By Dr. Amy Tan, M.D.

"Justice demands integrity. It's to have a moral universenot only know what is right or wrong but to put things in perspective, weigh things. Justice is different from violence and retribution; it requires complex accounting."

- bell hooks

Two toxic workplaces, almost a decade apart. Same person affecteda racialized woman physician but at different stages of her career. Two different provinces, two different institutions, two different chains of command, two different policies and procedures to navigate. Two different decisions about whether to submit a formal complaint for gendered racism (and ageism) for harmful behaviourby different white male physicians. Two different decisions and experiences once initial informal complaints made. Same outcome: no justice, no acknowledgement of the harm endured, no accountability. While I may have made the decisions to leave both of these workplaces, they were not actual choices I had due to the great harm that I endured. I still suffer from the trauma, and physical and psychological ramifications of ongoing injustice that I endured in both of these workplaces. My family has also endured the effects alongside me.

The most recent ordeal dragged on over the last 12 months until I excised myself from the horrendously toxic situation. As Im left picking up the pieces again, doing everything I can to bring down my blood pressure and stress hormone levels, and healing from what was a traumatizing formal complaint process, I cant help but ask, if I truly feel that both experiences have left me with the same outcome of feeling unheard, unseen, unacknowledged, and without justice with regards to my harmful experiences in the workplace with other physicians, then what real options do racialized (Black, Indigenous, Asian, and other Persons of Colour) women and nonbinary persons in medicine have when disrespect, gendered racism and other mistreatment occurs in the workplace? My two complaints were specific to certain male physicians and incidences that crossed the line for me. There have beencountlesscovert and overt racist aggressions Ive endured over the 23 years of training and my career in medicine. I could fill pages with stories of unwanted touching, or of being told to my face that I was a diversity hire, that Asians dont experience racism, so be quiet, that my English is so good, and that my people are responsible for the pandemic because of our disgusting eating habits by colleagues and patients. I have been mistaken innumerable times by patients and staff members to be a member of the housekeeping or food services staff in to collect dinner trays over my entire career. I know that Im not alone in suffering persistent racism throughout my years in medicine. A survey of physicians in Alberta (one of the provinces Ive trained and worked in for many years) that was published last month, showed thatover 75% of cisgender BIPOC women physicians surveyedhad experienced harassment and discrimination. 74% of the small number of physicians who reported such workplace harassment and discrimination were unsatisfied with the outcome due to retaliation or lack of satisfactory outcome. While I didnt complete this survey, these statistics completely resonate with my experiences. Theovertly violent and racist commentspublished in the report by white physicians, our colleagues, shows beyond any possible shadow of a doubt, the truly toxic and racist culture that people like me must endure in our careers.

With over50% of Canadian physiciansreporting burnout two years into the pandemic, I am stating clearly that without addressing the rampant racism experienced by Black, Indigenous, and racialized physicians (most especially women and nonbinary), along with all healthcare workers and patients, there will be no improved wellness for us.Wellness is more than the burnoutthat racialized women and nonbinary physicians are at increased risk for; it includesunderstanding and addressingthe fact that there arephysiological impacts on racialized physicians healthfrom being subjected to ongoing racial injustice in the healthcare system.

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The first time I tried to put in a formal complaint for two white male physicians, who I will call Jeff and Bob, I was told by the Department Chair that I should be warned of how hard a formal complaint process would be for me and my young family. Is this really what you want or need right now, Amy? You know it will simply become a he said, she said situation.

When I pushed back that I had a paper trail for Jeffs years-long mistreatment of me, and that the egregious way in which Bob treated me was witnessed by several other department members, the Chair responded, No, thats not how it works. Then he went on to say, Amy, you have to understand that they feel threatened by you. They see you as a young whippersnapper, 20-30 years younger than them and you make them look bad with how productive you are. What was alluded to in that conversation was that as anAsian woman leader, I was just expected to work so hard but not do it in a way that threatened anyone else. I wasnt to make any waves. I was to just do the work demanded of me and be quiet. I was supposed to know there was an unspoken societal agreement in that my age, identity and productivity would be seen by others as tacit justification of their bullying of me. The Chair would not support my request for a formal complaint; he would sit it out if it came to that.

I resigned and left that position six months after that conversation. I gave up my hard-earned tenure achieved at age 35 at that university after years of enduring this toxicity upheld by so many complicit colleagues, and for which there was no end in sight. It took me several years to process, unpack and undo the belief that I was the problem, as they had made me feel. Truthfully, it wasnt until Jeff had a very public run-in with the law that exposed his true lack of a moral compass, could I even start to believe that maybe I wasnt at fault for having to leave that institution.

Fast forward several years and another leadership position in another province within another institution. My past experiences had taught me a tremendous amount, and put me on the alert for any disrespect. In feminist scholarSara Ahmeds book,Complaint!,she writes, You cant go back to the person you were before the complaint, you cant unsee what you come to see through complaintbeing able to see what is going on, to see more, is also to see what you did not see before (Pg 29). In addition to not being able to unsee gendered racism and disrespect, I now had even more years of experience and expertise under my belt. I was not going to tolerate ongoing gendered racist undermining of my work and leadership 17 years into my career. As part of my ongoing anti-racist and anti-oppressive praxis, I actively call out power differentials and the elephants in the room when I perceive conflict and tensions between groups that must work together in an effort to actively address them and find workable solutions. At this new workplace, I was told at first that they appreciated my ability to call out power dynamics that were affecting working relationships and people's work (which was ultimately the care of patients and families). But they became more resistant to address these concerns as I kept bringing it up. It only took six months of subtle othering and subversion as the only racialized physician (and leader) in this group for a more overt gendered racist attack to occur that challenged my leadership in a public manner. Lets call this white male physician, Bill. It was immediately apparent as the only racialized physician in this group, that no one understood the gendered racist impact Bills comments had had on me, or that I was being punished by him for not conforming to the racist stereotypes of the subservient Asian woman who is not to take a stand. The people who could have intervened on my behalf were immobilized by their own white fragility. When I expressed my harm that had been witnessed and unconfronted by the other white physicians, I got the Oh, Im sure he didnt mean that, and No, were not racist, were (colour-blind) nice physicians types of reactions, including from the leaders who would receive the complaint. I had no choice but to proceed with the formal complaint process against Bill to be seen and heard; this process was horrendous and traumatized me even more.

There were so many points in this formal process where I endured even more harm and that exacerbated the threat I felt in my workplace: a) the notion that both the complainant (me) and the respondent were seen as onequalfooting as colleagues, completely disregarding the societal power differential of a white male physician with that of an Asian woman physician, in a virtual face-to-face alternative dispute resolution attempt where he could be allowed to exert his power and privilege over me without any restraint, b) the stance of neutrality by the institution in adjudicating this complaint of gendered racist harm, and c) the eight months of silencing during the investigation that fostered the ostracizing of me in my workplace with the whispers of my being difficult and unwell by my other (white) colleagues, while all the benefit of the doubt was given to Bill. The worst part was that my complaint was only handled by various white people, none of whom had eitheranyunderstanding or lived expertise to understand racism. The institution used a colonial legal framework and lawyers to determine whether I was treated differently than a white man, which is missing the point entirely. In making my complaint, I was not seeking to be treated the same as a white man (equality not yet achieved in society); I was seeking to be heard and seen as an individual with an incredibly different lived experience for which my psychological safety isnever assurednot only in spaces of vast whiteness, but also within the colonial healthcare system and society in Canada. Recognition that I would havedifferentneeds for how to be treated is, in fact, theequityI was seeking as a person who has less societal and systemic power and privilege than my white colleagues. We have not yet achieved equality in society and must stop deluding ourselves that treating everyone the same is appropriate. I was morally injured and mentally exhausted throughout the complaint process. I have come to recognize that the entire complaint process itself, and subsequent ostracization I endured for putting in a complaint were an extension of the harassment for which I complained. This in it of itself is the goal of harassment: to tire out and inflict weariness through the repetition of trying experiences (Ahmed 2021).

So to answer my own question that I had at the outset of this piece, I can honestly saythat neither option was helpful to me as a racialized woman physician leader.Neither option gave me any validation, acknowledgement, or any accountability for bad behaviour. Both options caused further trauma and harm that has affected my well-being and that of my family over the years. My well-being is affected not only by the psychological ramifications and burnout I suffered through this mistreatment, but the physical effects that coping with oppression at work have due toincreased stress and inflammatory responses(Marya and Patel 2021). There has been absolutelynojustice for what I endured.

The sad truth is that there arenogood choices to seek acknowledgement of harm, receive any accountability for harm, or have any systemic changes made that would make institutions less harmful for racialized women and nonbinary persons in healthcare to navigate. This is the despairing reality of the patriarchal, colonial, and racist medical culture in North America, and that of the Western world. I also live and work with disabilities due to ongoing neurological effects from surviving a near-death rollover motor vehicle collision that punctured my lung, broke several ribs, and crushed my backbone (vertebrae) in four places when I was a resident physician. I havent, however, even touched how the unwillingness of call groups to accommodate such disabilities in call schedules has resulted in even more oppression for me.

How is this acceptable?The ongoing pervasive nature of systemic racism means that the medical profession is not adequately supporting racialized women and nonbinary persons within the profession. This also elucidates that if colleagueswithinthe medical profession are subjected to ongoing racism, the racist harm that our profession causes the patients and families we serve to suffer is immense. The racialized physicians who are harmed within the profession are arguably those who would be most acutely aware of the need for cultural safety for patients and families. But, if we are not supported and holistically healthy as professionals, how can we work to ensure safety for our patients in a sustainable manner?

Another quote from the book,Complaint!, resonates with me, What I learned about institutions froma complaint led me to leave; at the time it did not feel like a choice but like what I had to do. If complaints are more likely to be received well when they are made by those with more power (Ahmed 2021 Pg 38), then how do we compel complaint systems (both informal and formal) to rectify this ongoing power imbalance that only serves to further harm racialized women/nonbinary people, and others from intersectional oppressed backgrounds who have the courage to make a complaint?

We must overhaul the colonial complaint system to better support and protect racialized women/nonbinary people in medicine. Physician wellness will be the most critical priority we have going forward as we continue through this pandemic to a post-pandemic recovery of the physician workforce for years to come. For racialized women and nonbinary physicians, addressing gendered racism in medicine will bethewellness issue that must be tackled if theres any hope to curb the burnout amongst us. We must have systems workforthose with less societal and institutional power by virtue of their social location and oppression. The system must workforthose who must fight daily to be seen, heard, and respected. We do not have the privilege of having existed as a white male in society who has always been afforded the benefit of the doubt. We continue in our careers to be denied the same privileges bestowed to white male physicians and to some degree, white women physicians, in our profession. We must acknowledge this hard truth. While white male physicians have been emboldened to take up space by being praised and rewarded for it, racialized women physicians are punished for daring to take up space, even when they have the expertise and job title with responsibilities that requires speaking up and making decisions. We must acknowledge that medicine is not immune to the systemic systems of oppression pervasive in society. To better support racialized women and nonbinary physicians, we must have a safe and effective accountability system to submit complaints that has the principles of equity as its foundation.

The systemmuststart out withbelieving victimsand those with intersectional identities that are oppressed who have the courage to submit a complaint about racism or oppression. The system currently treats the person who has been oppressively harmed and dares to file a complaint (to try to seek help), as the wrongdoer. Any complaint about racism (and/or any other oppressive harm) must be immediately directed to a specific pathway where only racialized people and actual experts in anti-racism and anti-oppression deal with the complaint. The people tasked with managing racism complaintsmust havelived expertise on having to navigate the world with racism on an ongoing basis.

Every complaint must have a power and privilege and power differential analysis at the outset. As Archbishop Desmond Tutu has said, the system cannot be neutral in the face of oppressive harm complaints.There is no neutral.The inordinate amount of effort in protecting the innocence until proven guilty and confidentiality of the (white)respondent of a racism complaint (who already is afforded the benefit of the doubt over the racialized complainant, societally) means continued harm to the complainant through the inequity in the colonial processes and policies. Clear boundaries and safety measures must be immediately put in place for the complainant, and monitored. While I had called the Canadian Medical Protective Association (CMPA) for legal advice on how to navigate this complaint process, I was informed, to my incredulity, that they were not positioned to advise or support me, as the complainant, despite being a physician member who pays my medical-legal protection dues as required to practice. The respondent, however, would have been supported by the CMPA in this complaint. Talk about the system upholding systemic racism, power and privilege within the profession.

Existing in this society with its dehumanizing messages about racialized and Indigenous people creates internalized racism within racialized people that take decades to unpack, understand and actively resist. The fact that a racialized person would have concluded that making a complaint was required would have only resulted after much internal torture, self-gaslighting, and introspection. We would have already tried to obtain informal help because we know that the system is not set up to protect and support us. In my two cases where I needed to proceed with complaints, I had sought help repeatedly from people who had the power and jurisdiction within the institution to help me. I had had several informal complaint meetings with my Chair, and his predecessor, regarding Jeff over six years to no avail. This was despite having a thick file full of documentation of the various incidents over the years and many belligerent emails from him. One very high level white male superior advised me that I just had to put more effort into making nice with them (in a patriarchal, condescending tone akin to being patted on the head), but that I was just to carry on as I was supported by leadership in my work. Another white male superior said that I just had to get some white hair, some wrinkles, and not look like I was twelve to command respect. No one in a position of power to help me deal with these bullies was willing to step in because they didnt want to upset the faculty members who had been at the institution for such a long time. In the situation regarding Bill, as detailed earlier, I was met with white fragility byeveryonedirectly involved who could have used their white privilege to help me. Be it the silence, staying out of it, remaining neutral, protecting oneself, outright dismissal of the impact on me, not seeing the racism, or defending Bill, these were all forms of furthercovert racisminflicted on me by these colleagues. While two people within the physician group acknowledged in private that they could see that I had been attacked by Bill, when it came to actually putting their privilege on the line to speak up for me, they choose not to. They actively chose, instead, to harm me further by upholding the status quo at a critical time. It is near impossible to recover from such disappointment and betrayal from your colleagues.

Oppressive harm requiresrestorative justiceto occur so that there is acknowledgement that violation of a person (and relationship) has occurred, not a violation of a law. Restorative justice focuses on healing of the individual harmed while requiring accountability from the respondent that also includes their own personal learning and growth. This process involves receiving an acknowledgement of harmful impact (regardless of intention), accountability for future incidents, and sending a clear message that lashing out at people in a gendered racist way is never acceptable, but especially in a workplace. The complaint process for racist and/or oppressive harm should be focused on the institution recognizing the complainants pain as ahuman being,not shielding those who cause harm and are already protected by the status quo of society and the institution. The person harmed should not be the person tasked with teaching everyone in the complaint process about racism and oppression, including racist gendered stereotypes, as I had to do ongoing over months to the several people who (mis)handled my complaint. This included, ironically, having to explain how covert racism exists to the third party white lawyers hired to investigate whether gendered racism had occurred. Leaders ateverylevel in medicine must be competent to not only support those on their teams who have been harmed, but more importantly, to not further perpetuate harm through their defensive responses.

Complaints about racism and other intersectional oppressive harm must be acted upon as urgent, and concluded quicklywithin 8 to 12 weeks. At the conclusion of the complaint process, there must be a wrap-up meeting that not only discusses actions or outcomes, but determines what ongoing needs, changes and system feedback is required to help complainants who have experienced oppressive harm going forward. Institutions must understand that regardless of a complaint investigation being concluded, the complainant will be forever changed for having gone through the original harmful event, and the complaint process that dehumanizes them.

I resigned from my position last fall before the conclusion of the investigation for my complaint. That was how untenable my situation became over the eight months of the complaint process. The last straw was receiving yet another harmful email. After several requests that I not be present in regular administrative meetings with the respondent of my complaint, I was told that it had been decided that I was to meet with the whole physician group, or none of the group. This email was from a white woman physician colleague who had heard through my tears and anguish in the preceding months, the immense toll and impact that this whole ordeal was having on me and my family. If I had broken my leg and the elevator to an upper floor was out of service, would they have denied my reasonable accomodation if I had requested a meeting in the lobby so that I wouldnt have to crawl up the stairs? If they did, this would be so disgustingly and overtly dehumanizing to make someone crawl up the stairs. My insistence that I not be in the presence of the person who was causing meongoingharm, and the respondent of an ongoing complaint (itself a harmful process) was treated as unreasonable. I was essentially barred from being able to do my job while trying to advocate for my own safety. As Sara Ahmed writes, You can be exhausted by not being accommodated; you can be exhausted by the work you have to do in order to [try to be] accomodated (Ahmed 2021).

I was demoralized, exhausted and dehumanized. I had to end that pain for myself, and my family by resigning.

As youre reading this, you might be thinking, what expertise do I have to demand such system changes? I have lived expertise as a racialized woman physician with disabilities working in Canadian healthcare institutions for 18 years, a medical educator who has supportedcountlessracialized and otherwise oppressed learners who have experienced hardship due to oppression in their training, and a physician who has gone through and been failed by both the informal and formal complaint process at different stages of my medical career. Do not perpetuateepistemic injusticeby thinking that my testimony, and my blood, sweat and tears in 18 years of experiences (23 years if you count my training years) do not carry any weight or expertise.

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In attempting to make sense of the injustices I have faced, I have read and researched this topic in the social psychology, sociology, psychology, medicine, social justice and anti-racism literature for years. As a qualitative medical researcher, I have attempted to make meaning from these injustices to enact institutional change to improve things for the next generation in medicine.

Epistemic injusticeprops up systemic racism within the policies and procedures in Canadian healthcare institutions. Epistemic racism plays out every day in Canadian society, in the silencing, exclusionary, and disbelieving responses to discussions of racism, be it in the national news, or within organizations and workplaces. The dominant narrative has been formed by white people in society over time and continues to this day. This means that the lived experiences of racialized people are not only undisclosed or unheard, they arenotbelieved and/or dismissed if heard because they dont fit the dominant narrative (ie: the dominant group doesnt suffer racism so does not see or understand racial harm). These exemplify the two ways in which epistemic racism exists:testimonial injustice(the person not being believed due to racism, subconscious or not) andhermeneutical injustice(not understanding or believing the interpretations of lived experiences by racialized persons because it doesnt fit the dominant narrative). Harm is perpetuated through the stories of only the dominant group who then make the rules and direct the narratives upon which racist and oppressive harm is adjudicated. This is why all the white physicians with whom I worked in the second complaint were so quick to confidently dismiss and punish me for daring to utter the word racism in relation to a colleague and their group, when they have zero understanding of racism. It is also why I was overtly denied any accommodation when asking for protection from the respondent in not being in his virtual or physical presence, despite my clear articulation of the threat he posed to me. As a result, I was forced to give up clinical shifts (and income) because I was so fearful that being in his (to me, threatening) presence on the wards would adversely distract me in caring for patients safely. It is also why when asking for help, that other leaders could dare to say, Well, none of the other physicians (all of whom are white) have stood up and supported you, so who are we to believe that racism occurred. I did not need an investigation to confirm what I knew to be gendered racism.

This is why white men (and women) are defended so quickly in media stories about oppressive harm. This is why many racialized people who aspire to the seductive power and privilege in society that centres whiteness will give white people the benefit of the doubt over racialized people, especially women and nonbinary people, even when they themselves are racialized. This occurred in my first complaint experience. Lateral violence from racialized colleagues in many ways, is more violent than racism from white people or institutions. How do we move past asking the question of does systemic and other forms of racism exist within our healthcare organization or institution to what can we do to minimize the harm to racialized people within our organization and the healthcare system? How can we support them better within the organization to strive towards achieving equity?

Ultimately, the question I have for all healthcare leaders across Canada is do our voices, perspectives, and our lived expertise in having a lifetime of navigating colonial society as racialized individuals not matter within healthcare? Why must we endure racist harm in the workplace in silence and isolation?

Every workplace policy must consider restorative justice principles to achieve what is earnestly being sought by complainants of oppressive harm; help to be seen and heard as a person with different needs, that impact matters more than intent, and that it is not punishment but accountability being sought. The complainant is simply trying to lessen their chances of such a harmful incident occurring again. We know it will occur again, especially if unchecked. This is our reality. We must not continue to exacerbate the harm of inequities in the workplace through complaint policies that only aggravate oppression by virtue of how they are written. More importantly, the process harms by being disconnected from the problem the policy is intended to address (Ahmed 2021). These policies themselves serve to only avoid the person harmed and the oppressive problems within the institution.

Since my most recent ordeal, some of my healing has been fostered through my work with the newly formedAnti-Racism Support Groupin UBCs Family Practice Residency Program. The decolonized approach to achieving restorative justice that our group strives for, led by an inspiring Indigenous Elder, gives me hope that colonial institutions can change and actively work towards safety and authentic support of racialized physicians in medicine. It is past due thatallinstitutions concretely address the problems that complaints bring forth to those who have less institutional and societal power within medicine. It is past time thatallinstitutions create explicit safety for racialized women and others who experience intersectional oppression, rather than continuing to burden those with less power and privilege, as the most affected, to fight to be seen and heard in these institutions. Only then, can physicians who are racialized women and other intersectional identities, and those who are coming after us, haveanyhope of surviving our careers in medicine.

Excerpt from:
Why must Black, Indigenous, or otherwise racialized women and nonbinary physicians endure racist harm in the workplace in silence and isolation? - The...

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