"Are you a medical student?"
I whipped my head around to see who was addressing me, beads of sweat dripping into my eyes. I stood face-to-face with the attending trauma surgeon, who was staring at me as she slipped on a pair of medium gloves. Stunned, I turned back to my patient and continued to cut open the pericardium looking for signs of trauma. Warm blood poured onto my sneakers from the patient's left chest.
"No...I'm the emergency medicine attending...do students usually do thoracotomies?" I responded.
"Oh, uh...it's just that you...it's just that you have the same hair as the last medical student on our service," she continued.
I did not respond.
She quickly got to work as we stood side-by-side, working simultaneously to try to save the life of our young patient.
Moments before this brief interaction, a 19-year-old Black man's lifeless body was rolled into the trauma bay with a single gunshot wound to his chest. He lost his pulses immediately upon his arrival. As the most senior physician in the trauma bay, I swiftly began to perform the indicated emergent thoracotomy. It is common knowledge and practice that this potentially life-saving procedure is performed by, or under the direct supervision of, the most senior and experienced physician or surgeon in the room -- never by an unsupervised medical student. Thus, the comments from the trauma attending were not an innocent case of mistaken identity, but a blatant demonstration of bias. While the hair comment theoretically could have been regarded as a seemingly innocuous observation, my hair was fully covered by a surgical bouffant. In fact, I had on a mask, gown, and gloves as standard trauma PPE. The trauma attending had made a swift judgement on my identity, role, and experience based on the only thing that was visible to her: my skin.
Being Black and a woman in medicine means I am constantly wedged into the intersection of racial and gender bias. With less than 3% of U.S. physicians being , we do not fit the stereotypical depiction of what a doctor should look like, historically and proportionally.
I am aware that for many, my dark skin and waist-long braids may perpetuate a cognitive dissonance that reaffirms bias and leads to constant role misidentification. It is commonplace for me to be mistaken for almost every role in the hospital, from registration staff to environmental services. "Hold on, the nurse is here" is something that many Black women physicians (actually, women physician of all ethnicities) hear multiple times a day upon entering a patient's room. But the offense is not the specific mistaken (non-physician) role -- I hold very high esteem for every department and understand how crucial each role is in the delivery of efficient patient care. This is not an issue of hierarchy, but a matter of awareness, recognition, and respect. The constant misidentifying affirms that as a Black woman, you could not possibly be the doctor. And that is the issue.
As my initial anecdote illustrates, role misidentification does not solely occur at the patient level but happens even with the clinical staff. I have had consultant physicians refuse to convey information to me because they are looking to speak to my "superior." I have had nurses ask if I am "ready to transport the patient to CT scan" whilst sitting at the computer labeled "attending only," wearing physician-designated scrubs as I typed patient notes. Not only are these types of occurrences exhausting, but they are damaging. They interrupt and dismantle the congeniality that is crucial to a team-based approach to patient care.
As a result of these prevailing gender and racial biases, Black women physicians are forced to over-identify themselves. Many of my white, male colleagues introduce themselves causally, by first name, to patients. This informal approach can be beneficial in establishing rapport, particularly in the ER where rapid connections are essential to foster patient trust and confidence.
I do not have that same luxury. I have developed a well-choreographed verbal introduction in which I mention the word "doctor" at least twice while making sure my badge is clearly displayed and my name and title are visible on my jacket or scrubs. I have imparted this strategy to several Black women trainees and residents in an effort to confront and mitigate the racial and gender biases we experience regularly. During my training, I was told it was not enough to introduce myself as "doctor," but that I should also wear a white coat every day so my patients could properly identify me. It frustrates me that in addition to the unrelenting stress that comes with working in healthcare, Black women must also be hyper-vigilant in their presentation to patients. We must simultaneously work to combat biases that we, ourselves, are not propagating.
Constantly having to be aware of making ourselves known in a space can lead Black women to feel isolation and discontent at work. Such feelings may result in physician burnout and overwhelming job dissatisfaction, which is counterproductive to increasing our numbers in the medical field.
It is well studied that women have experienced gender discrimination in medicine for decades. However, Black women (as well as other women of color) have had to bear the burden of both gender and racial biases. In order to tackle these biases, their existence must be acknowledged by patients and hospital staff. Black women physicians should never ignore misidentification as a benign mistake but must continue to constantly correct it, in real time, when it occurs. Lastly, we must also continue to diversify the face of medicine to expand the perception of what a physician should look like. I hope to see the day when a surgeon joins me in the trauma bay and consistently assumes that I am a fellow doctor. I am optimistic for the day when Black women physicians become the norm, not the exception.
is an emergency medicine doctor, assistant professor of clinical emergency medicine, and emergency department lead for inclusion, diversity, equity & antiracism at Penn Medicine.