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Carrying the Weight of Representation, For My Patients and Colleagues

Op-Med is a collection of original articles contributed by Doximity members.

Leaving all I knew behind and immigrating to a homogenous neighborhood as a 7-year-old was a difficult transition. I couldn’t understand why no Disney channel heroine looked like me; why I felt so abnormal. Years and assimilation pass: I am 21 years old and one of the refugee women I work with asks to speak to me in private. She is embarrassed to tell that she hasn’t been able to attend our meetings on navigating the American health care system because she and her neighbors lack transportation. She stops to think about her words and apologizes profusely, expressing how difficult the bus system is to use. She needs her son’s help to figure out the routes after he comes home from middle school. 

I am 23 and a third-year medical student on my pediatrics rotation when Earth shifts off its axis. When we step into the room of A, a 9-year-old with chronic kidney failure, his mother is there. She only speaks Arabic and leans forward, the wear of miscommunication and fear clear on her face. A is sitting up straight on high alert, translating for his mom because she doesn’t understand the dialect of the phone interpreter. He’s frail with sunken eyes, but holding his mom’s hand, comforting her. I am transported to being 8 years old and being protective of my parent’s accents against the grocery store cashier’s aggressively loud and condescending tone when my mother asks a question. I am 18 years old and learning all there is to know about mortgages and escrows, reading the fine print and talking to the accountant to help my family buy a house. I am 20 years old and trying to understand retirement funds, because my parents never started one, never knew to.

The tiny room is bursting at the seams with our entire team, including our attending, three residents, a pharmacist, and four medical students. As we’re leaving, I stay behind. 

“Eid Mubarak,” I say softly. It’s a holiday. Both of us should be celebrating; in fact, I spent the entire morning silently lamenting not being surrounded by family, food, and celebration. There’s a physical reaction to hearing Arabic. I introduce myself, asking A and his mom where they’re from. The boy leans back, shoulder dropping in relief at the exchange of duty. The mother breaks down, taking a hold of my hand. She grips it strongly, a desperate attempt at connection, a life jacket, a plea, a prayer. Be here, don’t let go. So I squeeze her hand back, keep it there, lay my other on her shoulder. She confesses how they have been there for months, how lonely and isolating it has been. She asks me to visit every day; I agree. I visit the family for the remainder of my rotation, chatting about anything but A’s condition. I overhear complex multi-team discussions about A’s condition. A worsens. I will play video games with A and lose badly.

I am 24 in the OR on an ophthalmology rotation. In checking the case chart I notice the elderly patient’s preferred language is Arabic. As the resident makes the first incision, the patient begins to rapidly move his eyes. “No se mueve, señor,” is uttered as a command into the quiet OR. He doesn’t speak Spanish, I think. They probably know, I think. The patient continues to move his eye every time the phaco gets close. “لا تحرك عينك” I say loudly, stumbling over the words, my mother tongue sounding unused and awkward in this foreign location. The patient stops moving; several heads snap my direction and there’s a small nod of approval. As the case finishes up and the patient comes to from the sedative state he was in, he apologizes. He’s embarrassed, I can tell. I’ve seen the same look on my family member’s faces when someone underestimates their intelligence or ability because of an accent or mispronounced word. When I reassure him, he visibly relaxes, cracks a smile, and pats my hand.

Advocacy and service have been fundamental aspects of my journey. As an individual with an intersectional identity, I have developed a deep connection with marginalized populations. Through my personal and professional experiences, I have witnessed the complex health disparities that afflict minorities. I became acutely aware of the barriers, such as language, transportation, bureaucracy, and social determinants, that hinder immigrants and minority populations from accessing adequate health care, leading to long-term health issues. My involvement as a congressional intern equipped me with the skills to navigate health policy, effectively engage with policy-makers, and drive systemic change. Personally, by leveraging my background, professional experiences, and deep understanding of the challenges faced by immigrant and refugee communities, I have had incredibly moving experiences that have changed me fundamentally. However, representation is a heavy weight to carry. 

Representation matters. Throughout my time in medical school, I realized how deeply intersectionality in medicine affects patient care. There is profound privilege in being able to serve and operate on patients. Cultural competency is essential to fully understand, represent, and compassionately care for patients. Literature has shown increased utilization of health care and improved perception of the quality of health care by underrepresented minority patients when they are treated by underrepresented minority physicians. Yet ophthalmology, my desired field of choice, falls behind. Of the 232 ophthalmology leaders appointed between 2002 and 2022, 22.8% were female. Recent data shows that only 7.7% of ophthalmology residents are underrepresented in medicine (URiM) and only 6% of practicing ophthalmologists are URiM. Meanwhile, prevalence of glaucoma and diabetic retinopathy is nearly two times and 1.4 times higher, respectively, for Black Americans as compared to white Americans. Despite experiencing high rates of low-vision, underrepresented patients face barriers to access for low-vision devices and use them at lower rates. Not only would a larger underrepresented minority presence improve the cultural competency of the workforce, but it would also help address mistrust in underrepresented populations and systemic racism in the medical field.

As medical professionals, it’s easy to forget the immense privilege in the sacred exchange of trust between physician and patient. Through involvement in service organizations, advocacy efforts, compassionate and culturally component care, and elevating underrepresented voices, we have the privilege of gaining the perspective of incredibly resilient, diverse peoples who have weathered unimaginable storms allowing us to become better physicians, advocates, and humans.

May Ameri is a medical student at McGovern Medical School at The University of Texas Health Science Center at Houston. She is pursuing a medical humanities concentration and is passionate about narrative medicine as a vehicle for connecting with patients and preventing burnout. She is passionate about bridging the gap between medicine, policy, and advocacy. As an immigrant and previous Albert Schweitzer Fellow and Graduate Archer Fellow, Ameri encountered the complex health disparities that affect minorities. Her goal is to work toward reducing health disparities faced by her local immigrant and refugee community. She hopes to become a policy advisor on issues of health care disparities and serve as a strong advocate for marginalized patients.

Illustration by April Brust

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