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A Different Shade of Black

Ask any medical student what makes them unique among their peers, and you’ll almost certainly be treated to a two-minute answer that’s been rehearsed in countless mock interviews and essays as part of their preparations for residency applications.

It’s ingrained in the collective medical-student brain that to be recognized, we must stand out–constantly looking for opportunities to demonstrate our unparalleled competence. As we all strive to distinguish ourselves from one another, we end up acting so similarly that it reinforces the stereotype about medicine’s toxic hyper-competitiveness. Given this situation, what actually determines whether a student is truly “different”?

In my case, I feel a profound difference that stems from my experience of growing up as the child of Nigerian immigrants.

The US census identifies me as African-American, and the Association of American Medical Colleges identifies me as underrepresented in medicine. But I grew up in a community in which many doctors had dark skin like mine; the Nigerian community was strong and numerous enough to afford me that privilege.

I have learned that African immigrants’ relationship to medicine differs drastically from that of Black Americans. I grew up viewing doctors as revered and respected healers, members of a medical system that I was raised to admire. But in the five years that I’ve been training to be a doctor, my views have undergone a profound and painful change.

In the Bronx, where I’ve been training, I have seen both patients and clinicians of color suffer from racism within the medical system–being ignored, undertreated or completely abused. For instance, I’ve seen a Black woman with arterial insufficiency be denied pain medications, because staff believed that she was seeking opioids. Conversely, I’ve seen a patient’s mother request a different resident because she didn’t feel comfortable having a Black resident give her child medical care.

Although many medical students and doctors acknowledge the existence of systemic racism and do what they can to address it, few of us can escape its pervasive and painful effects. Racial underrepresentation is pervasive in medicine, but economic barriers prevent many Black scholars from pursuing a medical career—and those in the field consistently report being treated differently than their white counterparts during training. Predominantly Black or Latino neighborhoods with lower average socioeconomic status are often medically underserved.

Black people have fought an uphill battle for so long that many have stop voicing any complaints. But every police shooting of an unarmed Black man is a reminder that no matter how law-abiding I am, or how much I smile, some people may automatically see me as a threat, solely due to the color of my skin.

In this, my experience is the same as that of my Black patients. Even so, when my Black patients congratulate me for making it this far in medicine, their praise feels foreign to me, because it highlights the disparity between our backgrounds. Growing up, I always felt encouraged by seeing role models who looked like me, but I know that many of my patients have never before met a Black doctor of any kind, let alone a Black psychiatrist.

Granted, my personal background does not protect me from the pervasive hurts of racial bias. For instance, during my own medical checkups at outpatient clinics, the clinicians will often comment on my increased risk of high blood pressure, diabetes and kidney disease; or during triage a white nurse might say, “You must smoke weed, right? I can smell it on you,” despite my not having been anywhere near cannabis.

Sometimes, during these visits, I’ve listened politely as a clinician, apparently assuming that I’m not intelligent enough to understand, oversimplifies medical concepts that I’m well-versed in. When I say something that reflects my actual level of understanding or medical education, I’ve noticed that the response is often surprise—followed by closer scrutiny.

Subtle microaggressions like these, although I try to ignore them, take a toll on my psyche that my white peers don’t suffer. And experiences like these have led me to believe that no matter how many credentials I have after my name, my skin color will always be the first thing some people see when they look at me.

A different set of erroneous assumptions comes into play when I’m with other Black people. I’ve found that my skin color creates an expectation that we’ll enjoy a mutual understanding born of shared experience; but it’s an understanding that I don’t always share, due to my Nigerian-American upbringing. For instance, the concept of generational trauma resulting from being descended from slaves was something I didn’t encounter until later in life; at the same time, it feels alienating to be told that I don’t get it “because you know where your roots are.” But I’ve found that adopting an attitude of radical acceptance and willingness to listen to these perspectives has consistently helped me to bridge this cultural divide.

This perplexing mix of experiences can be understood by only a few physicians of color in the country—a group that I hope will continue to grow and thrive. And as a member of this group, I feel a responsibility to provide support to communities of color who were not afforded the privilege of having Black medical providers.

A Nigerian doctor I met during my training told me that he aspires to make every patient’s hospital stay a therapeutic experience, so that they’ll feel comfortable seeking care from any type of doctor when they need it. My experiences have helped me to determine the type of doctor I want to be: one who celebrates everyone’s differences and helps each patient as much as possible, no matter who they are or what their background may be.

Obioesio Bassey, a first-year psychiatry resident at Montefiore Medical Center, graduated from Albert Einstein College of Medicine in 2023. He was raised in Columbus, GA, by two Nigerian immigrants who were the first in their respective families to make the phenomenal journey to the US in search of opportunity. Prior to medical school, he graduated from Georgia Institute of Technology (Georgia Tech) in 2015 with a BS in psychology, and from Georgia State University in 2018 with an MPH with a concentration in epidemiology. His interests include psychiatric epidemiology and health-equity research. “I plan to dedicate my career to providing communities of color with adequate mental-health resources and support.”

Comments

3 thoughts on “A Different Shade of Black”

  1. Brenda Scearcy

    My heart aches, just aches, over all the never-ending pain we cause others because of melanin??? How absurd! And how valuable your thoughts are, calling out the great harm done and the absurdity of it. I hope that slowly, one interaction at a time, one eye-to-eye deep look, one careful listening, and one slow-down to consider what another person’s experience might be, that we build that more compassionate world. I sure hope you’ll keep telling us what it all looks like from your end.

  2. Thank you for this grounded perspective, Dr Bassey.
    I am an Aboriginal doctor in Australia — we are also rare. My skin is fair. I come from the south east of the island, where the British first arrived. I am a product of several generations of white people marrying into our Aboriginal family.
    Skin colour prejudice is still a real and significant aspect of racist exclusion and prejudice in Australia. I have experienced it with friends and family. And racism is more than that here, too. I recognise the shock–it’s almost a flinch, it’s a stiffening– and extra scrutiny from colleagues that you describe.
    It was a relief to me when the concept of microagression was first describe, having felt battered by these all my life.
    Institutionalised assumptions harm and deplete all of us, since the survival and flourishing of Indigenous knowledge and experience are so important to all humans.
    Your connection to Nigeria is a window into a broader understanding of healing and we are all the richer for it.
    Love and respect from one bridge to another.

  3. Tina Castañares MD

    Thank you so much for this wonderful essay. I am half Mexican, half european-American. My Mexican father emigrated to the United States and became a plastic surgeon. I am retired now, but was a family physician and a hospice physician, working chiefly with Latino immigrants and farmworkers for decades. Some of your experiences about incorrect expectations or assumptions — by professional peers and patients alike — regarding your cultural background resonate with me. I appreciate very much your sharing your words.

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