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Your personal account washed over me with so many emotions.

Once upon a time, when we were in very different financial circumstances than we are now, I took my daughter to emerg for a dental abcess.

I could see that the young female doctor was furious from what she was seeing. After writing the Rx, she spat out at me "And GET her to a DENTIST"

I nearly cried. We had no dentist, and no money. She couldn't know that my husband and I were working ridiculous hours trying to keep a failing business afloat. She wouldn't see that I would be calling a cab to get us home. We had no car.

I try to take this memory as a lesson. You absolutely cannot tell what is going on behind the scenes. I try (but don't always succeed) to give people the benefit of the doubt. Some memories I have of my "customer service" over the years are cringeworthy

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Thanks so much for this comment. I wish I could go back in time and treat that man differently. I don't think he had a mean or racist bone in his body. I assumed that because of his use of a word that grated on me. Plus, I think I had been indoctrinated with the "fact" that there were a lot of racists out there. (I am ashamed to admit it, but I got much of my "information" back then from CBC). We doctors tend to spend our whole lives living with others in the laptop class, and forget that there are other people in the world, and that they are almost entirely reasonable.

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An important article. Thanks for sharing. Your personal account, Chris, will resonate with many truly compassionate people that work in the public sector.

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Interesting timing of this - as today, the article came about about the guy screaming racial slurs at international students on the bus here in CBRM. Not experiencing overt racism is more an indication of a position of privilege, than a representative sample of racism in our communities - you wouldn't have witnessed that, because you don't need to take the bus. And I wanted to match your anecdote with one of mine - I don't often discuss my ethnic descent, as it's not entirely obvious, but spending my formative years in Thunder Bay, when working the showroom floor in a music centre, after a First Nations couple came through, looked at some guitars, and left, the only other guy in the showroom - a white, middle aged man, waiting for his 2 kids to finish their private music lessons and testing a $2500 guitar (if that tells you anything of him), looked at me and said "Man, if I got a cancer diagnosis and had one day left to live, I'd get a machine gun and kill as many of those f#$@(* [indians] as I could." There it was - overt - the father of 2 kids, and I wonder what he says to his friends, to his family, to his coworkers, if he was willing to say that to me, a complete stranger.

In truth, as a CFA that isn't obviously a CFA in Cape Breton until I have conversation with people, we see this perspective play out in most of our circles - at work, volunteering, and in our leisure activities (running groups being the exception to this rule). As a well educated, well employed person who "looks" to be of the proper descent, I have been pulled aside and been told "We do things differently here, and no offense, you're not from here and so we don't want your ideas" by many people. As someone being told I'm "less" than "natural born Cape Bretoners" (as if that's a thing), it's an easy transition to knowing that overt racism - that seeing and treating people as less than yourself simply because they look a different way - is a thriving mindset here.

Twisting the narrative to say "He wasn't racist, he was just uneducated" is an important perspective - it is not a medical professionals job to "educate" people who are unintentionally (or intentionally) "overtly" racist. The gentleman in your anecdote - would he have said the same about a white soft-spoken female Doctor he wouldn't be able to hear as well (I'm sure glad your not the woman)? Hard to say - but what I can say is that we have been divided into a dichotomous society, where people who genuinely would benefit from the opportunity to ask questions that society deems uncomfortable could - guilt free - and that as such their limited perspective comes out at the wrong time - in an emergency setting where they are in pain. You shouldn't be the teacher in a setting that they shouldn't be a student in (at least for non-medical related things).

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This comment is unfortunate. I didn't "twist" the narrative. I said what I think was the truth about the man. You have given 2 examples of overt racism. In a country of almost 40 million people. It proves that it exists, but not that it is rampant. And certainly your 2 examples from your life are not evidence that doctors should be charged with fixing racism.

All humans are naturally tribal. Julie was frequently asked "Where are you from" when she moved to Cape Breton. It didn't mean that people didn't want her here, it meant that she had an accent and name that was unfamiliar. In a small community, it actually means "Hi, I've never met you before, tell me a bit about yourself so we can connect".

Cape Bretoners (I would argue all people, and especially those from islands) are naturally insular. There are logical evolutionary and cultural reasons for that. I highly recommend reading Douglas Murray's "The Strange Death of Europe" or, if you want to go deeper psychologically read some Joseph Campbell about culture and myth. Or for a lighter touch listen to Coleman Hughes or Camille Foster speak about these issues. Canada and the US remain the LEAST racist countries in the world by any measure. Anecdotes don't change that.

In answer to your speculation - yes, I think the patient would have said "I'm glad it's you and not the lady doctor" if he had an experience with a soft-spoken female (most hearing-impaired people lose high-pitch acuity before low, so hear male voices better on average). And that wouldn't have made him misogynist.

By the way, I really dislike the word "privilege" in the way it is now used. Different people have different "privileges". We are all individuals, and have different experiences. I have "tall privilege" but that's actually a disadvantage sleeping in a single bed, or when flying in economy. Ii would argue that the child of a black millionaire might have far more "privilege" than the white child of a single mom with a drug habit who pimps her out at age 13 (real story). We should never make assumptions about people based on skin colour, as the new woke ideology demands we do.

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Sorry - "twist" meaning we see how you narrate your version of a plausible upbringing and mindset of a person from one interaction with them, so presenting it from only your perspective to narrate a broader theme. I didn't mean it in an accusatory way, and apologies it came across that way. However, while you tell your interpretation of why someone like that would use a derogatory word unbeknownst to him, I see a weird dynamic where you felt it was your position/right to educate him on racialized terms during an ER visit - and from your own story, how poorly it played out for you both. IMO, the hospital is not "ground zero" of battling overt or systemic racism/bigotry/mysogyny/etc, something many institutions and the popular press, seem to disagree with. And to the quoted articles point - biased questionnaires that present leading questions to a group of people who practice medicine continue to blur the lines between what the professional setting is in healthcare, versus looking for "victims" on both sides of the patient experience.

Let me also be explicit - when people say to us "we don't want your input" or "you don't get an opinion because you're not from here", that's not the same as "tell me a bit about yourself so we can connect." It's not a large logical leap to then consider how even more profound this narrative is for people who look different even before they begin a conversation.

But of course - we can trade anecdotes all day of how a CFA Doctor feels "welcomed" in a a medically underserved community versus an imported baker from the mainland. But that's not empirical evidence - we could only speculate to the reason for our different experiences.

Anecdotes aside, what we do know is that minority populations, and particularly first and second generation immigrants to Canada, along with woman, have far poorer outcomes in healthcare - and that's because of a lot of things, some known (language, presentation of signs and symptoms, adoption of a western diet, etc), some still poorly understood (amyloid plagues in dementia rate differences in men and woman, etc.). However, the saying that "95% of treatments are approved from testing them on caucasian males aged 35 - 65", sheds a bit of light to how a system of pharma research is biased in their selection of participants (and how various layers of government allow this bias to happen - actually, almost design it that way). And if our baseline understanding of disease and treatments is inherently biased, it's easy to see how that permeates through all the way to education of front-line healthcare workers through no fault of their own.

All this to say, there is bias in delivery of healthcare, as we see clearly in the diversity of health outcomes for woman and marginalized populations. There is not proportional representation of under represented populations working as HCW's. Where people receive care from people who have the same culture and descent as them, there appears to be more competent delivery of care, independent of other factors. Addressing these bias and inequalities is not the sole realm of healthcare workers at any level, and involves a lot of moving parts.

I don't think there's a single reason pointing a clear path to where we are today. It's unlikely due primarily to overt racism - that may be a very small part in the overall complexity of human biology. But I don't believe excusing racism is a step in the right direction, either - in truth, I can find no evidence to support that position.

While I recognize that my few anecdotes mean not much in the "is Canada racist" conversation - there are plenty of studies describing how we certainly do treat different some races as "less than" Canadian. The ongoing narrative around the fastest growing segment of the Canadian population is the perfect example of well evidenced (and oft-prosecuted) overt racism across our country. Is everyone to blame? Certainly not - but it's not a "fringe" problem either, especially when so many lives are destroyed compared to proportionately representative numbers of other populations measured for the same adverse outcomes.

Lastly, while I did not prescribe your skin colour to you not taking the bus, your point is well taken. "position of privilege" could be anything - education, income, upbringing, gender, race, place of birth, date of birth, height, genetics, whatever... So let me rephrase. You're unlikely to economically be in a position in where you must bus to and from Glace Bay, so your current situation may inherently distance you from being party to overt acts of racism.

And that's completely fine - and why solutions involve many diverse opinions working to a common goal.

Hope you are both keeping well. Cheers.

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Again, I don't think I"m "distanced from racism". I hang around with and see a wide swathe of society. Events happen, get publicized highly, and then people think they are common. For instance, in the USA there are 60 million arrests yearly in a country rife with guns (and someone being arrested is much more likely to be "carrying". Despite this huge number, the police shoot less than 1000 people per year. 1/4 are black. And less than 10 are "unjustified". We listen to the news - whether about George Floyd, or about an incident on the bus, and make sweeping judgments based on these rare occurrences. (Highly recommend reading both Roland Fryer, and Wilfred Reilly about real data on racism especially as it pertains to policing (I realize that's not the focus of our discussion, but is one of the hot spots that keeps people freaked out about supposed "systemic racism").

An analogy is how parents now worry so much more about kids being abducted and harmed, when in fact kids are statistically far safer. It is a very bad idea to formulate your ideas about society based on the lead story on CNN, or the cover of the CB post.

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really good points andy. i agree with you and appreciate your openness

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