Chapter 3: The Culture of "Human First"

Examining the Paradox of “Human First” in a Flawed Healthcare System

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Residency training was the most eye-opening period in my life. The experience of becoming a doctor was exciting and overwhelming. I remember walking onto our L&D unit, overcome by emotion, anxious to prove myself, and terrified of making a mistake. I remember the pure happiness of delivering my first baby; the triumph of flawlessly performing my first emergency Cesarean delivery—moments that define you as a physician. I was part of a unit filled with dedicated staff of physicians, nurses, technicians, and administrators focused on achieving a common goal of providing the highest quality of care to the patients we serve.

However, despite good intentions, good people—people that I respect and care for deeply—have allowed this flawed system to persist. It’s hard to reconcile an institution, department, and culture full of dedicated, honest, personally generous individuals with some of the most negative experiences of my adult life. How can they both exist in the same environment?

Perhaps part of the problem is that we’ve come to rely too heavily on individual goodness—as if good intentions alone can create an environment of equity and inclusion, without deliberate action or accountability.

The motto of our hospital is “Human First.” There are beautiful signs throughout the corridors illustrating large, warm smiles of our community—doctors, nurses, technicians—with the logo “Human First” etched on the bottom. The smiles are inviting and reflect an ethos that we work hard to portray. However, as the newness faded and the cracks began to appear in the veneer, I became increasingly more troubled by what I saw on a daily basis. I started asking myself, as I passed those signs each day: “Which humans, exactly, come first?”

The irony is not lost on me that the history of our hospital is forged in the fire of inequality. Beth Israel was founded by the Boston Jewish community to provide care to Jewish immigrants (and jobs for Jewish doctors) during the times of antisemitism. This history, however, has not immunized us from racial and cultural insensitivity, and sometimes, not even outright threatening racist behaviors.

In fact, this history makes our current state of affairs even more troubling. Here was an institution born from the recognition that discrimination in healthcare was not just morally wrong but actively harmful to patient care and physician development. The founders of Beth Israel understood viscerally what it meant to be excluded from medical institutions, to have their competence questioned based on their identity rather than their abilities, to face barriers that had nothing to do with their qualifications or commitment to healing.

And yet somehow, this institutional memory hasn’t translated into present-day vigilance. The founding story feels more like a framed relic than a guiding principle. It’s no longer a reminder of what exclusion feels like—it’s become a forgotten footnote.

These issues are not unique to this institution and are a reflection of the broader experience of African American physicians, or of African Americans in general, throughout this country. However, it was the first time in my (in retrospect privileged) life that I faced these issues with such frequency and ferocity.

The daily reality of working in this environment was exhausting in ways I had never experienced. It wasn’t just the long hours or the medical complexity—I had trained for those challenges. It was the constant need to decode interactions, to determine whether a comment or action was motivated by professional concern or racial bias, to decide how to respond to microaggressions without being labeled as “difficult” or “oversensitive.”

Racist ideas and behaviors manifest from the mundane to the extreme. To keep this from becoming a laundry list of all the racially insensitive attitudes and actions I’ve seen, I’ll group them into three categories:

1. Exclusionary work culture

2. Racist language, actions, and attitudes

3. Limited opportunities for physicians of color

Let’s start with a benign example, persistent name confusion. Despite dramatically different body types, hair styles, skin shades, and personalities, it’s astonishing how often the four Black women in our program are mistaken for one another. Sometimes it’s a harmless slip—calling me by the wrong name.

Other times, it’s serious: documenting my name in the medical record for procedures I didn’t perform or assessments I didn’t make.

On many occasions in the call room, we have had a collective laugh as we review the medical record and identify the magical black resident who is both everywhere, and nowhere, all at the same time, performing cervical exams from her bed or simultaneously doing a hysterectomy and placing a fetal scalp electrode. I often chuckle imaging this truly magical superhero resident merging all the best qualities from each of us into one superstar human that has truly mastered the art of the multitask.

The humor was our coping mechanism, but beneath the laughter was a more troubling reality. This wasn’t just about names—it was about visibility, recognition, and ultimately, humanity. When people cannot be bothered to learn to distinguish between you and your colleagues, it suggests something fundamental about how they see you, or perhaps more accurately, how they don’t see you.

The department, to its credit, has attempted to solve this problem with a variety of well-intentioned, yet sometimes bizarre, interventions. My personal favorites included magnetic head shots of each of the residents, attached to the board during our shifts. This may have worked if we did not constantly forget to change them when the next shift ended. The pictures were always wrong which further reinforced the name confusion. I did often wonder though how a person could look at my face, and then look at the magnetic face on the board, see that the two faces are different, override that discrepancy in their brain and still call me by the wrong name, knowing that name matches the face on the board not the face on my body.

Another favorite of mine is the growing poster board. What started out as an 8 by 11 sheet with our names and photos has grown in size each year and now the size of science fair poster. As if to suggest that if people could see the names in EXTRA LARGE PRINT, they would remember them better.

These solutions, while well-intentioned, missed the deeper point entirely. The problem wasn’t that our names were too small or our photos too unclear. The problem was that in an environment where four highly accomplished, distinctly different Black women could be routinely confused for one another, something fundamental was broken in how we were being seen and valued.

Sometimes the name confusion can be very annoying like when I am paged from my bed at 2am only to discover that they are actually looking for one of my black colleagues. On some level its funny, but when you really think about it, if someone cannot be bothered to learn your name, what does that say about your integration and value in the work culture?

Sometimes the racism is humiliating like when I’m repeatedly called “lady” in grand rounds while my junior white colleague is called doctor, or walking into a patients room for morning rounds and being handed a plate of food. Sometimes the racism is irritating as a hospital cafeteria administrator interrogates you as to the origin of your meal card implying that you somehow obtained it through some sinister means despite full scrub attire and the word DOCTOR written in large print across my name badge.

Racism can be hurtful, when you find out an attending you have been working with for months has no idea who you are and awkwardly sends you an evaluation under another residents name. Racism is when all your accomplishments are never quite good enough for praise and all your mistakes always rise to the level of admonishment. You work yourself to exhaustion because you know your reputation cannot withstand mistakes.

In singularity or with rare frequency you can ignore racism. However, on a daily basis these jabs, some little, some larger, are tenderizers which prime you for the eventual knockout blow that will take you out when you least expect it. For me, this moment come when I finally connected my mistreatment with the mistreatment of my patients and began to understand the effects of systemic racism on the physician and the patient as two manifestations of the same cultural disease.

The realization was both devastating and clarifying. The same patterns—the same assumptions, blind spots, and dehumanization—played out in both contexts. The line between professional bias and clinical bias was a mirage. It was all part of the same culture, the same institutional DNA.

That’s when “Human First” stopped being a hopeful slogan and started to feel like an urgent question:

Which humans, exactly, come first? And what happens to the ones who don’t make the cut?