How Physicians' Experiences With Racism Inform Our Care

The impact of medical racism — the prejudice and discrimination based on someone's perceived race experienced while navigating the healthcare system – is profound. But how do race and identity impact the doctors and healthcare practitioners who work within the system itself? How does their own racial identity shape how they practice medicine today?

Doctors Brian Muthyala, Serin Edwin Erayil and Alexandra Alejos reflect on their personal experiences in the following three original essays.

Fifty years ago my parents left India. They took with them their combined histories, cultures, food and fears. My father, Ramaiah, was the first in his family to leave the small farming village where my parents grew up — to go to school. My mother, Vimala, was 17-years-old when she left home. Eventually they moved to Michigan where my brother and I were born.

I was born early, and so had to stay in a Neonatal ICU (or NICU) for several weeks. Because my arrival was unexpectedly abrupt my parents had not yet chosen a name for me…. So, the nurses called me "Baby Boy Muthyala" until one was chosen. My parents wanted my grandmother to help choose a name for me but the phone connection to her small village was poor and so they were unable to hear from her… and this went on for weeks.

The NICU was about a 30-minute drive from our home. Every day my dad would drop my mom off at the hospital, then drive my older brother, Sharat (who was almost 6 at the time) to school, before going to work himself. In the afternoons, he would pick my brother up, visit me in the hospital, and then all three of them would go home, to do it again the next day.

During this time, my brother made friends with the neonatologist — and they would go on rounds together (this was before HIPAA). One day the neonatologist asked Sharat, "Does your little brother have a name yet?" And in classic fashion, my brother answered, "Yes. His name is Brian." So the next day, when my parents returned to the hospital, written on my crib was the name "Brian Muthyala".

To this day no one knows how he came up with it. My parents were, as you can imagine...surprised. But in our traditions, it is considered bad luck to take a name away from a child once it is given. So eventually, I was sent home to join the family — a "Brian" amongst "Ramaiah, Vimala and Sharat".

As the son of immigrant parents, I often felt torn between cultures, values, beliefs. Brian could play soccer, go to the mall and play video games, whereas Kirti (my middle name) was a dutiful son, who knew how to act with the Aunties and Uncles in his small Indian community.

As a teenager I was grateful that my brother gave me a name that allowed me to blend in. Strangers would see my brown skin and my last name, but my "otherness" was often less visible because "Brian" felt so familiar to them. Today as a doctor, I watch my patients stare wide-eyed at my ID badge after I introduce myself…. trying to enunciate "Moo-thee-yala", I quickly say "but you can just call me Dr. Brian". And I often see the relief wash over their face as we share a quick smile together. I have often reflected on how my life has been simpler because of the mysterious split-second decision my 6-year-old brother made all those years ago.

But more recently those thoughts have made me uneasy. Names are important and while my name made introductions comfortable for others, it also placed me further away from the rich history and traditions that my parents worked hard to maintain in our family. So, when it came time to name our children, my wife and I intentionally chose traditional Indian names realizing that they will not have some of the benefits that I had. At times, I fear for my two young beautiful kids. How will I teach them to not be afraid, shy or embarrassed of the richness of those that came before them? I hope I am as courageous as my parents, who braved an unknown world to make a better life for me and Sharat. I hope I can be the parent, son, partner, doctor, friend and neighbor and live up to the name I was given all those years ago.

I first visited the United States as a 24-year-old. Coming in, I thought it was very obvious that I was cool. I mean in India in the 90s it was aspirational, in kind of a shameless way that I cringe at now, to be as American as possible. And I checked all the middle class Indian boxes for American sophistication. I was arguably well spoken, I got the pop culture references, I understood and dealt in sarcasm very well. I had watched all 10 seasons of Friends. And all the episodes of Star Wars. I thought I had it DOWN. I saw myself as "one of the guys." Every bit as American as the next person. 

However, I remember the first time I ordered at a McDonald's in Boston. The person at the counter double checked that my non-vegetarian order was in fact intentional. Then it happened a few other times before I realized the color of my skin to some meant I only ate vegetarian food. As a hardcore bacon-lover I was very offended. 

Then as an exchange medical student I started taking my first patient history. I saw the split second look of confusion on the elderly gentleman's face. He screwed up his eyes, like he was bracing to not be able to understand me, before eventually realizing I did speak English in a way he could understand. My eager and insecure little 24-year-old heart however sank a little bit. "But, but…I aced my English boards, I reasoned in my dramatic 24-year-old head, how could he think that I was not "well spoken", this is so unfair!

Then the same thing happened with the younger guy who showed me around the first gym I joined. Eventually the split second look of confusion became so familiar I began to expect it at every new interaction. I hardly even notice it now. But about a month ago, after I had practiced medicine in the United States for about 6 years, I saw a scheduling note on Epic from a patient of mine requesting a different provider because he "did not understand that doctor." "Oh that's not a big deal at all," I thought to my by now Minnesotan self, "of course he should be with a provider he is comfortable with, who works best for him." But my grown-ass heart too sank a teeny bit. 

With a little trepidation, I have now realized, after all these years, maybe, it was not so obvious to others. My coolness, my fitting-in-ness. I think it finally clicked that one time I realized my best friend here, who to me was just "my best friend", referred to me to her other friends as her "Indian Friend." My dear friend meant no harm at all obviously. But I essentially had failed in my aspirational American-ness. Whether these aspirations were required/well-placed are a question for another day. 

And I cannot help but feel like these are trivial grievances. That is a common theme with these experiences often — Am I imagining it? Was it because I am brown? Or a woman? Or young? Was it even real? I must be over-reacting. This is all in my head. Go take a walk now. 

Do they matter that much? My American friend asked once recently while we were discussing the perceptions and nuances of racism. Should we all be such wallflowers? 

Of course none of these people meant any harm, in fact they were all genuinely lovely people. 

But here's why it may make things a little more difficult for us people of color: When you look back at middle school/ high school, do you remember not wanting to stand out in any way at all? I did. The most pressing motivational factor was the need to fit in. The need to not be seen as different or weird in any way.

But then do you also remember that first day you had to wear glasses to school. Or braces? You can perhaps still feel the anxiety in the pit of your stomach as you turned the corner in the hallway and walked into class. 

When you think about it, that motivation remains for most of our lives on some level. At the end of the day, you kind of hope you fit in within the community you spend most of your time with. And that's why it matters. Because it feels like middle school a bit, all of the time, for all of our lives in this country we chose to call home. The anxiety in the pit of your stomach, every day, at work, at school, at the grocery store, at the gym, at the DMV, being a little bit fearful. Fearful of microaggressions and exchanged glances and subtle changes in body language indicating discomfort; fearful of being dismissed and talked over, all of which still make us feel like outsiders sometimes. And they make the track a little more arduous for us. It is hard to perform at your peak when you are also navigating a rougher than average terrain. 

But these discomforts are going to be here for a long time for people of color. 'Cause change is hard, and takes time. And there are far more overt racially charged experiences we need to tackle first. So in the interim, what CAN we do? What we could do is maybe offer some extra kindness to that intern who is treated a little differently. 

As First Lady Michelle Obama reminded us once, "when it comes to all those tidy stories of hard work and self-determination that we like to tell ourselves about America, well, the reality is a lot more complicated than that. Because for too many people in this country, no matter how hard they work, there are structural barriers working against them that just make the road longer and rockier…. but that doesn't mean we should feel hopeless ... when anger is focused, when it's channeled into something more, that is the stuff that changes history." 

It is late May 2020.  Two days after the murder of George Floyd. I am seeing a two-year-old Black child in my primary care clinic. He is a ball of energy, full of joy and curiosity, not yet aware of the cruel inequalities that will surely shape his life and already has. My heart breaks for his mother as she shares with me her fears for him and her hope that by the time he becomes a man, the world will be better. I promise his mother that as his doctor, I will do whatever I can to help him have a better life.

Yet this is a promise that I am not sure how to fulfill. And I wonder how she perceives me sitting there across from her in that cramped exam room — as an allied underrepresented minority or as another white person with good intentions but little understanding for her and her son's lived experience.

The truth is, I'm not sure how to answer that question myself.  

I identify as Latina, but I've recently been questioning what that means for me.

My father's parents emigrated to the United States from Peru, and my mother identifies as white. My younger sister and I are proof that genetics are complicated. Her skin is much darker than mine, and I'm six inches taller than she is. She looks "more Latina'' than I do. In high school, people used to ask if we really had the same parents.

We grew up in the same household, went to the same schools, played soccer and softball and shared countless adventures together. Yet recently I've wondered what role our physical appearance played in shaping our lives.

I embrace my racial identity. I speak Spanish, was an active member of the Latino Medical Student Association and love cooking Peruvian food, even if it will never taste quite as delicious as my grandma's. But I realize now that my identity has always been a choice. Our society uses appearance to define race and set expectations, yet my appearance does not tell my whole story and I find myself consumed by the questions around my position as a Latina who "looks white."

And in recognizing my privilege I struggle to keep hold of my identity.

Do I count as a minority?

Am I getting all the perks without having paid the same price as my peers?

I grew up with the trauma of racism surrounding me, but not directly touching me. My father, whose skin is also darker than mine, is a doctor. One night, he came home late after a night on call. While he was unpacking his trunk, the police arrived to question him after a neighbor called to report suspicious activity. I can still remember the pained expression on my grandma's face on the day that her car was impounded after she was pulled over for speeding on her way to the airport after her brother died. She was flustered and sad and the police officer didn't understand her English. At the time, I could not yet understand the complexity of her expression. An expression riddled with pain over the loss of her brother, the worry over missing her flight and the shame that this officer made her feel. In that moment I was confused, and could only offer a hug — now I know I should have been angry. Angry for her, but also angry that these situations, which for my family, led to inconvenience and shame, might have cost someone like my young patient their life.

In learning to recognize my own privilege I also see the harsh reality of injustice and difference in experience based solely on the color of one's skin won't be limited to this generation. My sister's partner is Black and I'm married to a white man from Minnesota. He is a wonderful man and I consider myself incredibly fortunate to have him as a partner. And yet, I can't help but recognize that my future children will have a different experience than those of my sister because of the color of the skin of the person we love.

This realization inevitably brings tears to my eyes and then makes me angry. I think about something as seemingly innate as our last name. I take pride in being an "Alejos" but also recognize its role in defining my identity. Without it my heritage is not immediately clear. My sister does not have this option.

And so, I ask again, who am I? Where do I count? What can I do?

So as I touch my patient's mother's shoulder and promise to help her son in whatever way I can, I also make a promise to myself. To continue putting myself in the humbling position to ask my patients about their experience with racism, their fears for their children and their hopes for the future. My own experience constantly reminds me that race is not simple or straightforward and each person experiences it differently. However, regardless of how I see myself, I know society places me among the privileged: to ignore that is to be part of the problem.

Curatorial Team: Jon Hallberg, MD; Maren Olson, MD, MPH, MEd; Jennie Magner- Parrisha Roane, MD; Tseganesh Selameab, MD; Ben Trappey, MD;  Anthony Williams, MD, MS

Production Team: Abdifatah Abdi, Elizabeth Crippen Allen, Daniel Bergin, Jonathan Camp, Julie Censullo, Peter Chey, Carrie Clark, Jack Davis, Alyssa Franklin Fuller, Adam Geiger, Anne Guttridge, Laura Hammerbeck, Ted Hinck, Jacob Kelso, Slade Kemmet, Jim Kron, Ben Malley, Eric Pagel, Jennilee Park, Michael Phillips, Brittany Shrimpton, Scott Trotman

These personal reflections are a part of Art + Medicine: Speaking of Race, a one-hour special funded by the Center for the Art of Medicine at the University of Minnesota Medical School.

They are presented online by Racism Unveiled, TPT's digital storytelling project funded by grants from the Otto Bremer Trust, HealthPartners and the Saint Paul & Minnesota Foundation.