Last month, Dr. Oluwadamilola Fayanju, a Surgical Oncologist at Duke University wrote a thought-provoking opinion piece in JAMA entitled, Hiding in Plain Sight. In this piece, Dr. Fayanju discusses her superpower—the fact that she can hide in plain sight, when she is not in her white coat. This is far too common among female physicians, especially African Americans; I have heard countless instances very similar to what Dr. Fayanju describes in the article. She describes this as a gift and a curse. When she does not have on her white coat, she can observe patients within a health care setting but outside the role [she] typically plays in clinical contexts. [She] can see how they are buffeted and battered in small but cumulative ways throughout the day and, indeed, throughout their lives.
Dr. Fayanju’s thoughtful article motivated me to share my own experiences. As a 5’9”, 190 pound African American, I’m rarely invisible - even the times when I want to be invisible. I stand out. People notice me and watch me closely, especially police officers, security guards, and employees at retail stores. My appearance (i.e. my black skin) often makes me intimidating to people. My appearance (i.e. my black skin) makes me intimidating, “people are afraid to say anything to [me] because I’m black and they don’t want to be called racist” or “they assume I will start swinging when I’m upset.”
During my junior year at Johns Hopkins University (JHU), I was completing a neighborhood assessment as part of a JHU research study in a neighborhood directly adjacent to JHU’s Homewood campus. After being in the neighborhood for ten minutes, police arrived and questioned why I was in the neighborhood. In a city that is predominately African American, the city that raised me, the city where I had been volunteering since I was 10 — I had to justify my presence. The police officers said a resident called 911 reporting a suspicious person in the neighborhood. The officers continued to question me until I showed them my Hopkins’ student identification card, because, of course, my Maryland driver’s license was not sufficient. I was humiliated and furious afterward. I sent a letter to the president of JHU, the mayor and the police commissioner. It turns out that the police responded to a non-urgent call in less than six minutes for an African American male walking on the sidewalk of a neighborhood directly adjacent to his college campus. I am not invisible.
This experience (and countless similar experiences e.g. having a police officer draw his weapon for an unwarranted traffic stop) is not unique to me; African Americans are more likely to experience traffic stops, to be ticketed, and frisked after a traffic stop. More concerning is the disproportionate extrajudicial killing of African Americans, in fact, African American males are 2.5 times more likely to be killed by police compared to their white counterparts. This phenomenon is not new, and little has been done to address this crisis which is a leading cause of death among young African Americans.
Similarly, I’m not invisible at the hospital, but I’m never seen as a physician although I have both a doctorate and medical degree. Hospital employees are quick to ask me if I’m lost or who I was there to pick up; this happened frequently during my intern year of residency. Despite my white coat (or jacket) and my badge which listed my name followed by MD, PhD; despite me introducing myself as Dr. Milam, I was always a transporter, dietary aide, or a nursing assistant. The thought that I could be a physician seemed to be unbelievable. While this can be frustrating, I can understand why one would make the assumption that I’m not a physician. African American males make up less than 3 percent of the physician workforce and the number of males graduating from medical school is the lowest in three decades. This resonates with me as I was 1 of 5 African American males in my medical school class of over 300 and 1 of 4 African American male residents among 450 residents at my hospital.
While I may not be invisible, I can empathize with Dr. Fayanju; I often feel invisible and undervalued. People see me, but they refuse to see me. To see me for who I am, and all the work that I have done to get to here. The unconscious biases that creates the assumptions in people that I cannot be a physician, are the same unconscious biases that discourages African Americans from applying to medical school and gaining acceptance into medical school.
We need a paradigm change to improve diversity in medicine so that an African American physician is not seen as an anomaly.
“I am invisible, understand, simply because people refuse to see me. Like the bodiless heads you see sometimes in circus sideshows, it is as though I have been surrounded by mirrors of hard, distorting glass. When they approach me they see only my surroundings, themselves, or figments of their imagination -- indeed, everything and anything except me.”
~ Ralph Ellison, Invisible Man