To the organizers of the AAFP Adult Medicine Course,
I just attended the Adult Medicine Course in Phoenix Arizona, and wanted to take a moment to share some reflections and feedback with the organizers of this event. There was a lot of important, succinct, and relevant material that was presented in the four-day conference, and I am grateful for some of the clinical highlights I was able to take away from it.
However, I was disappointed with some core structural issues of the conference, and wanted to take the time to bring up my concerns, as well as provide some suggestions for things to consider in the future.
I think we are in a moment in society and in medicine, where there is an invitation and social responsibility to acknowledge the impact of structural oppression and inequity on health. We are in a time of greater wealth inequality than ever before, a time of climate change induced crises and migration patterns that are affecting health globally, a moment when movements for racial justice are drawing attention to the ongoing epidemic of daily police murders of people of color. We are living under a presidency that is assaulting our healthcare system, decimating the reproductive rights and access to reproductive choices of most women, and where millions of elderly, poor, and otherwise vulnerable Americans are facing the loss of health insurance.
I believe we are in a moment where it is no longer acceptable for large, well respected, healthcare leaders such as the AAFP to not only ignore these issues, but in fact reproduce the same oppressive dynamics that we are seeing under our current administration, and in the worst of our society at large.
In the entire four-day AAFP Adult Med conference, there were exclusively white, male, physician presenters. This is concerning for a number of reasons. There are growing numbers of female and people of color physicians and allied health professionals, and it is only appropriate to have presenters at a conference reflect the demographic of the field. Further, due to the socialization process within a society that systematically prioritizes men over women, white people over people of color, and educated and/or wealthy people- like physicians- over working class people, there are countless blinders and biases that white male physicians have been socialized to carry-albeit often unconsciously. This lack of awareness and lived experience from a diversity of identities creates gaps in knowledge of the presenters, and robs participants of a comprehensive educational experience.
I wanted to share just a few of the numerous examples of how the presenters reinforced oppressive dynamics and stereotypes throughout the conference.
- One presenter made a joke about “you know…the obese woman stealing Halloween candy from her neighbor and then demanding thyroid replacement”. This exemplifies the unacceptable sexism and body shaming in western medicine, which reinforce negative stereotypes about women, and especially obese women. There were a number of body shaming remarks throughout the conference that exemplify the fatphobia physicians consistently enact on patients in ways that are both dehumanizing and oppressive.
- In the hepatitis C case presentation, I noticed that the majority of the case studies were of African American patients. The over-representation of African American people in the hep C case studies reinforces negative stereotypes of African Americans through subtly implying that there are disproportionate Black IV drug users, as well as eliciting other narratives of anti-Black racism such as African Americans being “dirty” or “infected”, which have been inherited from generations of slavery, Jim Crow segregation and persistent manifestations of racism today.
- One presenter continually referenced and projected his own Christian values. He made several comments such as referring offhandedly to “Jewish culture” when talking about religion, and telling the audience that, “everyone should just be monogamous because it’s safer and better”. This kind of Christian dogma from a presenter in a position of power is inappropriate at a medical conference that likely has participants from a variety of religious and spiritual backgrounds. Further, it is an unacceptable model for patient care in a time where non-Christian religions and especially Muslim people are being targeted and threatened at increasing rates.
From the AAFP website:
The American Academy of Family Physicians (AAFP) has a long history of supporting health equity and reducing health disparities in patient care. In fact, one of the key strategic objectives of the Academy is to “take a leadership role in addressing diversity and social determinants of health as they impact individuals, families, and communities across the lifespan and to strive for health equity.”
This ethic and commitment I see articulated on the Center for Diversity and Health Equity AAFP page was sorely lacking from the AAFP Adult Medicine Conference. Beyond the specific examples I provided, there was a consistent lack of analysis around this core understanding of social determinants of health and how they impact our patients. This was demonstrated repeatedly, as presenters would provide racial demographic information such as the risk differential between African American and white patients in regard to ASCVD risk without any context or acknowledgement of why African American males’ 10 year ASCVD risk is 6.1% as compared to 2.1% in a white female with the same risk factors. Without the appropriate framing of how social determinants of health impact health risk and outcomes, this information is implicitly interpreted as inherent or genetically driven, which is not only inaccurate but a missed opportunity to invite providers to better understand and address the social determinants of health and the health disparities that result in these risk differentials with our patients.
I am not suggesting that you make a superficial effort to “diversify” the presenter team by inviting in a token female or person of color presenter. Rather, I am inviting you all as leaders in family medicine education nationally to consider intentionally reflecting, evaluating and addressing these dynamics to improve the quality of your work and conferences in the future. People of color, women, LGBTQ and other marginalized people have a lot to offer the field of family medicine education. This might require asking the difficult questions such as; Why did we organize a conference with all white male presenters? What barriers exist that would keep qualified women, people of color or LGBTQ presenters from playing more leadership roles? What steps would we as an organization need to take to truly move towards our stated goal of addressing diversity and social determinants of health and strive for health equity? What kind of resources, time, money and support would be necessary to authentically work towards organizational transformation that addresses white male patriarchal standards and uplifts the voices and leadership of people of color, women and LGBTQ people?
As an organization that makes tremendous contributions to medical education and care Nationally, I hope that you are able to invest the appropriate time and resources to ask the difficult questions.
Leah Jo Carnine