Chapter 5: The Devaluation of Black Life

Exploring the systemic devaluation of Black lives within the medical profession and its implications for patient care

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The devaluation of physicians of color is not separate from the forces driving health disparities; it is another symptom of a medical culture that devalues African American life in all forms—physician and patient alike. The interconnectedness of the physician and patient experience is rarely studied. However, one study found that minority physicians are almost 30% more likely to withdraw from residency and eight times more likely to take an extended leave of absence. To borrow the words of James Baldwin,

I can’t prove that medicine devalues the lives of African American people, but I can infer it from the state of its institutions.

It is sobering to realize, even as an African American physician, that despite great personal effort—a good job, a high salary, advanced education—even this is not enough to undo the paralyzing damage of systemic racism or protect me and my family from its consequences.

The pattern became clearer the longer I observed it. It wasn’t just about individual prejudices or isolated incidents—it was about a systematic devaluation that operated at every level of the institution. When I watched how differently white residents were treated, how their mistakes were framed as learning opportunities while ours became character indictments, how their ideas were received with interest while ours required extensive justification, I began to understand that we were operating under fundamentally different rules.

It has been revealing to watch how warmly the new incoming class has been received—a much-desired return to the norm, perhaps. Small things stand out: nurses asking the interns their names or showing interest in their personal lives, while Laura is still confused with Rachel on a daily basis.

On two occasions, nurses asked a white intern to do things far beyond her level of training, despite me or one of my Black colleagues—both her seniors—being nearby. During her second week, a nurse approached her to AROM a patient. Luckily, I was there and performed the procedure myself. I don’t think she had ever done a cervical exam, let alone ruptured membranes. Maybe this was an isolated incident, a one-off bad judgment.

But then a totally different nurse asked the same intern to review a concerning fetal heart tracing. I was just briefly on the unit, using a computer, because I was assigned to work on another service. I remember debating in my head: Should I get involved? Maybe it’s fine. Maybe I’m misreading the situation. I was kind of annoyed. By this point in the year, inundated by microaggressions, I was tempted to ignore it altogether. Trying to focus on my own task, I heard the intern confidently proclaim, “These look like early decels.” The nurse replied, “Are you sure?” Her voice laced with doubt, as if second-guessing her own initial interpretation. I tried not to look. I really did. But my eyes drifted to the computer screen next to me, and I could clearly see the decelerations were not early—they were late and variable. And just like that, I found myself in the uncomfortable position of needing to correct a dangerous error.

I specifically told the nurse that if she had any questions about tracings, she should direct them to either senior resident—both Black—and that it was inappropriate for a brand-new intern to be reviewing concerning tracings, especially ones with potential consequences.

I don’t blame the intern. She was just trying to survive in a system that is constantly drowning you. This is the system. A system where nurses feel safer asking a brand new white intern to do something that could have critical consequences to avoid an interaction with a black physician. I can only assume this is because they feel more comfortable with them or trust their judgment more. Things that those of us of color were not trusted to do until at least the last 6 months of intern year.

The implications of this incident went far beyond the immediate clinical scenario. It revealed something fundamental about how competence and authority were perceived and distributed in our environment. The same nurses who questioned every decision I made, who seemed to view my presence with skepticism, were literally asking someone with two weeks of clinical experience to make decisions that could affect maternal and fetal outcomes—simply because that person was white.

It’s only very recently that I can go through a full day without being constantly challenged. Challenged on my skills, my knowledge, my judgment—and that’s on a good day. You can only imagine what it’s like when I make a mistake.

So what do you do? You keep your head down. You do the work, calmly and competently. Because as a person of color, you don’t get the benefit of the doubt. You have to prove you belong, every single day. I thought maybe my pedigree would help. Dual graduate degrees from MIT and Harvard—surely that counts for something? Surely that would earn me some credibility? But then I remember: I’m Black. Sometimes I forget that.

Every day I come to work, take care of patients, handle emergencies, and I do it all knowing that I will be undermined. And that if someone white shows up, regardless of their experience or skill level, their presence will be trusted more than mine.

And through it all, you must stay composed. Never raise your voice. Always show respect, no matter how much you are disrespected.

I’ve come to understand, as hard as it is to admit: a white person is assumed competent until proven otherwise. But a Black person must prove their competence before they are allowed even basic trust. That double standard chips away at your confidence. It makes the workplace a profoundly isolating place.

It took six months before anyone even noticed I was in the program. People describe me as the quiet one. Reserved. But anyone who’s known me for more than a minute would laugh at that. I am outspoken. Confident. Opinionated. So why am I so muted here? Why do I feel like I have no voice? Why have I allowed myself to be silenced? The answer is clear: there is no room here for anyone who challenges the norm. Dissent is punished. Contradictory voices are slowly erased.

That internal transformation is perhaps the most disturbing part. I had always spoken up. Always challenged ideas. But this environment suppressed that part of me so effectively that even those who worked closely with me daily had no idea who I really was.

The suppression wasn’t loud. It was subtle. Every time I spoke, my words were received differently than if a white colleague had said the same thing. My suggestions were met with skepticism that required extensive justification. My confidence was labeled as arrogance, my competence as threatening.

It was death by a thousand cuts—each individual incident small enough to dismiss, but collectively creating an environment where speaking up felt not just futile but actively dangerous to my professional survival.

Lately, I’ve been thinking about this idea of intrinsic value. The idea that an individual has value beyond the work they do or what they can accomplish. I’ve known intuitively that in our society, black people have no intrinsic value. However, it’s taken me some time to be able to articulate it clearly.

This, I believe, is why Black sub-interns or medical students are written off so easily, because it is ingrained in people’s core thinking that black people have no intrinsic value. I hear words thrown around like “garbage”, “horrible”, “terrible”, “I hate”, “the worst” used to describe these students.

As a white person, you have value just for being alive. Whether it is back in the day when you were “hung by a noose” or today “shot dead in the street,” the message is the same: negros who cannot demonstrate their value have no real claim over their life.

Black people cannot be nuanced. Of course, there are those black people who are held on a pedestal. Those who are truly exceptional, the Barack Obamas, the Beyoncés, the Oprahs of the world. Those who far exceed their white counterparts, although no one will ever articulate this... and those people, they can stay. But if you don’t happen to be this naturally gifted, and I would argue 99.99% of people aren’t, and you’re black... well... your value is only in how much you can produce.

This realization crystallized everything I had been experiencing but hadn’t yet been able to name. The constant need to prove myself. The exhaustion of perfection as the only acceptable standard. The way my mistakes were magnified while my successes were minimized—all of it stemmed from a fundamental lack of intrinsic value assigned to people who looked like me.

I know that my value is measured only in what I can demonstrate. I can point to accomplishments that prove I work harder, that I’m smarter, more accomplished—and therefore I am tolerated. I have no delusion that if I weren’t these things, I’d be dismissed as just another Black girl with an “attitude,” and labeled “horrible, terrible, the worst.”

If I feel this oppressed by the culture at times, I can only imagine what these poor students must feel. I’m an adult. I’m older than many of these girls. I’ve had more life experience, and I’m more accomplished. I have a great life, with a great husband and a great family. I’m beautiful, popular, and fun. I have everything a person could pray for or desire out of life—my life is as close to perfect as one can reasonably ask God to make it—and still, the weight of this oppression sometimes brings me to my knees.

It makes me doubt and question things that I know to be true. It makes me question my self-worth, my ability, my intelligence, my capacity. It makes me hate parts of who I am. It makes me wake up in tears. And then I have to remind myself, or God reminds me, Yamicia, you are being ridiculous. You know your value. You know your self-worth, even if no one around you does.

And the people I actually work for—I mean, the real people I work for—my family, my friends, my community—they know my worth. Everyone else is just a roadblock. What I want people to understand is: if there were another way—a way to sidestep white people to reach our goals—don’t you think many of us would choose it? But white people are the gatekeepers. They hold all the keys. They hold all the power. There is no road to any meaningful life without going through them.

The weight of that reality—that success in medicine requires not just competence but acceptance from people who fundamentally question your humanity—was almost unbearable. And yet, it clarified the stakes. This wasn’t just about my personal comfort or professional satisfaction. If the same attitudes that devalued me as a physician were present in patient care, then this was quite literally a matter of life and death for the communities I came from.