White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse

Abstract

The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine’s whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training’s hidden curriculum. We argue that ‘ungaslighting’ the physician burnout discourse requires exposing the history giving rise to medicine’s whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.

No More Building Resiliency: Confronting American Psychology’s White Supremacist Past to Reimagine Its Antiracist Future

“…Abolition medicine is gaining traction (Kaba & Murakawa, 2021), calling for historical redress through reparations and transforming the upstream structures, like policing, enabling the downstream violence that ended George Floyd’s life (Iwai et al, 2020). It mandates reimagining healthcare as an antiracist practice by first confronting its widespread human rights abuses, scientific exploitation, segregated workforce, and race-based clinical algorithms (Iwai et al, 2020; Legha et al, 2020, 2022; Legha & Martinek, 2022; Legha & Miranda, 2020).…”

“…White saviorism is the White supremacist assault, thinly veiled by the language of “strengths-based,” “trauma-informed,” and playful acronyms suggesting “we got you.” Saving people from harm rather than eradicating the harm is the strategy to cover up and sustain the harm. There is a long history of civilizing, charitable agendas cloaking White supremacist, assimilationist violence (Legha et al, 2022; Legha & Martinek, 2022; Schuller, 2021). Amidst psychology’s legacy of eugenics controlling the non-White races, White people helping or harming them are indistinct entities that run the risk of being one and the same.…”

“…These compelling but fabricated conceptual frameworks sustain its White hegemony while providing systems justification to defend the psychological profession as legitimate, fair, and good (Jost, 2020). The overarching strategy: distract from the systems of oppression and White supremacist violence causing harm; scapegoat non-White individuals brutalized as a result; choreograph the charade of ostensibly “helping” while actually doing nothing or perpetuating harm; and finally, control the narrative about racism to thwart antiracist change and preserve White self-interest at all costs (Legha et al, 2022; Legha & Martinek, 2022). Rigged discourses have given eugenics, racial intellectual inferiority, diversity and inclusion, and the whiteness sustaining them legs to stand on.…”

The prenatal care color line and Latina migrant motherhood

“…The US healthcare system favors the advancement and dominance of White people (Nguemeni Tiako, Ray, and South, 2022). Clinical encounters reinforce norms of paternalism, individualism, defensiveness, and obedience to hierarchy, along racial axes of power (Legha and Martinek, 2022). When White (and White-adjacent) providers treat Latinx patients, this racial and cultural power hierarchy sets the stage for harm.…”

“…Because providers share no racial (or linguistic) proximity to their Latinx migrant patients-and largely represent White dominant schema-their capacity to combat pervasive and harmful rhetoric remains limited, despite engaging in a "caring" profession. Further, because they are professionalized in academic medicine, their observations-hierarchized by race and professional expertise-about their patients' parity (i.e., the number of times a persona had given birth), "compliance," pain tolerance, pelvic girths, newborns' health, perceived intelligence, and grooming practices become systematized in how they treat, speak about, and instruct trainees to care for pregnant Latinxs (Cerdeña et al, 2020;Legha and Martinek, 2022). Racist ideologies have pervaded practice and medical education surrounding the suitability of pelvic structure for vaginal birth, diagnostic criteria for anemia during pregnancy, and guidelines regarding vaginal birth after C-section (O'Brien and Clare, 2023).…”