show.

Michelle Lee: Thanks so much, Kevin.

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