Tell us a little bit about yourself. Where did you grow up? What did your parents do for a living? Why did you decide to become a doctor?
I am an immigrant’s kid. I am first generation born in the United States to an Indian woman and a Pakistani father. I was born in Spanish Harlem in New York City. I have a little bit of that ‘Spicy Mami’ component in me. I grew up in a lot of different places. I was born in the seventies in New York City. Then when I was a teen, like around 13, we moved to Kansas. That’s a little different from Spanish Harlem. My mom is a retired pediatrician. During the eighties there was a movement to get physicians to the Midwest. My mom decided to move to the small town in Kansas because my aunt was out there. Kansas was a culture shock. Suddenly, you are in a small town, where if you blink, the town is gone. You are told things like: ‘Oh you are Indian, What tribe are you?’ Your identity is: You are the foreign doctor’s daughter, even though my mother is a U.S. citizen. As quickly as I could, I escaped Syracuse, Kansas and moved to Kansas City with my aunt and uncle.
Did you always want to be a doctor?
I wanted to be a musician. I went to Berklee College of Music to sing. But I ended up doing a lot of different things. I was not disciplined. I did not fit the stereotypical description of a “good Indian girl”. For the longest time, my mom would say, ‘I don’t know where you came from.’ I did not become a doctor because of my parents or any of that. I went against the grain. One day in Boston, where I lived for a long time, I was crossing in a crosswalk, and was hit by a car in Copley Square. That was a trigger for me to be a doctor. I had four major hip surgeries. I had to learn how to walk again. But I had an experience with the healthcare system that stung me. I came from privilege; I had never gone without. At one point in my recovery, I was dropped by an insurance company because I was considered a pre-existing condition. That made me want to learn more about this injustice. I became a healthcare rights advocate. I learned about the healthcare system. I realized it was bigger than me. And so, I decided that to change the system, I had to become part of it and better understand it. So, in my early 30s, I become a doctor. But I did not want to be just any doctor. I really wanted to be an activist, a physician activist, an advocate. I wanted to do social medicine and that is what I did. I was clear that I did not love medicine for the sake of medicine. I just love helping people.
Do you feel like at any point in your career that you were the victim of racial bias?
Oh God. There are so many. There is this thing about South Asians and medicine. There is always this perception that South Asians are doctors, engineers, or lawyers. There are a large number of South Asians in the medical field. Regardless, there is always racial bias. If I am in a room filled with White people, whether they are students, physicians, or otherwise, I am not perceived to be a doctor. I’m the nurse, or I’m somebody who’s not a physician. I have had patients spit on me and tell me they will not let me touch them. I have had patients ask me what kind of doctor I was, “the ‘dot kind’ or the ‘feather kind’ ”? There are times when you are scared to be in the room with some patients.
How does it affect you personally when you see patients that are impacted by structural racism in the healthcare system?
Well, I am going to speak up when I see it. That is just who I am. But I have colleagues and friends, even some of color who will not speak up. They will say, ‘Well, it is what it is.’ Or ‘Oh, you’ll get used to it.’ They are just so defeated by what they see. You are taught to just shut up. It is just one of those components “as part of your job”. One of many stark moments came when I was in training in the Bronx. One of the attendings was a White Cuban. We had a patient who was Jamaican, and she was speaking Patois and I understand Patois. We were doing our rounds. And he insists the patient has an altered mental state. ‘I don’t understand anything she’s saying.’ I remember looking at him and saying that she is speaking Patois. He is demanding that we get a CT of her head. He was doing it with good intention. But the issue was, she was saying things like, ‘I don’t want him in the room.’ She was extremely uncomfortable with him in the room. She only wanted to be treated by doctors of color.
How does this biased environment impact doctors?
Medicine is so pathological in the sense that you survived it. So now you are teaching the next generation to survive it. And then they go teach the next generation. And that is exactly what must stop. This should not be about surviving through medicine. This should be about thriving through medicine. If you are Black and Brown in medicine, if you are an ‘othered,’ minoritized population in medicine, we should not be just surviving. We should be thriving. When you talk about racism and medicine, we are taught to survive it. But that is what must change, that is why it is so important that we dismantle the structural racism that permeates throughout the medical field. I try to remember what I learned from Dr. Camara Jones: We need to constantly be asking, ‘How is racism operating here (in our environment)?’
How important is the Healing ARC framework?
The Healing ARC framework is critically important to the future. Those satisfied with the status quo will always look for reasons not to act. We do not want them saying there are no tools to fix the structural racism. We do not want them saying there is nothing that can be done. The Healing ARC removes that argument. It enables effective tools.
Are you surprised that a Medscape poll found that only 22% of all physicians see racial disparities in how patients are treated?
I am surprised it was 22%. I remember a poll of white medical students awhile back about 50% thought that Black patients perceived pain differently than White people because they have thicker skin. What does that tell you? These were educated students on their way to becoming doctors. The Medscape poll is a testament to the level of bias in the medical field and the amount of work that needs to be done to fix it.
Are you optimistic that race-conscious interventions, like those inspired by The Healing ARC, can help dismantle structural racism?
Yes, I am extremely optimistic. I recently led a workshop for family medicine physicians, students, and residents. There was hope in the room. A lot of them were young, White doctors, physicians-to-be. Interestingly, the leadership was of an older generation and White men. But I give them a lot of credit to sit back and listen when I made them uncomfortable with talk about structural racism. But the young doctors gave me hope. They were saying this exists and this is wrong. It showed that they are aware of the environment they are stepping into.
What can individual physicians do about structural racism?
Listen and learn. Ask yourself the questions. If you are in a position of power and someone is coming to you to talk about these issues, create a safe space. Create psychological safety for people to come see you, to tell you this is existing. Create a safe space for your patients to tell you that they feel uncomfortable with you or what is happening. Ask yourself, ‘Does racism operate here?’ And then do something about it. Help dismantle the structural racism that exists in our institutions. Be a part of the solution.
What can hospital administrators do to eliminate racism in their systems?
They need to ask themselves what are they doing to perpetuate it? Hospital administrators need to look at who is in their C-suite. Who is in power? Are they being inclusive in terms of people who advocate for equity, people who will be change-makers in an institution? How are they promoting physicians of color? Is the hospital administration setting minoritized physicians up for success? Are there pipelines for their advancement? How are they intentional with their work? How are you dealing with racism as an individual? The good hospital administrator today must be comfortable with being uncomfortable with issues about racism. And they must look in the mirror and ask, ‘Am I actually contributing to racism in medicine as an administrator, as an institution, as a person in power?’ This is what really needs to happen in hospitals in Massachusetts and around the country. The Healing ARC campaign is providing a platform for these questions to be asked.
Can racism be rooted out of the healthcare system in America?
Yes, but first we must acknowledge it exists. That is a first step, right? Acknowledge it. Cities and communities around the country are declaring that racism is a public health crisis. These narratives are really, really important. Once you name it, you can start to change it. We have had racism for 400 years in this country. That is what the country was built on. It has permeated into an array of institutions. Do I think we are moving the right direction? Yes. Because people are coming out and saying, ‘This happens to me, this is happening to me,’ With technology and social media, people are seeing the things that are happening. The Black & Brown patients at Brigham and Women’s Hospital in Boston that were not being admitted equally to the cardiology unit. Thanks to courageous professionals, like Drs. Michelle Morse, Bram Wispelwey, Michael Wilson, Regan Marsh and a whole team of folks, that is being directly challenged. They documented the structural racism in a study and developed The Healing ARC to address it. People know about the structural racism at the hospital; the hospital has acknowledged it and now The Healing ARC is fixing it. The bigger point is people are not ignoring racism anymore. Right? I hope that we can really, truly see racism uprooted in my lifetime. I am cautiously optimistic. We need to invest more into race-conscious interventions that are highly effective at rooting out racism.
How does racism in healthcare get eliminated?
Like we said, first it must be acknowledged. And that is what is happening. We are getting a broad range of people from the medical field to public officials to community and civic leaders, to see it and believe it. Then the next step is what The Healing ARC is doing: Giving people tools to fix it. The tools are a critical piece of the equation. People need to know what they can do to eliminate the racism in the medical field. And based on this new knowledge, we need to change curriculums, change the way doctors are trained, and make changes to the race and gender of the people in power, so the governing bodies can be more inclusive.