See no evil, hear no evil, speak no evil no more: discrimination in medicine and medical education can no longer be ignored

Journal of Psychiatry Reform vol. 10 #12, November-December 2023


Mariam Abdurrahman, MD, MSc, FRCPC1, and Ana Hategan, MD, FRCPC2,iD

Author Information

1   Assistant Professor, Chief of Psychiatry, Unity Health Toronto – St. Joseph’s Health Centre, Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada. [email protected]

2  Clinical Professor, Geriatric Psychiatrist, Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. [email protected]. iD:

Physicians have a mandate to protect the professional integrity of medicine and promote safe care, thus structural competence is critical to the professional identity.  Without recognizing the issues of equity, diversity and inclusion (EDI) that chronicle the patient’s course, physicians cannot truly be effective healthcare providers, nor will they be able to identify the same equity disparities as they affect their colleagues from equity-deprived groups. In this vein, healthcare leaders need to listen to and examine the experiences of physicians at all levels (i.e., medical students, residents and practicing physicians) in the context of EDI, including the issue of burnout in relation to physicians who experience othering (discrimination and exclusion). It takes the premise that physicians who are not attuned to EDI-related matters cannot deliver on health equity.

Literature has explored the implications of being benignly unaware of the impact of othering and being othered with respect to the ability to effectively deliver patient-centred care [1]. The concept of loud silence is evident in today’s social justice discourse as there are still so many EDI topics that cannot be read or said aloud “for fear, for shame, for keeping the peace” [1]. Fostering conversations and hope about the EDI elephant in the room remains an open invitation for “those unable to tell that story but who know it well, and will someday read it out loud” [1].

However, shifting towards structural competence (which applies an understanding of structural inequities and social determinants including race to clinical care [2]) and integrity requires close examination of the organizing structures of medical science and practice [3]. Transformative shifts like these require organization-wide engagement with clear evidence of action plans within the leadership ranks. Building an inclusive medical culture that values equity, diversity and fosters a sense of belonging requires a medical community invested in advancing health equity from within. Common barriers to promoting EDI include unconscious bias, representational bias, and privilege [1]. With these challenges at the forefront, clinicians and healthcare leaders need a range of useful resources and tools at hand to help eliminate biases and promote EDI in healthcare settings.

As the old adage goes, charity begins at home, thus we cannot expect to leverage that charity to patients and interprofessional peers without our home being in order. We invite our peers and the profession to begin examining the many ways we can start to chart a course of hope and inclusivity in the profession, and beyond.


  1. Abdurrahman M, Hategan A, Giroux C. (Eds.) Gasping for Air and Grasping Air in Medicine: Equity, Diversity, and Inclusion on the Medical Frontlines. UK: Ethics International Press; 2023.
  2. Hansen H, Metzl JM. New medicine for the U.S. health care system: training physicians for structural interventions. Acad Med. 2017;92(3):279-81. doi: 10.1097/ACM.0000000000001542. PMID: 28079725; PMCID: PMC5540156.
  3. Sabin JA. Tackling implicit bias in health care. N Engl J Med. 2022;387(2):105-7. doi: 10.1056/NEJMp2201180. PMID: 35801989; PMCID: PMC10332478.
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