My name came from a dream. My parents were not sure what to name me — my mother had many miscarriages, so they decided to not name me until I was born. As they argued, and the days passed, my father saw me in a dream where I yelled at him for not naming me. Waking up terrified, he named me the first name he thought of. To this day, I am not particularly attached to my name — just as anyone would not be particularly attached to a dream.
I grew up with many reasons to be discriminated against — a non-native of a Middle Eastern Kingdom (Syrian in origin), white-looking (in a country of mostly darker skin-toned people) and having different religious and sexual minority views. I grew up with institutionalized racism where it was okay to not have the same rights as nationals because my parents came from another country. I cannot say with certainty when I first thought that I deserved more than what was offered. Perhaps it was when I was asked to write an exam essay on how foreigners interfere with the local economy and how I should be deported. Perhaps it was when I was a teenager and wanted to have a summer job but was not permitted by the state. Perhaps it was when I was unable to apply to public universities. Most likely it was a culmination of these events. I became sad. Then I became angry — angry at the injustice directed towards me and people in similar situations. I knew I had to leave the Middle East because I could not go back to the only country that accepted me as a national.
So, I left. I left my family and my culture in search of a better society, — a society where I would not be discriminated against based on my skin tone, passport or family ancestry; a society where I could express my opinions freely. My first experience in the US was as a research exchange student in Jackson, Mississippi — a place not particularly famous for tolerance. Yet I saw more tolerance there than I ever experienced at home. Was it because I was of a fair skin tone and “white-passing”? I will never know. It is exhilarating yet confusing to find a place that feels more like an accepting home than your actual home. The seed was planted, and I wanted to move to my new accepting home permanently.
It is no fun navigating the United States Citizenship and Immigration Services (USCIS) — long forms and longer waits. Long waits at airports and longer random checks. After many years of traveling back and forth from the US, it finally happened: I look at myself and find that I am a physician practicing in the land of opportunity as a permanent resident. Tears ran down my face when I got that elusive green card. I no longer had to worry about all that racism against me. I had finally made it.
Except — racism finds me here. I realize that even though I look white, the second I mention my name or where I come from, I automatically go back to being the minority. I sadly see this in my practice as well. Not only discrimination against patients of color who are disadvantaged in almost all areas of life, but also discrimination against me when patients learn more about their provider’s background. It took me several more years to accept that this place is not free of racism. I was in denial because, in my head, to acknowledge racism persists here was to acknowledge that I failed at finding a new accepting society.
However, I also find an important difference — much of the racism in the US is not written in law (as was the case back in the Middle East), but rather more cultural and implicit. I noticed this when I was a medical student. During one of my Sub-I rotations in the US, one of the residents I worked with was presenting a consult to the attending and remarked that his “hospitalist is one of them unpronounceables,” in reference to his foreign-sounding last name. A friend from medical school who also moved to the US to continue his training had his name misheard by a senior staff member as Michael Mathews. When recounting the story, we mused over the fact that he is now “fully assimilated” into the American healthcare system.
I grew up with an unpronounceable name. Even in the Middle East my last name was particularly difficult to pronounce, and I had to correct people often. In my clinic now, patients and colleagues pronounce my name in many different varieties — often with comical outcomes:
Patient: “How do you say your last name?”
Me: “Aa-di or Ah-Dee. Both are okay.”
Patient: “Ah-Dee … like the tuna. Ah-Hee.”
Me: “Yes, like the tuna.”
While I do not have particular statistics on whether my clinic show-rates or outcomes are affected by my name, I have a hunch that I have higher no-show rates compared to colleagues, especially at the VA. The literature seems to support my hunch. One study looking at patient selection of physicians based on names remarks “in regression models, participants more frequently selected the physician with the randomized name when displayed with a white male name, compared to when presented with an African American male, African American female, or Middle Eastern name (ORs ranging from .59 to .64)”. It is understandable that as a social species we tend to favor people we can relate to and have commonalities with, including names. These disparities do not necessarily reflect a provider’s clinical competence or empathy but is rather rooted in implicit biases that are seldom in the conscious control of patients.
What can clinicians do to mitigate the name pronunciation effect? Some tried methods include adopting Anglo names that are closer to the original name (Zakariya going by Zack) or going by an initial (such as Dr. A). However, whether physicians decide to adopt some variation of a stage name or not, this is a topic worth discussing in resident teaching and medical education in general. I wonder how many international medical graduates and clinicians without a white-sounding name also struggle. Over the last decade, there has been a renaissance with regards to teaching cultural sensitivity to healthcare workers; however, how do we teach this to our patients who are not healthcare workers? It all starts with an honest narrative.