Challenging Stereotypes, Changing Medicine: An Interview with Michael Williams, MD, MSc

Data from the American Association of Medical Colleges shows individuals who identify as Black make up approximately eight percent of incoming medical students, and only four percent of Black physicians are working in academic medicine. Michael Williams, MD, MSc, is a fourth-year pathology resident at SUNY Upstate, and believes that the pipeline challenges toward diversifying pathology start at the educational level. Here, he shares his insight on how we can affect change and challenge stereotypes in medicine. 

What are some of the stereotypes or prejudices that individuals of color encounter from healthcare providers? 

We should frame the question as to where these prejudiced attitudes may have come from and why they possibly continue to exist. American medicine has roots planted in supremacy with stereotypes of Blacks that have unfortunately been passed from generation to generation. Even in the age of technology, we have reports and data of continued unequal health care to marginalized populations when compared to white counterparts. In a 2002 report by the Institute of Medicine (currently the National Academy of Medicine) entitled, “The Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” it stated that prejudice and stereotypes lead to widespread differences due to race and ethnicity. A 2016 study had surveyed first- and second-year medical students about pain in Blacks with the underlying assumption that Blacks have thicker skin and feel less pain compared to white patients. Other stereotypes include patients of color being late/no show to medical appointments on purpose without realizing that transportation is maybe an issue for these patients.  

Tell us about your personal experiences with racism in health care. How has it affected your education?

Medicine was what I aspired to practice since I was young. After a long, arduous and circuitous educational journey, I remember the excitement and validation I felt when I got my medical school acceptance letter. I was one of few Black students in my class and ran into classmates whose experience in talking to people of color unfortunately started with us. Our preceptors and attendings during clinical rotations consisted mostly of white faculty, so the pressure to succeed in our rotations was compounded by fighting whatever implicit biases they may have held. I remember one time entering a patient room with my short white coat and introducing myself as a student doctor, and the patient responded, “Oh, are you the janitor?” Not understanding if this was in weird jest, I had to repeat myself to the patient and only complain to fellow students who understood the multitude of microaggressions we encounter. 

This experience has even shaped how I seek my own health care, fearing what sort of implicit bias and difference in care I might receive, especially since I identify as both Black and queer. This goes to the continued shared experiences of microaggressions and underlying structural racism Black medical students, residents and even attendings go through when observing or practicing in medicine. Yet I still love that I entered medicine and am learning pathology because I wanted to be a physician and impact change on some level. I feel like being able to one day help encourage medical students to enter pathology and combat structural racism on my terms is how I can change health care for the better.

From your experience, what needs to happen in order for medical education or medical laboratory education to actually teach and practice respect and open-mindedness for one another?  What needs to happen for those teachings to follow through across a career? 

This is a multifactorial question which opens discussions of the myriad steps that could be taken, implemented and, if needed, readjusted so that we can work toward open mindedness. There is an interesting editorial written by Dr. Camara Phyllis Jones entitled, “Toward the Science and Practice of Anti-Racism: Launching a National Campaign against Racism,” which outlines tasks for institutions to undergo toward antiracism, including naming racism, asking how racism is operating at that institution, and strategizing how to act against it. Even recently, we have seen an increased visibility of literature that discusses developing and applying antiracist attitudes in healthcare organizations. National medical societies have even recognized racism as a structural determinate to health. These are part of the equation in broadening medical curricula that can range from highlighting the inequity that minority patients undergo in health care to having broad and open discussions about how race and culture affects patient entry in the U.S health system. I think we learn medicine and laboratory education through a heavy scientific lens without realizing the unfortunate impact that implicit bias has on how patient laboratory results may or may not be used and hopefully we can, at least on the laboratory side, learn what we can do to mitigate that potential negative impact. 

How can you start discussions about race and diversity and effect change? 

I think it depends on the environment you are in and how comfortable/safe you feel in bringing up these discussions. I have personally felt comfortable talking to fellow residents about race and inequality in medicine and recently gained the strength to talk to several pathology attendings about how it affects me without repercussion. A great friend of mine and I continue to have discussions about racism while learning of our personal journeys; him growing up white and me growing up Black. Having the patience to hear and listen to what the concerns are is the start to effect change. This can either be on a personal level, speaking out against racist attitudes in spaces or groups where there aren’t people of color or at an institutional level where antiracist policies and discussions are incorporated. We must continuously strive to cut down barriers and allow conversations that help create a positive impact on patient care.