Updated: Aug 29
In the aftermath of the murder of George Floyd, I have seen pathologists on social media share their perspective from behind the microscope (paraphrased):
“The microscope doesn’t highlight what race or appearance people have. We diagnose the histology which is the SAME for all humans.”
“It doesn’t matter what beautiful color of the spectrum you are, I just tell you what’s wrong so you can get better.”
“I wish all physicians could be like pathologists – making unbiased diagnoses from behind a “microscopic curtain .” “
In the deepest sense I agree with my peers; yes, we are all the same. I am able to diagnose your brain tumor, your breast cancer, and your dermatitis because they all look the same. It’s Human Pathology, not Chinese, Tanzanian or Mexican Pathology. Race is a social construction. I don’t treat biopsies from different patients differently.
I share these pathologist’s workaday familiarity with the human body and I think they have good intentions in sharing their perspective.
So I’m open to their positive intent. I just think they’re not looking at the bigger picture.
Physicians in general are excellent at excusing our role in the inhumane American health care system and abysmal health of Americans. You'd think the proof of worsening health outcomes would dampen our confidence, but I hear physicians regularly say versions of the same thing:
I am the exception.
My department is good.
My specialty is working to be more inclusive.
Pathologists would like to be more included and recognized on the health care team. I receive regular, urgent letters from Pathology professional (lobbying) organizations exhorting us to get more involved with the hospital at large. We pathologists are just like other doctors! We need to claim our role! We are not just tissue technicians! We are an important part of the patient care team!
But now, in this moment of unrest over human rights, many of these same pathologists write and say that we are the exception. We see only biology and we advise everyone in medicine to strive for this. This is the philosophy of biological essentialism.
By prescribing biological essentialism as the solution to medical racism, these pathologist advocates are getting ahead of their own advice. You can’t have it both ways - either we are part of medicine and should reflect on our role in the racist practices of medicine, or we are technicians analyzing parts of people.
What would it mean to reflect on our role in the racist practices of medicine?
Maybe start with some humility and curiosity. We are not just observing, documenting and diagnosing biology. We are looking at the end result of human experiences in this society and their experiences in health care. We receive specimens obtained within the racist capitalistic health care system. These pieces of tissue come from humans who experience social determinants of health outside our field of vision.
What if we considered our perspective an illusion of colorblindness? Things under the microscope are distorted by society and we don’t acknowledge this. What if, just as one of potentially thousands of ideas, our institutional pathology departments emphasized environmental diseases, focusing on environmental racism? Injustice can become disease.
Under the microscope it seems as though we’ve isolated an innate and natural 'essence'. We want to believe this because it seems purer than dealing with the reality of disease as a product of circumstances and culture - a culture that we, the ‘objective’ eye behind the microscope, belong to. It might feel easier to excuse ourselves from the system we are baked into. We can defer to professional race relations consultants that are hired by the institution’s graduate medical education department. But to say that we in pathology stand outside this system - which alters everything it touches - is like isolating values while ignoring the Heisenberg uncertainty principle.
I have several caveats to my commentary that I’m totally aware of in writing this.
I’m not in academic medicine, which is where most of the action happens in pathology. No one really wants to hear from someone like me. The tone of these essays reminds me of why I didn't like academics; I'm generally allergic to self-congratulation. Although I’m not in academic pathology, my time there means I can well imagine an academic pathologist’s scornful reaction to the phrase ‘Injustice can become disease’.
As a white person, anything I write about antiracism is derivative. I would never have written this were it not for the original authors' statements. Interestingly, several of the posts about being a colorblind Pathologist also talk about the author’s experiences as a person of color and an immigrant in our society. Those moments they shared, of vulnerability and injustice, are more interesting to me than proscriptions for how all of medicine should follow our depersonalized Pathology lead.
When we say things are the same, it becomes easier to lie and ignore root causes. Like another shibboleth of academics, the meritocracy narrative, biological essentialism is a cover for a lack of structural analysis. Things that are actually different about us get framed in a way that plays to the power structures of our society. I’d rather pathologists acknowledged our role in a system that is discriminatory and racist. Denying our culpability in sustaining that system creates further damage and more mistrust. Instead, Pathology could offer a way to see the rich array of colors we actually have.