Medicine Is Getting Woke

September 2022

“Good morning. I would like to see Dr. Woke.”

“Of course. Let me check your ethnicity and your position in the oppression hierarchy. According to the Oppression Questionnaire you filled out when you registered with our clinic, you are a straight, white male. As a straight, white male, you score extremely high in the oppression hierarchy. Indeed, you classify as Master Oppressor. So, for you, Dr. Woke can only see you in a month.”

“A month? This is a bit long! I feel unwell and I think I cannot wait for a month.”

“People lower in the oppression hierarchy are usually seen the same day, given their status as historically marginalized groups but Master Oppressors are privileged. You will do fine; white people do not really suffer. We are very committed to equity and restoring justice at Dr. Woke’s clinic, situated in the traditional territory of our Native ancestors!!”

This exchange may seem to you absurd and dystopian but maybe we are not so far from such a reality. We are already seeing some signs. The State of New York has made race a preferential criterion to access some treatments for COVID-19. A document titled “Prioritization of Anti-SARS-CoV-2 Monoclonal Antibodies and Oral Antivirals for the Treatment of COVID-19 During Times of Resource Limitations” clearly states: “Non-white race or Hispanic/Latino ethnicity should be considered a risk factor, as longstanding systemic health and social inequities have contributed to an increased risk of severe illness and death from COVID-19.” The criterion here is not medical but social. This preferential access has been challenged in a lawsuit against New York State, which was promoted by the Foundation Against Intolerance and Racism (FAIR).

Sally Satel, an American psychiatrist, is also worried about the woke trends in Medicine and the contamination of Medicine with the social justice agenda. In an article she wrote for the online magazine Quillette, Dr. Satel mentions a document from the American Medical Association (AMA; the main association of physicians in the United States). The AMA wants to create a new language to replace “the limitations and harmful consequences of some commonly used words and phrases”. For example, it will be forbidden to use adjectives such as “vulnerable” and “high-risk” or words with violent connotations such as “target,” “tackle,” “combat” when referring to people, groups or communities. It will also be forbidden to describe individuals as obese or refer to the morbidly obese.

This document, while pointing to some important social determinants of health, also explores “power relationships” and calls for a redistribution of power and resources, which means white people need to be punished and persons of color rewarded.

Another example from the same document: according to the AMA, you cannot say, “Low-income people have the highest level of coronary artery disease in the United States.” You have instead to say: “People underpaid and forced into poverty as a result of banking policies, real estate developers gentrifying neighborhoods, and corporations weakening the power of labor movements, among others, have the highest level of coronary artery disease in the United States.” In order to be a doctor, you have to think that capitalism is evil and you have to fight it.

The same AMA position paper criticizes what it calls “The narrative of individualism”, which means the Classical liberal ideas that made our Western world a better place. The AMA criticizes one concept in particular: meritocracy. It is worth quoting the paragraph, to give a sense of what will be expected from a doctor: “Among these ideas is the concept of meritocracy, a social system in which advancement in society is based on an individual’s capabilities and merits rather than on the basis of family, wealth or social background. Individualism is problematic in obscuring the dynamics of group domination, especially socioeconomic privilege and racism. In health care, this narrative appears as an over-emphasis on changing individuals and individual behavior instead of the institutional and structural causes of disease”. So goodbye good old individualism, say hello to collectivist thinking in medicine.

The situation is not much better in Canada. In March 2021, Kirsten Patrick, the interim editor-in-chief of the Canadian Medical Association Journal (CMAJ; the most important medical journal in Canada), wrote an editorial taking a clearly Ibram X. Kendi-like antiracist position for the journal she leads. She stated: “I will work to further an antiracism agenda at the journal. In the short term, to alter the balance of power among those who make editorial decisions, I will seek to add an editor with expertise in critical race theory to CMAJ’s editorial team […]”. She also planned to subject the editorial team to unconscious bias training, an approach that is not supported by the best available evidence and can even create less tolerance (Kalev et al, 2006). To make matters worse, more and more hospitals in Canada (including the one where I work) are now requiring their staff to undergo Diversity, Inclusion and Equity training with its usual curriculum of “structural racism”, “unconscious bias” and all the woke buzzwords and flawed concepts. Also, job ads for physicians, particularly at the administrative levels, frequently require applicants to write a Diversity, Inclusion and Equity essay, seemingly to vet out dissenting voices. The 2022 Canadian Conference in Physician Leadership, that I attended, was all about Climate Change emergency (yes, physicians also need to work hard to fight Climate Change) and, obviously (you guessed it right!), structural inequities.

That’s not all: a more recent letter was published by CMAJ on June 13, 2022. It was written on behalf of Canadian associations of pediatric surgeons. The letter advocates for antiracist practice for all pediatric surgeons in Canada. The authors state that “although slavery was outlawed in Canada 27 years before the United States, Black people have continued to face restrictions of their civil rights”. Interestingly, they do not quote any document to support their claim. Moreover, once again, they want antiracism and unconscious bias training to be mandatory requirements for continuing medical education in Canada, across all programs. In spite of being an association of physicians, and thus followers of evidence-based practices, they seem not to be aware of the flimsy evidence behind unconscious bias training. Ideology has trumped science.

Doctors are now asked to become not the healer of sick people but agents of collectivist social justice and social change. Healthcare change, in itself, is not a bad thing: the Canadian healthcare system can be harsh and unforgiving and needs to be deeply reformed. However, there is only one direction of change allowed: the woke direction.