Bethany T. Samuelson Bannow, MD, MCR
Assistant professor of medicine at Oregon Health & Science University in Portland, Oregon.
The week I sat down to write this editorial, I found myself feeling unexpectedly reflective over a seemingly banal topic. Actress Christina Applegate received a star on the Hollywood Walk of Fame. The images of her standing and sitting with a walking stick (she suffers from multiple sclerosis) struck a chord with me. This undoubtedly was of little notice to Hollywood or the general population, but to me, as a disabled person, it was a powerful moment of representation.
As we have heard repeatedly – and are hopefully beginning to understand – representation matters. In medicine, it is incredibly valuable for trainees to see faculty and attending physicians who “look like” them, whether based on gender, race, ethnicity, or some other outwardly apparent characteristic. Greater diversity among medical school faculty has been clearly associated with greater diversity among medical students with respect to race, ethnicity, and gender.1
We still have a long way to go with improving racial and ethnic diversity in medicine, and there are many other aspects of diversity that have not been well-studied or addressed and which are often entirely unrecognized by all but those who experience them. None of us falls into only one identity category. We all have intersectional identities that are a mix of distinctive characteristics, backgrounds, and experiences. Each identity aspect is, in turn, associated with some degree of privilege or disadvantage, making it either easier or harder for us to function and fit in with the world around us.
Flávio Azevedo, PhD, of the National Aeronautics and Space Administration, has done some fascinating work in this field.2 His “Academic Wheel of Privilege” comprises 20 features associated with privilege or disadvantage. Tools like this can help us think through our own lives and experiences and recognize what aspects of our identities may lend us unrecognized privilege or result in disadvantages. I won’t go through all 20 identity aspects here, but I will touch on a few that have affected my own experiences. I encourage you to go through the same process yourself.
First, and perhaps most obviously, I am white, of Northern European descent. I will probably never know how much privilege this aspect of identity has afforded me as I go through most days without even thinking about the color of my skin. I am free to go pretty much wherever I want without fear of physical or psychological danger due to my skin color. The vast majority of people around me look like me and have shared experiences with me.
Second, I am a woman. This means I have been – and will likely continue to be – paid less than men doing the same work (83 cents on the dollar in 2020).3 It means I am less likely to gain academic promotions compared to male colleagues4 and that I have experienced – and am likely to continue to experience – disrespect in the form of untitling,5 role incredulity,6 and sexual harassment.7 Statistically, it means I am likely to shoulder the larger share of child care and domestic tasks.8
Third, I am cisgender and heterosexual. When I got married, no one questioned the legitimacy or legality of my marriage to my cis-male heterosexual husband. I have never been mis-gendered or had a patient refuse to see me because my “lifestyle” was not compatible with their religion or morality.
Finally, on the topic that led to this whole discussion, I am physically disabled. I require a mobility device. I was not always disabled, so the differences are readily apparent to me. Every physical activity (including walking from the car into a building) requires more thought, preparation, and energy than it did before. I must worry about being stranded somewhere if there is no way out other than walking a long distance. I can no longer meet expectations at academic conferences that require quickly walking between conference rooms and hotels. I have to choose between asking for accommodations and feeling like a burden, forcing myself to do things others assume I should be able to do (and potentially paying for it with an injury), or simply not participating in roles and activities I value.
All our identities, regardless of privilege or disadvantage, are an intersection of many components that make us and our experiences unique. We, as a society, are slowly becoming more aware of the importance of recognizing our privileges and making meaningful, systemic changes to improve equity. To find common ground and increase empathy, it can be helpful to reflect on the barriers we have had to overcome as a result of aspects of our identity. My personal experience with disability has been incredibly eye opening and helped me understand the value of seeing people who “look like” me in positions of power or recognition.
As we usher in 2023, may we all benefit from reflecting on where we have come from, where we are going, and how we may encourage our beautifully complex, intersectional companions along the way.
Bethany T. Samuelson Bannow, MD, MCR
Associate Editor
References
- Yu AYL, Iwai Y, Thomas SM, Beasley GM, Sudan R, Fayanju OM. Trends in racial, ethnic, and sex representation among surgical faculty members and medical students in the US, 2011-2020. JAMA Surg. 2021;156(12):1177-1179.
- Kim SS. Dr. Flavio Azevedo. Published July 25, 2022. Accessed November 21, 2022. https://science.nasa.gov/open-science/transform-to-open-science/stories/dr-flavio-azevedo.
- Shrider E KM, Chen F, Semega J. Income and Poverty in the United States: 2020. Washington, D.C.: U.S. Census Bureau; Sept. 14, 2021.
- Richter KP, Clark L, Wick JA, et al. Women physicians and promotion in academic medicine. N Engl J Med. 2020;383(22):2148-2157.
- Harvey JA, Butterfield RJ, Ochoa SA, Yang YW. Patient use of physicians’ first (given) name in direct patient electronic messaging. JAMA Netw Open. 2022;5(10):e2234880.
- Diehl A, Dzubinski LM. When people assume you’re not in charge because you’re a woman. Harvard Business Review. December 22, 2021. Accessed November 21, 2022. https://hbr.org/2021/12/when-people-assume-youre-not-in-charge-because-youre-a-woman.
- Bagenal J, Baxter N. Sexual misconduct in medicine must end. Lancet. 2022;399(10329):1030-1032.
- Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-53.
The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.
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