AMA VICDOC Autumn 2024 - Magazine - Page 75
I N T ER S ECT I ON A L I T Y
one of my first surgical rotations,
I nI learnt
that seeing truly is believing.
Despite the diversity I noted in medical
school and the hospital as a whole, I had
also noted that certain pockets of the
hospital – leadership positions, surgery
– seemed to house a more homogenous
subset. Yet, when I met the senior
registrar of the surgery team, my previous
observations and the known statistics
suddenly felt less relevant. The senior
registrar of the general surgery team was
my idol. She was cool, kind, collected and
a great surgeon – and I was in awe. In fact,
I think every one of my female colleagues
left that rotation inspired, and more
accurately, fangirling over this surgeon.
After that, no matter our individual interest
in surgery, the possibility and path were
wide open.
We notice when we see people like us,
particularly in positions which we aspire to.
And we also notice when we are missing.
As a woman of colour, when I look towards
doctors in leadership roles, most don’t look
like me. And the statistics back this up –
the diversity in medical school, of sexuality,
race, gender or otherwise, isn’t reflected in
leadership positions later on.
This lack of diversity is also apparent
in other aspects of medicine. For example,
many are aware of the historical gender
imbalance of participants in clinical
trials. Although some areas still lag, there
has been considerable headway made
in achieving adequate representation
of women in trials. However, this
underrepresentation is not only a gender
issue. A recent publication from the Lancet
Regional Health Americas suggests people
from diverse ethnic backgrounds continue
to be disproportionately underrepresented
in clinical trials, with only modest
improvement over time. While data on
the intersection of these two identities in
clinical trials is rarely reported, given the
underrepresented proportions of women
and ethnically diverse people, we can
comfortably infer that women from diverse
ethnic backgrounds are even less likely to be
adequately represented.
Adequate representation of the people
that make up our populations in research
is essential to the provision of effective
healthcare to the entire population.
However, uplifting marginalised groups
in silos – as has historically been done
– can result in the prioritisation of
certain subgroups while leaving others
behind, particularly those who may fit
into additional marginalised identities.
Additionally, addressing lack of diversity
one population at a time, as opposed to
attempting to overhaul bias within a
system as a whole is surely inefficient.
Intersectionality recognises that
human beings possess multiple identities,
each of which overlap and intersect to
influence their individual experience of
the world. Intersectionality isn’t about
forming increasingly granular categories
of individuals, but instead considers all
individuals, and it is extraordinarily relevant
to all aspects of medicine. Indeed, just
one search reveals a multitude of articles
in many reputable journals discussing the
need for a shift towards an intersectional
framework, for medical research, medical
education, health policy and so on.
For example, in clinical research,
multiple intersectional frameworks have
been proposed which outline inclusivity
guidelines for research trials, as well as
outlining identifying data which should be
collected to further understanding of how
different characteristics of patients may
intersect and impact health, experiences
and treatment responses.
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