The question of what it means to be a good doctor is one that Michael Drake, MD, has been contemplating throughout his career. Now president of the University of California, overseeing its 10 university campuses and five medical centers, Dr. Drake provided an ophthalmologist’s perspective during the 2022 Robert N. Shaffer Lecture.
“I want to use the time to discuss the critical challenge that faces all of us as physicians—and as people, really—and maybe give us a chance to think of some ways we might help move the needle,” he said.
Privilege of practice. From his student days at the University of California, San Francisco, he recalled a talk titled “The Privilege of Practice.” Along with the privileges of being a physician—doing good for others and having education, employment, and status—the speaker emphasized a deeper honor.
As practitioners, we see patients when they are at their most vulnerable and weakest, Dr. Drake explained. That is a unique trust that has to be earned and maintained.
“The first rule of medicine is ‘primum non nocere’—first do no harm,” he said. “And I question here this morning if that’s really enough. In today’s world, even if we are steadfast and true, we are dealing with a world that in fact has inherent inequities.”
COVID was “neutral,” but its effects were not. Pointing to the pandemic, he noted that it was driven by a virus that was neutral. It didn’t have judgment. It just did what viruses do: infect, replicate, mutate, and infect more people. “The differential effect it had on different people really comes from how we treat those people, how those people are situated in our society,” he reminded the audience.
There were stark differences in the people who were laid off, who were most likely to become infected, and who suffered serious health consequences.
“If we’re going to be the very best doctors and health practitioners we can be, we have to recognize the world we live in and practice accordingly,” he explained. “We have to work to produce the equitable outcomes that we believe are appropriate.”
No one did this on purpose. Dr. Drake described studies that assessed the amount of time it took Black and White pedestrians to cross the street. These studies found that drivers were more likely to yield to White individuals attempting to cross than to Black individuals and more frequently passed by Black pedestrians without stopping. As a result, it took Black subjects 32% longer to cross the street.
Another study found that managers felt that Black populations tended to exhibit more tardiness than the White populations—even though there was no actual difference. Black employees would also be punished more for tardiness.
“And within all of this, the thing that was so important is that none of the people who were involved had any idea that they were doing this. No one did this on purpose,” Dr. Drake explained. “These were unconscious, learned behaviors that were the normal way that people were behaving,” he said. Years and years of such behaviors culminate in the disparities we see.
How to get people to understand. Inspired by earlier talks on diversity and glaucoma during the symposium, Dr. Drake pivoted his talk to the challenge of talking about racism.
Based on his own experiences at various universities and jobs, he noted that there will often be individuals who know a certain behavior is unacceptable but they don’t understand that it’s wrong. There will also often be “hardcore” individuals who believe things have to be preserved to create the world they want to live in.
“So I think this work is very hard work, and we need to do it, and I applaud everyone here and elsewhere who’s doing the work,” he said, adding that it requires a consistent effort to accomplish.
One encounter with a friend helps him keep perspective. At a brunch with friends, a person who looked like an unhoused individual approached their table for money. While Dr. Drake’s approach was to give a polite denial, his friend—a fellow physician—pulled out a dollar bill. He asked the individual his name, where he was from, and asked if he knew how to get services. After the talk, he gave the individual the dollar and said goodbye, addressing the visitor by name.
The moment stuck with Dr. Drake: “I would guess that [my friend] was the only person who treated him with any respect that whole day, if not that week. It reminded me of how we can really take a moment and touch those people we see who are within our sphere or in different circumstances.”
He called for the audience to recognize and respect the humanity in all, regardless of condition or circumstance. Remember the small daily things we can do to tackle inequities.
The toll of the last few years and the pandemic has been hard. “But you’re here today and that means you’ve not only survived, but that you care deeply about your work, about your patients, and about serving the world with your gifts as physicians,” he said with gratitude. –Kanaga Rajan
Financial disclosures: Dr. Drake: None.
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