What Medicine Needs to Know About Social Location

I want to share a concept I recently learned …

But first, a story.

A few days ago I was talking with a male colleague who is a leader in his department.  He is a good friend, so we often talk about a variety of things. He brought up the issue of equity in his department. He told me (and I wasn’t surprised) that he was working hard to make sure that there was salary equity for the women in the group. I asked him if they knew he was doing that.  He responded, after a pause, that only he and his second in command knew.

“You need to tell them.”

He paused and said, “That’s a really good idea. I didn’t think of it.”

So let’s talk about social location.

Each of us has a “social location” that is a composite of our social identities e.g. gender, race, sexual identity, etc.  There is usually a perceived (and totally constructed) “hierarchy” of these social identities. In the United States, at this moment, it’s pretty clear that the “dominant” social location would be: White, Male, Heterosexual, Cis-gendered and Able-bodied (I’m leaving it there without adding other social identities such as immigrant status, age, education… etc. etc.)

Here’s the main point I want to make.  If you are in the “dominant” social location (i.e. White, Male, Heterosexual, Cis-Gendered and/or Able-bodied), you most likely cannot “see” the location of others that are not “dominant”… even though you think there is no way you are less than supportive of people that aren’t like you.

Huh? 

David Foster Wallace probably describes this phenomenon best in his amazing commencement address “This is Water”.

“There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”

Let me give you some specific examples from the world of medicine…

  • When a Lantinx colleague walks into Grand Rounds and notices they are one of three people of color who are there, their response is probably very different than mine.  Being white is never something I’m aware of when I’m sitting in Grand Rounds.
  • When we, as leaders, only acknowledge Christian holidays on our calendars, and even worse, when we schedule important classes, tests, or events on Yom Kippur, Eid al-Fitr, or Dewali, we are not discriminating intentionally, but we are acting from a place of not “seeing” students and residents who are not Christian.

I think that’s why my friend didn’t realize how important it would be to let the women in his group know that he had their back. I also think it explains the genuine confusion of many leaders in medicine who truly believe they are equitable and fair … and who are then at a complete loss when they learn they somehow “stumbled” into acting in a way that differed from that perception.  

Here’s another wonderful fact. Once you learn about “the water” (i.e. social location) it will change everything…for the better. Because – once you see it you can’t ever go back.

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“Try to learn to let what is unfair teach you.”

David Foster Wallace, Infinite Jest

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