Imposter syndrome at its best: A conversation between frustrated friends

Friend: Wait but what made you sad haha

Me: Essentially, in this like 2 page essay, I argued that all the things that have helped me succeed as a minority and an immigrant have been crutches to allow myself to do only okay academically so, for example, because I know I can get into med school with a subpar score, I’m not going to try to score higher and etc. but I don’t know that and I should stop being crazy, but I can’t and it is really sad

Friend: Ahhh when did you write it? I don’t think that’s true at all for the record. I know you to work super hard and go above and beyond. You do more than your best!

Me: the date on it is Jan 2014

Friend: Look at you now tho!

Me: which means I wrote it for a course at Fordham, which is even sadder! I had students at the time!

Friend: I understand the doubt tho. I have it all the time and I don’t know if it’ll ever go away

Me: My rational mind agrees with you
I spent the last two weeks working with a resident who I was too slow for. she would put in orders and write hand-offs and do things for my patients that I was supposed to do, but I’m slower than she is and she didn’t have the patience

Friend: Does she have more experience though?

Me: instead of thinking something was wrong with her teaching style, I’ve been beating myself up over it. She’s a senior resident and I’m the “sub-intern”…so I am supposed to act as though she has 3 years experience on me

Friend: Ugh exactly. I know so many minorities going through exactly that. Myself including

Me: she asked me to evaluate her today… “What can I do better?”… I wanted to punch her

Friend: Like I’m working on a new Project with this white lady and she has me send her draft emails before I send them. And they’re internal emails so they don’t matter at all.

Me: facepalm

Friend: Instead of being like, “I feel confident enough to send this out” I just do what she says

Me: that’s insulting!

Friend: Like I freaking went to Princeton, I can write an email to my actual supervisor

Me: EXACTLY

Friend: I’m gonna try to work up the courage to say something
Our society sucks
Blame it, not yourself

Me: Has she had any actual feedback for you….bc if not you should just tell her you’re good

Friend: Like minor edits
It’s so stupid

Me: I hate that shit. I spent the entirety of my psych rotation dealing with someone like that

Friend: And the people who got the email of course answer in 3 seconds with incomplete sentences

Me: She would sit with me to rewrite my entire note for each of my patients, she would just change single words, or rewrite a sentence and end up saying the exact same thing. it was such a waste of time. I learned nothing.

Friend: Omg exactly this lady. It’s so insulting but actually does make me question my abilities

Me: Its so stupid that these things manage to have us questioning ourselves

Friend: We should remind each other not to let it!
I definitely need the reminder

Me: haha, we should, reminders might eventually make the difference.

Friend: Yeah we have enough nonsense voices trying to tell us otherwise
So if we hear the truth enough, hopefully, we’ll believe it!

 

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Dear Roger Clegg and Mark J. Perry

Dear Roger Clegg and Mark J. Perry,

One June 28th, an article you wrote for The National Review came across feed. The article is titled Color-Coded Meds and it is where you, Clegg, express your opinion about students of color being allowed to go to medical school–like its 1960 or something. This wouldn’t have meant so much except that I watched a video just a week prior of a mom refusing care for her son, who with chest pain may have had something potentially life threatening because there wasn’t a white doctor. As the president and general counsel for the Center for Equal Opportunity, a “conservative think tank devoted to issues of race and ethnicity”, I would have hoped that at the very least you hadn’t equated color with a lack of ability to do this job.

Then again, you didn’t exactly make up your own mind about this, Perry, you provided the opinion in the first place. The data you present in you AEI post looks quite damning at first glance. The graph, front and center, displays acceptance rates for individuals with a certain MCAT score and a particular GPA. This graph is then interpreted to say that black and Hispanic or Latinx applicants are more likely to be accepted than other individuals across any combination of test scores and GPAs. Then the “bottom line” as you call it:

“Medical school acceptance rates in recent years suggest that medical schools must have “affirmative discrimination” and “racial profiling” admission policies that favor black and Hispanic applicants over equally qualified Asian and white students.”

Back to you, Clegg! You then take this and make the following assertion:

“It’s bad for patients who will not have doctors as good as they might have had otherwise.”

You are both entitled to your interpretation of the data and to your opinion. I also know I am unlikely to change your 60-year-old minds about Affirmative Action. It is, after all, as emotional for you as it is for me. You think we’re undeserving and stealing your children’s seats while I think I have worked incredibly hard to earn the privilege of taking care of human lives. Here’s my counter argument anyway, here’s why we will likely be plenty good at doctoring:

1. The number of white and Asian doctors serving our community, who actually want to be there, who are actually making a difference, is minuscule. They fear to work in locations like the South Bronx or the South Side of Chicago. In fact, I was just having a conversation with a friend about the Bronx Lebanon shooting. He said to me “now I know not to apply there for residency” not realizing that it is that kind of deduction that has ultimately lead to the increased crime rates in the Bronx.

Those who end up in these places believe the inhabitants make themselves sick and don’t deserve the kind of care they would give their mothers. Having no doctors of color would mean that places like these will continue to get subpar care, will continue to be sick, will continue to miss school and work because of illness, and will continue to live in poverty.

My pediatrician of 7 or so years once told me a story. During her residency, she overheard a fellow resident pat himself on the back by saying “I just saved the life of an infant who will grow up to mug my grandmother.” The baby was Dominican. My pediatrician who got to hear this because she has the privilege of a few, shall we say, Aryan features,  is Dominican and her colleague had no idea he had just offended her.

This is why I went into medicine in the first place. Health disparities don’t exist out of nowhere. They exist because the doctors we currently have (a mostly white and Asian contingent) don’t provide care in a just way. At the macro level, the government throws money into medical research for diseases affecting mostly white individuals and diseases that affect mostly Black get chump change. At the clinical level, the doctors we have will say that patients are non-compliant with medication (which, by the way, is an inappropriate term), won’t listen to medical advice, and they’ll “grow up to mug my grandmother” as excuses to provide inferior care.

Which gets me to my second point…

2. It is almost (almost) unfair to ask white and Asian doctors to provide culturally competent care. They can’t be the only ones caring for all communities in the US. Unless you’re also saying that you’re a White supremacist, you agree that the communities of color in the US are here to stay and need care that is responsive to their needs.

White doctors have been asking Hispanic and Latinx families to stop eating so much starch for as long as we have been able to put a white doctor and a Hispanic or Latinx patient in an exam room together. The fact of the matter is, starch is a huge part of the cultures of this group and our Hispanic and Latinx patients are not going to change their entire way of life because they have been eating this stuff for centuries. Also, guess what, Hispanic and Latinx folks have more metabolic illnesses and heart conditions the longer they live in the US than they do on their homeland. Meaning their cultural diet has a limited amount to do with the illnesses they present with to the office.

Before you say that they should go back to where they came from, I urge you to realize a little bit of history. They are in the US because of the crap that the US has pulled on their homeland. The US has time and again gone into these countries and left them to war-torn and in poverty. The folks that were able to immigrate to the US do so in search of a better life than the one the US left them.

I am not saying that it is impossible for White and Asian doctors to care for all communities, they simply don’t have the best track record.

3. When you say we are unqualified and “not as good”, I invite you to entertain the notion that you can’t be a mediocre doctor (academically, you can certainly be a shitty doctor in other respects, but that’s a separate blog post) because they don’t let you.

Do you know what we have to get through in order to be named MD? You have to have been an excellent elementary school, high school, college, and medical student.

Yes, elementary school counts too because well, you wouldn’t send your kid to a school in the South Bronx if you had the means not, now would you? You wouldn’t because historically, they’re not the best places, and don’t produce the best students. The foundation a kid in this environment receives is not the sturdiest, right. The word gap is a thing that exists, right? There are violence and drugs everywhere you look, right? No one is teaching them to take standardized exams, right? You’d be crazy to send your kid here because sending your kid here would mean they start life at a disadvantage next to your friend’s kids. Yet, it’s crazy that some kids hailing out of here will be seated next to yours in the medical school classroom–and believe me, Affirmative Action didn’t hold any of our hands getting there. It simply recognized that we started the race with one of our legs missing and will get to the end of the finishing line at some point too.

You have to take a gazillion exams and not just pass them but excel at them. If you aren’t performing, they make you do it again until you do—because human lives are at stake!

Even after you have an MD, they don’t let you practice on your own until you have at least completed a residency. Which is hell for every resident I have ever spoken to–insane hours, attendings chewing you out in front of patients, competing with your colleagues, incredibly subjective evaluations, the list goes on. Not to mention the Boards examinations, for which we study months and months for. Have you ever studied for anything for months?

For those of us who have had very little support and resource growing up and while in school, its a miracle we even made it to medical school! We didn’t get in because of Affirmative Action, we got in because we were good enough, because we volunteered and worked in labs and never took the summer or other breaks off. We got in because the admission’s committee thought that our personal statements and letters of recommendation said we would work to diminish health disparities and bring health care to all people. We got in because they knew we could take on the course work, they knew we had the passion and commitment to do well in an everyone that is dog eat dog, incredibly cut throat.

We certainly won’t graduate because of Affirmative Action, we will have done that on our own. There’s no special treatment in the lab while dissecting your donor. There’s no special treatment in the classroom when a question is asked. There’s no special treatment on exams (they are taken electronically and the grader is blinded to who’s exam they are grading). When we graduate, that MD after our names will have been earned with arguably more sweat and teardrops as any White or Asian student will have shed in the process–because we had little support and a not so solid base to stand on…oh and all the naysayers telling us we won’t ever be good enough all along the way.

Lazy Poor People

My mother used to make $18,000 a year. I know this because I helped her do her taxes each year and when my sisters and I started applying to colleges, we had to put that number into our forms.

My mother used to make $18,000 a year and, God only knows how, she stretched that to pay rent, feed us and she still somehow had some to send back home so that my grandma and brother could eat too.

My mother used to make $18,000 a year while working about 50 hours a week and going to school at night and still making sure her three daughters made it home each day.

Jason Chaffetz recently suggested healthcare is accessible to all if only people spent their money wisely. He suggested poverty results from stupid choices.

Here’s the thing Jason, dear…social mobility is really hard in America, especially for the marginalized.

Harvard’s Nathaniel Hendren, a co-author on a study that looked at how likely people are to advance to higher income brackets in the US, told NPR that “In areas, say, like Charlotte, N.C., kids born in the bottom portion of the income distribution have about a 4 to 5 percent chance of reaching the top…but kids born in, say, Salt Lake City, have about an 11 percent chance of reaching the top if they’re born to a poor family.”

When asked why social mobility is so hard Erin Currier, the director of the Economic Mobility Project at the Pew Center on the States, said “we would expect that parents’ educational attainment and their socioeconomic status would matter for children’s educational attainment as well…But if it was just the transmission of advantage, we would see that as a similar gap across countries. And the fact that there are differences points to environmental factors mattering, so policies in institutions that people interact with throughout their lives. The bottom line is that the United States tends to look the worst on all of these measures.”

“What policies and institutions?”, you might ask Jason, hmmm…let’s see, off the top of my head:
1. Debt buying is a thing that is legal
2. Multilevel marketing targets specific populations and that’s okay
3. Housing loans have historically had higher rates for some people and that seems fair: “Discrimination in housing and the wealth disparities are inextricably linked: Housing has been the primary mechanism for wealth creation in American life. But access to fair housing — and fair avenues to homeownership — have remained one of the country’s most entrenched racial problems. During the economic crisis of 2008 and 2009, blacks and Latinos effectively lost decades of wealth; by 2013, white household wealth was nearly 13 times that of black households and 10 times that of Latino households.” -Gene Demby, NPR
4. Credit card interest rates are higher if you’re Black or Hispanic, two populations with high percentages of lower earning individuals and you’re not doing anything about that.
5. The poor can’t afford to keep their money in the bank, which ends up being more expensive
6. Education, the great equalizer, hasn’t exactly panned out for most children living in poverty. These children are more likely to be absent and to drop out of school, because they need to help at home with income. Not to mention that all the public schools resemble prisons, that the teachers in these classrooms are not only unqualified, but they remind each child they won’t amount to anything each day by lowering their expectations, and that these schools are ill-equipped to deal with the population of student they receive. Yet, look who our secretary of education is and what she’s up to.
7. Living in poverty breeds bad health, which is a pre-existing condition. You would think we would want to prevent bad health from being a thing that happens in the first place.
8. We treat the homeless like lepers all the while they are more likely to need psychiatric help than the general population so that they can actually function in society and you know, not be homeless.
9. We incarcerate criminals guilty of theft, selling drugs and other nonviolent crimes, especially those of color, instead of offering rehabilitation and teaching them to use their skills so they too can function in society and you know, not need to steal to feed a hungry child.
10. Somehow a bag of chips is cheaper than a potato, the healthier version of the two–making the choice between the potato and the chips pretty easy for someone earning minimum wage trying to feed her kids who will end up fairly unhealthy because of this unfortunate choice that isn’t much of a choice and others like it. And then, they can’t afford health care so they accrue all of this debt in getting their health cared for.
11. Voting power is nonexistent for the poor and the already marginalized racial minority; they didn’t put you in your current position, Jason, had their vote counted more than others, they would have chosen someone else.

Laws and Policy have shaped the ability for poor folks to overcome poverty.

So no, your health care isn’t accessible to all if they just made better choices. One could even argue there aren’t many choices to make as a poor individual because they are all made for you.

My mother used to make $18,000 a year and she must have made some really stupid decisions, according to you, to still be undeserving of health care.

She deserves affordable health care because it is a human right.

If you’re not going to change the policies that keep people poor, at least attempt to not, you know, basically also kill them.

 

If you’re single on Valentine’s Day

Do you know why people hate group projects? It is because people don’t pull their weight. Apparently, holidays are an excuse not to.

At school, the 100 of us med students are split up into groups of about 10 each course. Each time, the ten people are different, or at least they should be. Within these groups, our job is to come up with what we’d like to learn for the week and then ensure that we all know it by the end of the week. To accomplish this, we split some of the work each week, but there’s no assigning of the work. Essentially, you call it if you have an idea on how to best present the material.

This past Tuesday was Valentine’s day. So on Wednesday morning, where we usually have about 4 students lead the discussion, we only had two people prepared to do so. A lot of this can be attributed to how hard the week’s material was and how little it lent itself to critical thought. Some other parts of it can be attributed to the coupled-up individuals in the group taking the night off.

It turns out that one of the girls in my group was asked if she was preparing anything and she replied: “no, let the single people take care of!”

Okay…

When did this become a thing? You can shirk responsibilities if you have a significant other now? You can say, not tonight because I have a date, even though others are depending on you? And what’s worse, those who are single have to take on that responsibility, be punished for not being in a relationship?

I don’t think I understand how this world works.

What have I missed today?

Today, while heating up my lunch during the 5 minutes I had to get between lab and a meeting with a professor, I asked 2 other classmates standing nearby “did Trump do anything while we were in lab?”

Sure enough, he had signed executive orders to resurrect the Keystone and Dakota Access pipelines.

My face dropped.

The second classmate then said “ugh…I was getting so tired of having to watch the protests on the news!”

I just looked at her, not knowing what to say next.

I think she was trying to sympathize. That’s the problem with this whole situation to you???

That’s the problem with this whole situation to you??? That they are on TV? Is it an inconvenience? Do you think that was the goal the whole time–to get on the news every day? Did you want newer news? Are you upset there will be more protesting? Do you want the news to focus on something else? Just what else would you like them to report on? Are there other happenings across the US we should be reporting on more?

Please explain.

Favorite commercial of all time

This is, to me, one of the best commercials ever. Every time I watch, I tear up. It seems to say so many things in so little time. It says, yes, there can be peace. It says, yes, love conquers hate. It says, we are all the same–we all kneel on our two knees if and when we pray. And it is a very much needed reminder of all that after all the hate overseen throughout 2016. What is most important is that we are tolerant each others’ differences and care for each other even though we may disagree.
Way to go Amazon.

Grow a backbone!

Before leaving home from a long day at school, I tend to stop by the security guard’s desk. He’s a super nice guy and I respect him deeply. All of my fellow classmates hang out with him at the front desk at times and care enough to offer him pizza whenever we are having class events at which pizza has been catered.

A couple of weeks ago, we talked a little bit about microaggressions. I had been fuming about yet another comment made by an undereducated classmate, I can’t even remember what that was because this, to me, was worse.

I argued that I people need to be more aware of the things they said.

He told me that I need a backbone.

Then it turned into an argument about economics.

He argued that he and his parents are hard workers and shouldn’t have to pay for other people’s children’s schooling when he has his own kids to pay for.

I argued that had it not been for scholarships, I would not be where I am today, that scholarships are necessary for people who cannot pay for an education and yet are every bit as deserving of one as someone who could. I mentioned that his son will inherit a house and possibly other assets while I, the daughter of an immigrant who, try as she might couldn’t achieve her dream of becoming a doctor, will inherit the debt she accumulated in pursuit of said dream.

He then recalled that he, as a cop, worked in areas like the Bronx and Hempstead and that every inhabitant did the same thing every day, most of which, he asserted was stand on the corner. He called the people of these areas and areas alike lazy. I understood that statement as an insinuation that I somehow cheated the system, that I got into medical school because it was handed to me for less than it was worth to other students. It’s a familiar standpoint–the minority only got in because of Affirmative Action.

A GPA worthy of Dean’s List at one of the nation’s top private universities is not Affirmative Action. Doing research through dawn every summer is not Affirmative Action. Interviewing at 7 medical schools is not Affirmative Action.

I struggled to argue that the schools in the poor income areas are shitty–even the teachers believe you won’t amount to anything. That the employers see last names or hear an accent and immediately surmise you won’t be good enough for the job. That when you have systemic conditions like these, yes, it will be incredibly difficult to actually amount to anything.

He is definitely someone who believes in bootstraps, which is not at all a bad thing, but it is somewhat flawed. It is hard enough to pull your boots up, but when your bootstraps have been nicked from the start, there’s only so far your boots will go. And when the metric for establishing someone’s character is whether the boot has been pulled up, it is important to take into consideration the amount of effort that it took to get the boot up in the first place.

He didn’t quite see that his son started wanting for nothing and will encounter little resistance on his way to further establish wealth that will allow him the opportunity and the privilege to pay for his children’s education. I and my friends started with nothing and have encountered many an obstacle and it is grit that has gotten me this far, not handouts.

I just so happened to be carrying an article about a young MD, soon-to-be-MD Ph.D. of Mexican descent who had just finished giving his dissertation and I left it with him. I joked that he must give me a full oral report on it the next day. I was trying to make the point that microaggression is a thing we see constantly that reminds us every day of where we came from and what people think that automatically means–less than, unintelligent, vagrant, lazy.

This physician was waiting for his car at the valet with his wife. While he waited, a car approached, a lady dressed in fancy threads go out on her way to the next event at the venue and handed him the car keys. He looked the part of a valet because he is of Mexican descent and remained so well after earning his degrees.

He read the article and then told me that the writer had lied and that “white privilege is not a thing.”

At that point, I was done talking, I was tired of trying to change the mind of a fifty-something-year-old man who has lived his fifty-something years believing that I am worthless and a burden to society. I am literally standing in front of him–a girl from the Bronx and Harlem who grew up in a single-parent home making well below the poverty line, who went to lackluster public school–a disadvantaged girl turned medical student, having worked immensely hard to get to here and working harder than I thought was possible just to pass my exams, and he is essentially saying that it is all for naught. He is essentially saying that I will always be where I came from and that where I came from produces nothing good, nothing that survives without leeching from the system.

One of my friends chimed in that first night with “we’re not asking for your hard earned money, we are asking you to be a good human being” which I thought was especially poignant.

All we ask is that you take a look at our color or our economic status and decide that those things don’t define how tenacious, creative, or adept we are. All we ask is that you understand and are sympathetic to the circumstances that lead people to their current state in life. All we ask is that you realize that yes, your ancestors worked hard, but they didn’t have to work from a legacy that devalued and negated their every move. All we ask is that you consider that if we started 10 miles behind you and are somehow still running the same race, we must be darn good at something and that we might be worth more than our stereotypes.