Medical Examiner

Northam’s Yearbook Photo Reveals Medicine’s Broader Biases

I was a Black medical student in the 1980s. The Virginia governor’s photo exposes the bigger issue we need to address.

Hospital hallway
Photo illustration by Slate. Photo by urfinguss/iStock/Getty Images Plus.

When I showed my husband the racist photos from Virginia Gov. Ralph Northam’s medical school, he responded with a question, his voice filled with disgust.

“Can you imagine being the Black classmate of this guy, or one of his patients?”

I can do more than imagine.

I attended medical school in the 1980s. I was one of 10 Black people in a class of well over 100 students. My alma mater was founded in 1810. To date, it has awarded 350 Black people with a medical degree.

Seeing the photo of a pair of students in blackface and a KKK outfit flooded me with emotions: anger, shame, hurt, and pain. The image wasn’t what hurt the most. The silence from organized medicine and our nation’s medical schools is what has been jarring. I, along with many Americans, wonder how Eastern Virginia Medical School allowed this type of behavior to go largely unchallenged and unpunished. (To its credit, EVMS banned yearbooks in 2014 and recently announced the formation of a Community Advisory Board.)

As a medical student, I didn’t experience this specific type of bizarre harassment-via-costume, but almost daily there were slights. I was invited to few parties by my classmates. Much of my time was spent studying. I worried a lot about paying for school. I worked part-time in the medical school library until I got into a verbal fight with a White boy, who refused to pay his overdue book fine and told me I didn’t know what a dissertation was.

One of my professors made a wisecrack equating Bridgeport, Connecticut, with a “Third World” country; with a wide grin he minimized, marginalized, and diminished an entire city. He made no mention of the substandard housing, high asthma rates, or the substantial health care disparities affecting Bridgeport. My White classmates laughed. I was a daughter of 1970s Brooklyn, and although my education made me a part of the “privileged” poor, I felt an allegiance to Black and Brown communities. In college, I had been a student activist. But medical school was a different beast—it was harder, the stakes were higher, the connections were essential. I put my head down. He was my teacher, and these were my future colleagues.

I spent the third and fourth year of medical school, the clinical training years, at one of the premier teaching hospitals in the country, in one of the poorest cities in the United States. I was eager to learn, but my enthusiasm was trampled when the staff mistook me for the ward clerk or housekeeper. I was fastidious about my attire and grooming. Still, one doctor told me my braids were unprofessional.

I learned how to draw blood, thread IV catheter lines, and deliver babies by practicing on impoverished Black and Brown clinic patients. Unlike my peers, I referred to my patients by their last name. I wasn’t going to be caught dead calling a woman who could be my grandmother by her first name. The nature of this practice—of having predominantly White, privileged students learning how to perform medical exams and procedures on Black and Brown bodies—proved fertile ground for the unleashing of deeply held biases.

The crack epidemic was in full force. There was little sympathy for the victims of this disease.
My chief residents called them dirtbags and made seemingly arbitrary decisions to withhold pain medication. One doctor referred to Black nurses as “dirty Haitians.”

My OB-GYN rotation was particularly cruel. Many of my patients were teens. Some spoke no English. Most were in pain. One woman would be admonished for birthing yet another baby while a woman in the adjacent bed was scolded for having had several abortions. I thought of my own mother, an uneducated West Indian immigrant, who had told me her story of having to fend off White doctors eager to perform a hysterectomy, a common mode of sterilization used in communities of color during the late ’60s and early ’70s.

To complicate matters, I was being evaluated by a medical hierarchy that was composed of these very same colleagues—interns, residents, attendings—who either held Black people in quiet disregard or openly despised us. Despite our fears, a group of Black students, with the support of one of our deans, met with the heads of every clinical department. We described our experiences on the hospital wards, and our worries that Black patients were not only being misdiagnosed but were potentially being harmed by the racist attitudes and behavior of the medical staff. We raised concerns about the lack of Black faculty and mentoring opportunities. One chairman turned and waved his hands dismissively, telling us that even though he and his colleagues were all White men, they were still a diverse group. Another doctor asked, “Are you concerned about all patients or only Black patients?”

The institutionalized racism in medical education has created a medical system in which only 6 percent of practicing physicians in the United States are Black. This, in turn, has exacerbated the shortage of primary care physicians and specialists who are willing and able to serve in high-need communities. We desperately need Black physicians to combat addiction, maternal/fetal mortality, diabetes, and hypertension in the Black community.

I believe that the vast majority of my clinic patients were not privy to the comments and jokes my superiors were making about them. Ralph Northam’s patients may have never experienced anything untoward from him, either. Does that mean it doesn’t matter? I don’t think so. The doctor/patient relationship is built on a foundation of trust and mutual respect. Northam has shown his violation of that trust. This is not about a photo, it is about the profound impact these actions have on the public, one that depends on us to heal and serve.

It is this distrust of the medical establishment that perpetuates the fears many Blacks feel about going to the doctor. Many of us who believe in health care equity still practice medicine in the shadows of these jokes and racist behaviors. We watch these communities suffer worse health care outcomes. And then we watch as blatant racism is uncovered in the yearbook of an institution meant to teach the next generation of doctors, and we wonder why so many people are surprised.

Northam should resign. But we still need to realize the change that must happen within these institutions that are tasked with providing health care for all of our people.

We must demand policies and programs that reduce health disparities, promote disease prevention, and foster inclusive work environments for underrepresented racial minorities in medicine. We don’t need empty apologies. We need measurable and meaningful change.