Chapter 6: When Good People Do Bad Things

Exploring the complexities of racism within well-intentioned institutions and the impact of cultural dynamics on equity and justice.

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I want to begin by stating clearly: I do not believe everyone is racist. Nor do I think racist ideas are exclusive to white people. On the contrary, some of the most shocking and deeply racist ideas I’ve encountered have come from peers I once relied on for support. What took me a long time to fully grasp is that racism is a set of ideas rooted in assumptions about the value of one racial group over another. Even the cloak of Black skin cannot immunize you. The only protection is recognizing that these ideas are pervasive and embedded within the foundations of our institutions and social frameworks.

That realization was perhaps the most painful of all—that some of the most cutting racism I experienced came not from those I expected it from, but from people I had counted on for understanding and solidarity.

When other residents of color questioned my experiences, minimized my concerns, or suggested I was being “too sensitive,” the betrayal cut deeper than anything from white colleagues. At least with them, the dynamics were clear and predictable. But when people who looked like me—who had presumably faced similar challenges—became agents of the very system that oppressed us all, it felt like a fundamental betrayal of collective survival.

It forced me to confront the uncomfortable truth that proximity to oppression doesn’t automatically create consciousness about it, and that sometimes the most effective defenders of unjust systems are those who have managed to find a precarious place within them.

I’ve been asked by many well-intentioned mentors, “Why are you more sensitive to racial discrimination in the workplace?” Could it be that despite the rigors of my training, I somehow failed to develop an essential coping mechanism? For a long time, I blamed myself for letting these racist ideas “get to me.”

It wasn’t until I understood that the source of racism is often rooted in fear—fear of inferiority, fear of the unknown, fear of retribution for past misdeeds—that I was able to respond to this question with clarity. The same gifts, talents, and opportunities that brought me to where I am today can be, to others, a source of fear. That fear manifests as racism. By projecting more of the good, I became more vulnerable to the bad. I now realize that I, and others like me, are not more sensitive—we are more vulnerable because we recognize and value our own strength.

What I hope to convey to these well-intentioned mentors is this: dignity and respect are not just central to being human but critical to producing our most creative and ingenious work. Instead of asking, “Why do you want this for yourself?” we should be asking, “Why doesn’t everyone?”

Silence in the face of your own oppression is not enlightenment—it is a sign of racism’s most insidious effects: when you become complicit in your own suffering.

The question itself revealed the deeper issue: the assumption that my reaction to discrimination was the problem, rather than the discrimination itself. It’s like asking someone why they’re sensitive to physical pain rather than questioning why they’re being punched in the first place. That framing made me the problem to be solved, rather than the environment that needed to be changed.

This dynamic played out across the institution. Good people—and I do believe most of my colleagues were fundamentally good—found ways to rationalize, minimize, or ignore the harm happening in plain sight. They weren’t actively causing harm, but their inaction allowed harmful systems to endure.

The department had good intentions. There were diversity committees and inclusion initiatives. There were statements about values and commitments to equity. However, when it came to addressing specific instances of discrimination or changing concrete policies that perpetuated inequality, there was always a reason why action couldn’t be taken immediately, why we needed more data, why we had to consider all perspectives, and why change had to be gradual.

The cumulative effect was a culture where explicit racism was technically unacceptable but implicit racism was ubiquitous and unaddressed. Where people could genuinely believe they were committed to equity while participating in systems that produced profoundly inequitable outcomes. Where the burden of proving discrimination fell on those experiencing it, while those perpetuating it were given the benefit of the doubt.

Culture is such a pervasive force. It’s the number one factor that enables people to succeed—or drives them to fail. We’ve built a culture that defines itself by how it values people. A kinder, gentler way of being. A place where wellness is prioritized. At face value, these things seem admirable. However, what I failed to fully appreciate is that when a culture is built on a shared feeling or an outward impression, any thought that doesn’t fully embrace that view becomes a direct challenge to the department’s identity.

This I didn’t fully appreciate. When I would bring up issues that challenged this identity, I didn’t realize how offensive this would be to the broader community. This culture cannot exist in its current form while also allowing contrarian viewpoints. So systematically, those views are suppressed, and the people who hold them are pushed to the margins.

The culture of niceness became a weapon against truth-telling. Any attempt to name problems was seen as an attack on the department’s carefully constructed image of itself as progressive and inclusive. The more I tried to address issues of racism and discrimination, the more I was labeled as negative, difficult, or someone who “had a problem with everything.”

There are many reasons that one can legitimately feel that this environment is not friendly and does not actually value ALL people. There is a strong white normative undertone within the culture that people refuse to discuss but comes out so blatantly when medical students are on service, or during interviews, or working on L&D. There is also a strong culture of oppression of women. The idea that women are expected to create this false, bubbly version of themselves to fit in is, at its core, inherently sexist.

I could go on and on—there are just so many examples. I haven’t shared many of these thoughts with other residents. When I tried, I was called a complainer who has a problem with everything and never has solutions (in other words, an “angry Black woman”). I realized in that moment just how deeply alone I was. There are so many other thoughts I want to share—but can’t.

The isolation was profound. Not only was I experiencing discrimination, but I was also cut off from the support systems that might have helped me navigate it. The very act of naming what was happening to me made me a problem to be managed rather than a colleague to be supported.

As physicians, we take an oath to do no harm. But by upholding this culture and making excuses for our lack of progress, let’s be clear—we are doing harm. The culture of medicine, through its deliberate ignorance, sustains the very institutions that uphold inequity. The logical result of perpetuating this culture for its members is inequity for its patrons.

There will inevitably be the counter argument that medicine is simply a reflection of a larger social paradigm. To which I will respond, it shouldn’t be. We should be better. We must be better. In donning the long white coat, we swore we would be better. We have dedicated our lives to service grounded in an aspirational belief that through improving health, we can help people to live their best, most fulfilling lives. Our patients must hold us accountable to the promise of this mission.

This was the heart of my disillusionment: the chasm between medicine’s aspirational ideals and its day-to-day reality. We swore to do no harm, but our institutions are actively harming both the providers and the patients they claim to serve.

We claim to be dedicated to healing, yet refuse to heal the sicknesses within our own systems.

The most devastating realization was that this wasn’t a case of a few bad actors corrupting an otherwise good system. The system itself was functioning exactly as designed—producing disparities, maintaining hierarchies, and protecting those with power while marginalizing those without it. The good people within the system weren’t failing to live up to its values; they were perfectly embodying values that prioritized comfort over justice, stability over equity, and the appearance of progress over meaningful change.

It is not surprising to me at all that the stresses I perceive are also perceived by patients. This data suggests that the racism within the department likely has negatively impacted outcomes for women of color. I’ve been black all my life, and I don’t say that to be facetious, but this is the first time I’ve been so acutely aware of it on a minute-by-minute basis.

Before 8:30 a.m. yesterday, four separate times, someone confused the four Black residents. Not just our names—our identities. This happens every day. It has medicolegal implications, affects how we’re evaluated, and speaks volumes about basic humanity and implicit bias. If the people we work with daily—including faculty—can’t see us as individuals, how can they possibly provide equitable care to their patients of color? The deeper you look into this issue, the more unsurprising the data becomes.

The connection is undeniable. The same attitudes that make it impossible to distinguish between four accomplished, distinctly different Black residents are at play when treating Black patients. The same assumptions. The same blindness. The same failure to recognize individual humanity. If highly educated professionals can’t overcome their biases in daily colleague interactions, how can they possibly do it with patients they may only see for a few hours—or minutes?

The good people created a system that produces bad outcomes. And their goodness—their belief in their own intentions, their comfort with the status quo, their resistance to discomfort—has become the very thing preventing this system from ever getting better.