Poison Embedded in the Education of Doctors
By Allon Friedman, Brownstone Institute
As the Trump administration expands its battle to stamp out Diversity, Equity, and Inclusion ideology by targeting medical schools and hospitals, recent interactions with medical trainees highlighted just how entrenched this ideology has become in the education of doctors.
I am a medical faculty member at a major Midwestern medical school and am frequently accompanied by medical students and residents during hospital rounds. In recent years, I have noticed that fewer and fewer of them wear the traditional white coat. On that particular day, for example, I happened to be the only one in my team of six wearing one. So I asked them why. The response? Wearing white coats was discouraged by medical educators due to concerns about power inequalities between doctors and patients.
After my initial shock wore off, I realized that this line of thinking was familiar. It came from critical theory, a political school of thought developed by Marxist thinkers in early 20th century Germany. Critical theory views societal interactions – from the individual to group level – entirely through the lens of power dynamics, and when this theory was imported to America’s shores, it morphed into critical race theory and ultimately into DEI.
Applying DEI to the wearing of white coats introduces obvious contradictions and problems. Though medical schools have “white coat” ceremonies to remind their students that they have entered an ancient profession dedicated to humanism and patient care, nowadays students are apparently dissuaded from wearing such garb when caring for actual, real-life patients. What proponents of critical theory in medical education clearly miss is that while there is an obvious power imbalance between physicians and their patients, patients willingly enter into such relationships because they trust that physicians will use their power not to oppress, but to heal. In fact, studies find that physicians who wear white coats instill greater confidence in their patients than those who do not, so the application of DEI in this instance actually undermines the physician-patient relationship.
After rounds, I helped review a medical student’s medical note-writing skills. Writing a patient’s medical notes, including the initial one usually referred to as the “History and Physical,” is a foundational skill taught to all medical students and an essential part of medical practice. More than just a medico-legal document, the H&P is designed to encapsulate the patient’s background information, presenting illness, physical exam, and laboratory findings in a manner that leads in a logical fashion to identifying the most likely diagnosis and establishing an appropriate treatment plan. The skill of H&P writing is an art and its perfection can take years.
For decades, medical students were taught to begin the H&P with a simple descriptive sentence that included the patient’s age, sex, and race as fundamental identifiers that help in beginning to hone in on the cause of the patient’s illness. In this instance, the medical student notified me that educators now teach that race should be removed from the opening sentence and relegated to a less perused subsection of the H&P.
This did not surprise me. In recent years, the concept of race in medicine has been treated in a strangely paradoxical manner. On the one hand, advocates of DEI in medical education and research obsess over race in ways that relegate it to supreme status, similar to what has been seen in society-at-large. On the other hand, using race as a neutral concept that can help properly diagnose patients has been deprioritized, as in this example. Physicians are now routinely taught that race is a “social” concept that has no biological relevance, despite indisputable evidence that some inherited diseases are more or less likely to exist depending on a patient’s genetic heritage, which is reflected in large part by race.
While most physicians likely still take race into account when considering possible diagnoses in their patients, the idea that race is now subordinated in the diagnostic exercise even though it offers so much useful clinical information is disheartening, as the exercise is essential to the intellectual training of medical students and the proper diagnosis of patients. As with the white coat example, the end result is the subversion of medical education and weakening of patient care.
The singling out of race as a factor that must not be considered like other demographic characteristics are also reflects a distrust in the ability of physicians to evaluate race in a mature, impartial, and unbiased manner. There is something both degrading and infantilizing about this from the physicians’ standpoint. The desire to control how physicians think also raises power dynamics of a different sort, this one controlled oftentimes by non-physician bureaucrats who advocate for DEI.
I have no doubt that innumerable other examples of DEI have embedded themselves into medical training across the nation. This has ominous implications for the practice of medicine and is essentially death by a thousand cuts. The public must pay more attention to this issue since they are the ones who will ultimately pay the price. As for the government, if the Trump administration is as serious as they seem to be about removing DEI from medicine, they will need to tackle it not just on the budgetary front but on the front lines of medical education.
Allon Friedman is a Professor of Medicine at Indiana University School of Medicine and a medical researcher focusing on topics related to kidney disease. The ideas expressed in the article are entirely his own and not necessarily those of his employer.
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