The Visible Man: “All Skin Folk Ain’t Kinfolk” - Balancing Respect & Trust within the Medical Community
“I am an invisible man. I am invisible, understand, simply because people refuse to see me. Like the bodiless heads you see sometimes in the circus sideshows, it is as though I have been surrounded by mirrors of hard, distorted glass. When they approach me, they see only my surroundings, themselves, or figments of their imagination- indeed, everything and anything except me.”
“Respect is a given…Trust is earned”.
“Respect the medical provider’s education, training, skills, and experience. Make the medical provider earn your trust.”
The Oath of a Medical Doctor
“I will maintain the upmost respect for human life. I will not use my medical knowledge contrary to the laws of humanity. I will respect the rights and decisions of my patients. I will hold in confidence all secrets committed to my keeping in the practice of my calling. The truth is that medicine is not immune to the biases we carry.”
“All skin folk ain’t kinfolk.”
“Psychological trauma has permanence. Trauma never ever goes away.”
My Dear Readers,
I am utilizing this writing to repair a psychological wound that was inflicted, thrusted upon me by an African American medical provider. The psychological wound was being devalued. Devaluation is defined as the reduction or underestimation of the worth or importance of something. In this situation, I am the “something”. The devaluation was a single spoken word, that was said with power and authority, by a person in a trusted position, a medical provider.
The word, slight yet meaningful, whether it was intentional or unintentional, disrespected me as an elder within the African American community. A community of which both I and the medical provider are members. She addressed me by my first name and introduced herself as Dr. Jones (not her true name). I looked at her in disbelief. In one word, I was devalued from my status as an elder of my community. In a flash of a moment, I became “invisible”. Were the actions of this young African American medical provider unintentional?
The devaluating act that created invisibility and disrespect was a microaggression. Microaggressions are indirect, subtle, unintentional or intentional acts of discrimination against members of a marginalized group. As such, members of marginalized groups are subjected to being psychologically traumatized by these daily acts of microaggression. Medical students in the early years of training are taught protocols about the power differential and inequities in the relationship between medical professionals and patients and therefore to be aware of behaviors that could be interpreted as microaggressions. This includes:
None of protocols were extended to me by this young African American resident physician.
There are those who would suggest that since she is one of the very few African American physicians working in a system that is systemically racist in its interaction and treatment of African Americans, she should get a “pass” on her actions. There is also the suggestion that her ignorance is negligible and should not be viewed in the same light as actions of white physicians.
Wait. Shouldn’t she, as an African American, serving members of her community in a systemically racist profession be held to a higher standard than a white physician? And what about the psychological wound that has been served? Whether unintentional or initiated out of ignorance, the actions of devaluation have created a psychological wound.
As I write about the incident, there will be those individuals that chuckle, smirk or laugh…. Viewing my concerns as either “no big deal” or as an “overreaction”. And there will be those who will reflect on their psychological wounds that created traumatic experiences that never ever go away. There is a silent reality of black realness, that black people in the context of the provide-patient relationship, who takes an oath to “I will maintain the upmost respect for human life,” have been left with lived experiences buried in systemic racism. This relationship built on an illusion of “trust” often leaves the black patient feeling devasted… denied… dismissed… discharged.
In writing these blogs, 200 throughout the years, I have often told the stories of others, seeking a safe space to air one’s grievance or feelings. Often in writing, I sought to offer hope, assistance and encouragement. As a medical provider, a mental health clinician, I can suggest that we as providers have a duty, a responsibility when our actions create injury or discomfort to acknowledge our actions, extend healing to the wound via the apology and take steps to learn from the action to prevent further injury to other patients.
The medical provider-patient relationship is unequal as the provider holds the power position. Due to the responsibilities of the provider, this relationship can never be one of equality. However, the relationship can be one that is balanced with mutual respect and trust that is earned through the relationship and interaction between the provider and patient. In my clinical practice, I teach my patients that respect is a given and trust is earned. Specifically, “Respect the medical provider’s education, training, skills, and experience. Make the medical provider earn your trust.”
In the relationship between the medical provider and the patient, the medical provider takes the patient in the state “as is.” This is defined as whatever history the patient has when entering the room. This includes prior treatment of microaggression, mistreatments, psychological distress etc. These concerns reinforce the reasoning that the provider holds the power and the relationship is unequal. Regardless of specific medical issues being seen for, the “whole” patient must be seen and treated.
It was my decision not to extend a free pass to the young African American physician. I decided to voice my concerns and in doing so, begin my healing from the wound of invisibility and disrespect that was inflicted upon me. In this healing, I applied a clinical protocol defined as ABC: Advocacy, Balance and Calmness. Specifically,
In this writing I will speak of my recent wounding at the hands of the “helpful” medical provider. I will also share a peek of my past in which lays the psychological foundation of the psychological wounding that I recently endured.
The Story of a Colored Boy
I was born… colored. “Colored boy” was the designation on my birth certificate. I am northern born and southern raised. My developmental years were spent in the segregated South. As a child I attended a school designated for “colored only”. At the age of eight, I was sent along with a group of colored children to integrate an “all-white” school.
My parents did not prepare me for this new experience which they stated would be a great opportunity for me. Once there, we were separated as I was the only colored boy in my class. A sea of white faces with wide open eyes was staring at me. The first thing the teacher, Mrs. Higgins did was instead of introducing me from my desk, she had me stand in front of the class to recite the alphabet. She wanted me to sing the alphabet and I sung like a bird in church from the letter A to Z.
I spent that year in isolation as none of the other children in class would talk or play with me. I was called names such as sambo, darky and of the class’s favorite term for me was ni**er. Mrs. Higgins stood by silently smiling, never uttering a word. When I told my parents what was occurring, they armed me with the following words to use when I was being taunted… “Sticks and stones will break my bones… but names will never harm me”. Well, I told them the verse… and they laughed. I was nine years old….
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The Story of an African American Healthcare Professional
My name is not Micheal. Nor is it, Mike. At one point, my name was Mr. Kane. Following eight long years of education earning a second master’s degree and a doctoral degree, I became what I am today and will be for the remainder of this life… Dr. Micheal Kane. I begin with the story of my childhood because it was a formidable part of my development. It was also the beginning of years… decades of microaggressions that I would endure during my lifetime.
One of my memorable microaggressions moments as a young adult occurred during my first graduate school program in which I was one of the two black males in the graduate school one of the professors pointily asked me whether I was exchanging sexual favors with my female peers for them to write my papers. I looked at him in shock as he attempted to play it off as a joke. My reality was simple, instead of having been seen as intelligent and a hard worker, I was being casted as a fox in the chicken coop of white women.
My Journey of Self Discovery: Dr. Micheal Kane Clinical Traumatologist & Forensic Evaluator
Since earning my doctoral degree, I have gone on to attain advanced international training in the field of Clinical Traumatology. I have also developed skills as forensic evaluator trained by one of best forensic science programs in the United States. I am one of the founding members of the Journal of Forensic Social Work. I have served as the clinical consultant to the Congressional Black Caucus. I have published a book on trauma impacting African American veterans. I am told that the book had been utilized by graduate schools across the US and the Veteran Administration in working with veterans.
And in my spare time (the little that I have) I have published approximately 200 blogs posting related to mental health and psychological trauma impacting the lives of African Americans.
So, understanding my achievements, I should be highly respected within the medical community… a community that I am a member of, right?
Nope. I am treated no differently than any other African American person who has had to deal with microaggressions from the medical community. A community that Black people depend on for medical treatment and healthcare. And yet the medical system is racked with systemic racism. The consequences of microaggressions can result in Racism Induced Stress Disorder. Which represents the combination of mental and physical disorders that can result from repeated microaggressions. What is concerning is that the perpetrator of said microaggressions can be an individual who is the same skin color as the person being psychologically wounded.
Respect … “You Obviously Were Not Raised Right”.
So, I have laid out my background… now comes my story. Recently, I went to a major medical setting to receive medical treatment. This medical setting is a teaching setting. The protocol is one in which the patient is first examined by the resident physician and following a short discussion between the resident physician and the supervising physician, they both return to the examination room to close the process of the examination. Upon arrival, I was issued a hospital gown with which I was to undress and be prepared, fully unclothed for the examination. For many patients going through this process, it is one of vulnerably, exposure and uncertainty as to outcome. The one expectation that I have is that I will be treated with RESPECT.
First Mistake: Informality/Disrespect – Strike One
Entering the room, the resident physician, a young African American woman age late 20’s early 30 looks at me, an elder 71-year male and questioningly addresses me as Micheal? My name is Dr. blah blah. I am completely astounded. I expect and am prepared to respond to microaggressions from white physicians as I know the level of their ignorance and lack of knowledge or respect for me and my community. I was completely caught off guard that such disrespect would be afforded to me by a member of my own community.
Second Mistake: The Back Door Apology – Strike Two
Catching myself, I corrected her error. “My name is not Micheal. My name is Dr. Kane.” No acknowledgement of the error or apology offered by the resident physician. She continued and completed the examination. At the end of the examination and before the resident physician left to consult with the supervising physician and returned to close the interaction, I requested a moment to share my feedback about the services I received. I complimented her on the examination. I then went on to share that I was impacted by her lack of respect in addressing me as an older black man by my first name. The resident physician’s response began with an “If I said anything that was offensive, I am sorry. I immediately interrupted and requested that she ceased with the “If” and simply accept responsibility for her actions. I went on to say that those who utilize the term “if” are merely seeking a backdoor out leaving the impression of an apology that lacks responsibility for the injury that has occurred.
Third Mistake: All skin folk ain’t kinfolk. Trust is earned not given away to the underserving. – Strike Three… You’re Out.
The resident physician then sought a different strategy; this one was to extend an apology for my feelings. She stated, “I am sorry that you feel this way.” Once again, I immediately interrupted by informing her that I and not she has responsibility for my feelings.
Furthermore, to apologize for my feelings and not accept responsibility for her actions is not acceptable. I went on to say that as a clinician I teach my patients to respect the medical provider’s education, training, skills, and experience. However, make the provider earn their trust. I also added that as black person, her lack of respect towards someone obviously her elder, gave the impression that “she was not raised right.” And that she had not earned my trust. The resident provider “thanked me” for my feedback and exited the examination room.
Conclusion: The Supervising Physician Providing Guidance & Excuses
As I stated earlier, the protocol is for the resident physician to return with the supervising physician to bring closure to the examination. The supervising physician, middle age white woman came alone. I understood the resident had no doubt informed her supervisor of the interaction and my remarks. I restated my concerns to the supervisor. The statement that was clearly made was young people today have a different way of speaking than people of my generation. They tend to be more informal.
The role of the supervisory physician was to quell the storm, put out any fires and provide protection for the resident physician. Once again, I am confronting stereotypes regarding black males. Here I was not a physical threat, rather a threat to the emotional well-being of a resident under the supervising physician’s care. At no point had I raised my voice, used profanity or spoken in a rude or negative tone. I simply provided feedback that was extremely difficult for the resident physician to receive. The supervising physician is privileged and clueless to understanding complexities of Black Realness.
Realizing that I was speaking to someone who simply wanted the issue, i.e. me, to go away with some sense of closure, I ended the discussion and terminated the medical visit.
Concluding Words Dr. Kane
The Crossroads of the Journey of Self Discovery leaves the individual with a choice in which way to go. The individual in making the decision must be willing to stand by and accept the consequences. It is from the decision and consequences that wisdom will flow. It is intended that transformation will occur and empowerment will assist the individual in continuing the Journey of Self Discovery.
There was a choice to ignore the devaluation and disrespect from the resident physician. Was her disrespect intentional? Was it a power play to show superiority? I will never know. The question of intentional or unintentional has no meaning to the psychological wound that was created by the actions of the resident physician committed in an environment where I sought to be healed of my medical injuries. I made the decision to advocate on my behalf; to seek balance within my traumatized self and bring calmness to my external environment.
Will the resident physician gain benefit from this experience? It is possible yet given her attempts to escape responsibility for actions and work towards creating a healing closure of the psychological wound created by her actions… it is doubtful. It may have been a traumatic experience for the resident physician. If so, there is the reality that trauma has permeance. It never, ever goes away. What will ring in her ears and be remembered will be the words “You Obviously Were Not Raised Right”.
I hope the resident physician will work diligently to extend courtesy to others of our community as she will no doubt be struggling to with microaggressions from those she works with. As for myself, although I work among those who hold to white illusion, I am grounded in black realness. To them as I quote Ralph Ellison author of the Invisible Man:
“… I am an invisible man. No, I am not a spook like those who haunted Edgar Allen Poe: Nor am I one of your Hollywood movie ectoplasms. I am a man of substance, of flesh and bone, fiber and liquids, and I might even be said to possess a mind. I am invisible, simply because people refuse to see me.”
My devaluation by others began long ago in school classrooms of the segregated South. Psychological trauma has permeance. It never ever goes away. Although powerless once, today, I am empowered. I will continue my journey of self-discovery. I will continue to insist on never accepting others devaluation of me. When empowered, one stands alone holding to belief… faith and trust in self.
My journey… the journey of Dr. Micheal Kane continues…
“When I discover who I am, I’ll be free.”
Until we speak again… I am … The Visible Man