Review of “Gasping for Air and Grasping Air in Medicine: Equity, Diversity, and Inclusion on the Medical Frontlines,” Edited by Mariam Abdurrahman, Ana Hategan, and Caroline Giroux.
- Posted by Editor JPR
- Posted in Book Reviews, Editorials & Commentary
Journal of Psychiatry Reform vol. 11 #3, March 2024
James A. Bourgeois, O.D., M.D.
Author Information
Vice Chair, Hospital Psychiatry Services, Professor of Clinical Psychiatry, Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA, USA. [email protected].
The editors of the book Gasping for Air and Grasping Air in Medicine: Equity, Diversity, and Inclusion on the Medical Frontlines [1] have assembled a multidisciplinary team (though most writers are physicians) in a timely and surprisingly wide-reaching volume that addresses the current imperative to promote diversity, equity, and inclusion (DEI) in medicine and healthcare more generally, and academic medicine more specifically. The editors take the premise that the institution of medicine, though nobly conceived with expressed high ideals, nonetheless has its own troubling history of discriminatory practices towards racial, ethnic, and gender minorities both in its research endeavors (they cite, though in greater detail than most other accounts, the Tuskegee syphilis study, as well as racialized models of illness that can be more reasonably attributed to social factors leading to illness in affected groups). They use this history both as fact (in that medicine must own its mistakes honestly and endeavor not to repeat them) and as metaphor for the residual racism and gender discrimination in medicine and currently practiced and taught.
As with all meaningful change, “the first step is insight”, i.e., honest acknowledgement of both historical practices and the discriminatory stances that led to them, as opposed to merely assigning these abominable practices to “being in the past.” Once embracing this insight, institutions and, more importantly, academic physicians currently in place, need to make contemporary, deliberate, and restorative practices in compensation so as to practice more inclusively and welcomingly. As the chapter authors illustrate, merely meeting “DEI quotas” by inclusion of a wide range of representative groups who were previously ill-represented in medicine, though needed, is not enough.
Academic leaders should search their own experience, and look for specific techniques to take a more inclusive stance toward all learners. In a pleasing, and serendipitous, juxtapose, a cogent example of this approach is to search one’s own lexicon to both eliminate harmful (even if benignly intended) “microaggressions,” while consciously and purposefully practicing “microaffirmations” in individual encounters with learners. The chapter authors offer numerous other helpful approaches; this is particularly welcome, as sometimes writing on this topic is experienced as broadly critical of current leaders as “privileged” and “entitled,” without offering them pragmatic and likely useful scripts to take a positive and inclusive stance towards all learners (positive reinforcement is a better pedagogic technique in any case), perhaps more sensitively targeted towards students from underprivileged backgrounds.
The editors thoughtfully include detailed discussion of gender/sexual minorities and, most notably, disabled medical students and physicians. As the book reminds us (and we do need reminding, in our excessively perfectionistic medical enterprise) that those of us fortunate to enjoy good health are in a state of “temporary ableism” that could be threatened at any time. Yes, this is unpleasant, but as more of us continue working into our later years (myself included) to keep the “medical system ship afloat,” this issue is essential to acknowledge, and to develop emphatically supportive systems for those with physical limitations. As such, their inclusion of detailed discussion of disabled physicians (and students) needing empathic acceptance, while needed accommodations and work-arounds are provided to them, is particularly timely.
This topic, while politically provocative to many and subject to at times rancorous debate, is critical, far beyond the pedagogy of all (more included) student groups. In western societies at least (and, I suspect, worldwide), the toxic stressors on the national medical systems are causing our overburdened care delivery systems to collapse under their own weight. The reasons for this are legion; one reason this is important from a DEI perspective is that we must promote every student, every physician, really, and every health care worker, to thrive in an equitable environment of high achievement, clinical skill, valued inclusion, and self-actualization. This is essential because we all need to make our systems work their best, but also, frankly, because it is the right thing to do for everyone involved.
The implications of this book for management of medical systems (beyond the medical educational aspects, which is its major focus) are important to emphasize. In an admirable synthetic twist, the book relates progress in DEI as likely to enhance the popular and well-accepted quadruple aim to improve patient care, enhance clinical outcomes, contain system costs, and to improve the lives of physicians (and implicitly, medical students). Therefore, interventions to improve physician (and medical student) experience are a priori worthy of consideration.
The modern, physician-supportive leader will be especially sensitive to the cultural experience (both historically and currently) of their physicians as they are hired. Concrete steps to employ that are in the spirit of this book include an openness to hire physicians with medical degrees from all over the world (interestingly, the book does not specifically address the experience of international medical graduates per se, so this inclusion is mine in the spirit of promoting DEI still further), to value and compensate those with second- and third-language skills, and offering (to the degree one’s system will support) flexible hours, part-time employment, working from home via telemedicine, more control over one’s clinical duties, and inclusion in shared, as opposed to autocratic, administrative decision making.
If the various approaches championed by this book are widely implemented, there is reason to be hopeful that we can all endeavor to produce a medical (and medical educational) system that is more inclusive, representative of the broader society, and a more humane place for all of our patients. We must recall always that it is all about the patients and their needs, not ours.
REFERENCES
- 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. https://ethicspress.com/products/gasping-for-air-and-grasping-air-in-medicine
