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- Page navigation anchor for RE: CMAJ and antiracismRE: CMAJ and antiracism
Dear Editor,
I was pleased to read the CMAJ’s commitment to ‘reduce both racism in the health space and the effects of racism on health’.(1) I share these important goals.
The author goes on to write that the ‘CMAJ’s existing editorial team will receive unconscious bias training…’.(1) Certainly, unconscious bias training (UBT) can take many forms with some far less ideological than others. However, to my knowledge, there is little evidence that UBT changes behaviour in the long term. Notably, the Government of the United Kingdom, in December 2020, announced that UBT will be ‘phased out in the Civil Service’.(2) This statement went further, and it was written ‘We encourage other public sector employers to do likewise’.(2)
To the best extent possible, I would hope that the CMAJ editorial team follows an evidence based approach to these matters. For example, how will the editorial team measure existing levels of unconscious bias so that the efficacy of training can be evaluated? Certainly, not with the Implicit Association Test.
There may be superior strategies to unconscious bias training.(3) I urge the CMAJ to lead the way by adopting effective policies on the basis of careful consideration, not following hasty and fashionable choices lacking in evidence of efficacy.
Sincerely,
Rolf Gronas, MD
Competing Interests: None declared.References
- 1. Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- 2. https://www.gov.uk/government/news/written-ministerial-statement-on-unconscious-bias-training)
- 3. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/944431/20-12-14_UBT_BIT_report.pdf
- Page navigation anchor for RE: Tackling Racism editorial Dr PatrickRE: Tackling Racism editorial Dr Patrick
The May Print 2021 CMAJ editorial was excellent. The topic of systemic racism is a difficult one particularly because many in our society believe that it does not exist, including amongst some in our medical profession.
Continued education and discussion is essential. Sometimes this then leads to painful dialogue, when parties just can’t agree. I have been involved in such discussions and it can be frustrating, but we carry on. Systemic racism exists.Hillel M. Finestone,
MDCM, FRCPC (PM&R),
Physiatrist, Bruyere.
Professor, University of Ottawa.Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Page navigation anchor for RE: Tackling racism at CMAJ - Dr Kirsten PatrickRE: Tackling racism at CMAJ - Dr Kirsten Patrick
Dear Dr Patrick,
I was dismayed and, quite frankly, insulted by your recent editorial in which you state categorically that systemic racism exists in the Canadian Health Care system. I have practiced as an ENT Surgeon in BC for 33 years (now retired) and can only think you must live in a different country from me. Part of my work was conducting a travelling clinic every six weeks to Fort St John. As middle ear disease in particular was common amongst First Nations people I had a lot to do with treating local First Nations patients. In my experience the local doctors, the hospital staff (including clinic staff, operating room, ward staff and the busy social workers) and everyone who dealt with the First Nations patients were, if anything, more caring, careful and attentive than with non First Nations patients. I have literally never witnessed the racism you refer to and challenge your statement that it it not only exists but exists systemically. That statement implies that our medical system is engineered around policies and practices that incorporate racism into its very fabric.
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I am not for one minute implying that racism does not exist in Canada but I am saying racism exists in every country in the world (in fact in every society) and is as prevalent in Asian, East Indian and African countries as it is in Canada. It is, sadly, part of the human condition. So, before you belittle Canada any further, please point out a country where some degree of racism does...Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Page navigation anchor for Author's apologyAuthor's apology
I’d like to apologise for an important omission in my editorial of 29 March 2021 on tackling antiracism at CMAJ. (1) At the end of the piece I thank people “who have already pointed out structural racism at CMAJ and have patiently taken the time to educate me” but I chose not to name or explicitly acknowledge anyone. In so doing, I did what many white would-be allies do: I made invisible the labour and courage of racialized people and organisations who’ve worked hard to raise awareness of structural racism and to advocate for change. As has happened many times before, some among them had to take the time to explain this to me. And so, my journey of learning continues. (2)
Dr. Janet Smylie, Dr OmiSoore Dryden and Dr. Onye Nnorom have spent much time informing my understanding of how lack of meaningful diversity among editors, statisticians and others who make publication decisions at CMAJ affects both what is submitted to the journal and what CMAJ publishes. Drs Smylie, Nnorom and Dryden have all emphasized the importance of acknowledging that observed differences in health outcomes are less related to race than to experiences of colonialism and racism. Dr Dryden offered the suggestion of hiring an editor with expertise in critical race theory, emphasizing – using an example of an article the CMAJ team chose to publish - that appropriate recognition of the expertise of such an editor would mean that they would be actively supported to challenge and override the uncon...
Show MoreCompeting Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Patrick, K. Let statements of solidarity on social media not be the end of allyship. CMAJ Blogs, 2020 https://cmajblogs.com/let-statements-of-solidarity-on-social-media-not-be-the-end-of-allyship/ [Accessed 27 April 2021]
- Page navigation anchor for RE: Racism, as a health, public health, and health care issue in CanadaRE: Racism, as a health, public health, and health care issue in Canada
Racism, as a health, public health, and health care issue has received important attention from CMAJ. This lead need to build momentum to medical education foundational changes and specifically, priority for medical education must be building an anti-racist, structural competency skill set of our future clinicians in Canada. Canada’s current model of training and delivering health care fails either to show an understanding of or to address the subset of health determinants that affect our patient and their overall health and wellbeing. Furthermore, Canadian Medical Association (CMA) reminded all of us that the profession of medicine is grounded in respect for all people. This commitment recognizes that everyone has equal and inherent worth, the right to be valued and respected, and the right to be treated with dignity (1).
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Medical schools across Canada serve the educational needs of thousands of students, advancing the full spectrum of clinical knowledge. These institutions are at the forefront of the fight against SARS-CoV-2.In addition, they all do commendable innovative research and development work including the clinical trials on treatments, keeping their communities informed, and treating patients at academic medical centers (2, 3). Is this enough? Today our society expects physicians to live up to standards of professionalism, deliver clinically efficient, timely care with integrity, while promoting the public good (3). “Nobility in medicine is not obsolete;...Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- (1). President- Canadian Medical Association- CMA Statement on Racism- https://www.cma.ca/news-releases-and-statements/cma-statement-racism (2). Canadian Public Health Association (CPHA)-Racism and Public Health-https://www.cpha.ca/racism-and-public-heal
- (3). Cruess RL, Cruess SR. Expectations and obligations: professionalism and medicine’s social contract with society. Perspect Biol Med 2008;51:579-598.
- (4). Yancy CW. Academic Medicine and Black Lives Matter: Time for Deep Listening. JAMA. 2020;324(5):435–436. doi:10.1001/jama.2020.12532.
- (5). Fihn SD. COVID-19-Back to the Future. JAMA Intern Med. 2020;10.1001/jamainternmed.2020.2498. doi:10.1001/jamainternmed.2020.2498.
- Page navigation anchor for RE: the disease of racism denial in healthcareRE: the disease of racism denial in healthcare
Dr. Kirsten Patrick disclosed, in her editorial, some resistance to the journal's most recent antiracism agenda.
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In 1998, in this same journal, Dr. William Goldberg wrote about the time when his own prejudice was pointed out to him. The occurrence surprised and affected him profoundly, but also helped him better comprehend the humanistic side of medicine. This happened in 1952, a time when society recognized the existence of racism, but race-blindness was advocated for addressing it.
Nowadays, Cognitive Psychology has helped experts decipher how cognitive biases condition professionals’ clinical reasoning, and has been shaping new perspectives on how racism should be confronted. But almost 70 years after Dr.Goldberg first understood how racial prejudice affects one’s care, some people continue to deny the existence of any racial injustice in the field. This negation, though, is not restricted to Canada.
Recently, JAMA released a podcast followed by the tweet: “No physician is racist, so how can there be structural racism in health care?”. (https://www.change.org/p/jama-editorial-board-ask-jama-top-medical-journ...). The podcast and the tweeted statement were not well received by many members of the community and were withdrawn. (https://jamanetw...Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- W. M. Goldberg CMAJ October 20, 1998 159 (8) 917-918.
- Kübler-Ross, Elisabeth. On Death and Dying. United Kingdom, Scribner, 1997.
- Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet. 2017 Jul 22;390(10092):415-423.
- Page navigation anchor for RE: CMAJ and antiracismRE: CMAJ and antiracism
The first paragraph of this editorial points to an essential problem in attempting to counter the issues surrounding racism. While clearly there is a lot of published evidence supporting the idea that racism exists in systemic form in so many areas of our society, I see little acknowledgement that the root of it exists within each person in society at several levels, including the unconscious ones. To provide an example: I consider myself not to be racially biased; I am a white, middle class, retired surgeon. Yet in the wake of the recent attention paid to race/anti-race issues, I have become more aware of views I have that are based in prejudice, such as when I note that certain 'racialised' persons seem to be attracted to certain occupations. This still does not interfere with any interactions I may have with racialised persons, at least in my own opinion.
My point in all this is that each individual needs to be or become aware of his/her attitudes toward this question deeply within their own consciousness and unconsciousness. This is in addition to the collective effort to deal with racial issues. It is NOT either/or. It is both/and. Without this total or whole attitude to the problem, no solution will be found.Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Page navigation anchor for RE: CMAJ March 29, 2021 193(13)E454; CMAJ and antiracismRE: CMAJ March 29, 2021 193(13)E454; CMAJ and antiracism
Dear Editor,
I was heartened to see your editorial on CMAJ and antiracism and challenging your readers' about their beliefs about the existence of systemic racism in the Canadian Health Care System. I am glad that you are being proactive to address by hiring and appointing an appropriate member on your team and on your Advisory Board. I like to narrate my recent experience with the Canadian Blood Services (CBS) to illustrate racism in health care and how difficult it is to address.
Turns of unforeseen events in December 2018 led me to the CBS website and I noticed a complete lack of diversity on their board and executive management team. The CBS is a nonprofit, charitable business corporation, funded by Canadian taxpayers with an annual budget of over a billion-dollar. The ministers of health of all territories and provinces except Quebec are the Corporate Board Members and appoint their designates as board members. I brought my concerns to their board, management and their corporate board members in form of several emails. While I was told they share my concern, no concrete policy was formulated to rectify the situation. Hence I decided to mobilize public opinion. I collected over 1000+ signatures including supporting letters from the politicians and the mayors endorsing diversity and equity on board and executive management team. The struggle lasted over two years. Finally, in November of 2020, Dr. Graham Sher, Chief Executive, CBS acknowledged the exi...
Show MoreCompeting Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Page navigation anchor for RE: editorial article on CMAJ and antiracismRE: editorial article on CMAJ and antiracism
Thank you so much for this article. I was born in Haiti and graduated from medicine at the Universite de Montreal in 1993. I am currently the inaugural faculty lead for Black and Indigenous resident application and mentorship at the DOM at the University of Toronto. I have experienced structural racism through the education system which made me doubt my capacity and sought to exclude me from the class room while in high school. I succeeded in being admitted to medical school after 3 applications over the course of 6 years and was submitted to interview questions that were designed to favor the ruling majority. I excelled in medical school but did not get recognition for my performance which led me to seek acceptance abroad. I am currently a staff internist and geriatrician at Sunnybrook Health Sciences in Toronto and I witness encouraging signs towards more inclusion, equity and diversity in medical education and research as well as leadership in academia at the University of Toronto. Your call for bold anti-racism in medical education and at the CMAJ editorial board is music to my ears!
Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Page navigation anchor for RE: To act or not to actRE: To act or not to act
Being antiracist comes at a cost.
As Dr. Patrick outlined, using CMAJ as a platform for antiracist research was met with criticism. Similarly, medical learners can also face resistance standing up for ourselves.
When a patient asked me if I eat bats, I ignored it. When I was assaulted and robbed by perpetrators targeting Asians, I shrugged off the correlation to race. When I got workplace comments on how I’m tall for a Chinese guy, I laughed with the rest of them. Should I have advocated more for myself? Should I have fought back? We are taught that racism is a significant determinant of health, but I still fear recourse should I call it out. My desire to remain an impartial professional and team player are at odds with the voice in my head thinking ‘that’s not right’. As the Author outlined, many are still hesitant to acknowledge the power of systemic racism – and I don’t know who they may be. Medical clerks are evaluated on subjective measures with great impact on our future careers. How can we advocate for racial justice when our own evaluator infringes on those rights? Wondering if we’ll elicit endorsement or eye-rolls? Being labelled a problem student is a potential cost of being antiracist as a trainee – risk that is tough to swallow this early in my career.
To those in positions of power– role modeling antiracism makes an immeasurable difference to learners fighting against the current of traditional medical culture. It takes any guesswork aw...
Show MoreCompeting Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.
- Sharda S, Dhara A, Alam F. Not neutral: reimagining antiracism as a professional competence. CMAJ. 2021 Jan 18;193(3):E101-2.
- Page navigation anchor for RE: CMAJ and antiracismRE: CMAJ and antiracism
Thank you for the passionate editorial. At an individual level, if one person makes comments about another person regarding their ethnicity, whether it is positive or negative, is identifying an external quality as being important. When the comment is negative, it is deemed 'racist', and rightfully so. We, as a society, must encourage people to value people beyond their external appearances.
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Systemic racism is a belief that racism exists in larger institutions and organizations, inherent to the population as a whole. Your position on this issue is that "systemic racism exists in Canadian society and within its health care systems". I challenge you to produce a current document that promotes racism as an institution or organization. Is there a policy that specifically 'gives privilege' to one group over another? You idenitfy 'Caucasian' people as being elevated above 'Black' and 'Indigenous' race groups - please produce an existing policy or document that elevates 'Caucasian' medical students and professionals above other races. You are using ideas from the popular ideology of 'Critical Race Theory'. Such theory is inherently racist, as it seeks to divide people by their ethnicity. Furthermore, you references articles that imply "Scholars in the social sciences have generated evidence of the effects of racist policies for more than a century" - social sciences observations are no...Competing Interests: None declared.References
- Kirsten Patrick. CMAJ and antiracism. CMAJ 2021;193:E453-E454.