Sometimes, it’s more than I can take to see the flaws in our health system and the archaic medical educational system that goes along with it. The levels of chaos, injustice, and downright negligence that pervade medical practice boggle my mind every day, as does the amazingly tolerant and even blind eye we as medical providers turn towards these issues.

I’ve come across a problem in addressing these attitudes: If anyone calls them out for too long, they become marginalized and lumped into the “things to ignore” category.

Perhaps before they hear me talk about these items, colleagues include such issues as racial injustice, the blatant discrimination against LGBT patients, the negative impact of providers’ unconscious bias on patient care, and  the role of social inequities in poor health in the “things to ignore” category. So when I come to them with my concerns, suddenly the “things to ignore” category includes “Jim Anderson” in addition to the other items.

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This bind reminds me a bit of the common perception among some of my closest friends about the “natural” nature of capitalism. The one sure way to get tuned out at almost any gathering is to bring up capitalism as something we should think about challenging.

The same reaction happens when discussing gender roles. For instance, if I have a friend who says, “Oh, she’s such a girl!” about a 1-year-old child who is dressed to the hilt in pink, lace, cute little shoes, and a hair bow. If I dare ask if such a perception might be a little self-fulfilling, or describe what I see as a possible negative health consequence of society’s bizarre need to socialize children into gender roles before birth, well it’s back on the “things to ignore” list.

All you can do then is take these concerns underground, offline, or out of sight. You can “Trojan Horse” it as well, like trying to get a “racial inequalities in health” topic onto a CME conference schedule. “PAs don’t want to sit and hear about racism; they know about this already. They want to hear about new COPD guidelines. Blah, blah, blah…” The only way to get even a cursory review is to hide the disparities or the bias topic by framing it like “Cross-Cultural Perspectives in Cardiovascular Disease,” etc.

I guess all you can do is keep plugging: keep attempting to assess and address racial and ethnic inequalities in every patient encounter, keep trying to find subtle ways to keep social inequality on the medical profession’s radar, keep striving to connect with the millions of other PAs, MDs, and NPs who share the same concerns, and keep identifying the excellent work being done in these areas by other organizations and colleagues who have not been placed in the “things to ignore” category.

Nevertheless, it still burns and still hurts to be part of a profession that, in so many ways, willfully chooses to ignore the social forces and inequality that harm and betray so many of our patients.

Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is a physician assistant in Seattle, WA.