College of Physicians and Surgeons of Nova Scotia looks to 'regulate racism out of medicine'

If racism exists in medicine, Dr. Gus Grant says it stands to reason that it also exists in medical regulation.

"[Racism] is demonstrable in patient outcomes, it's demonstrable in terms of representation within the profession," Grant, the registrar of the College of Physicians and Surgeons of Nova Scotia, said in a recent interview.

With the aim of exercising any systemic anti-Black racism from the college's policies and procedures, Grant set out to have an independent commission review operations to improve cultural competence and safety, equity, diversity and inclusion.

The decision to look outside the college to conduct this work was inspired by the same approach used in 2019 when the organization reviewed its processes related to sexual misconduct by doctors.

"We recognized that we needed independent and expert eyes," said Grant.

"It shouldn't be an exercise in self-examination, it should be an exercise in expert, independent, external examination."

Douglas Ruck, a lawyer and former ombudsman for Nova Scotia, is chairing the five-person group of Black professionals — which also includes a doctor and social workers — tasked with the job.

Ruck, who is doing similar work for the Nova Scotia Barristers' Society, said he took the job knowing the team would find systemic racism. The fact Grant acknowledged that would be the case from the outset makes the work easier, at least in the sense that there's no need to prove the existence of the problem, said Ruck.

"That becomes a very significant point," he said, because for years people and organizations have often fought the notion that racism exists within given systems.

"What we've come to realize is what we've always known: the few in fact are not the issue. It's not the individual, it's the systems themselves, the structural, the institutional racism. Therein lies the real problem."

With unfettered access to the college and its staff, Ruck said a big part of the commission's work will be raising consciousness and showing why and where biases exist within procedures and protocols based on how they're written or applied.

Ingrained biases

Institutional racism can be subtle, and perhaps unintended, said Ruck, but can manifest when something goes wrong or someone doesn't follow established procedures, only to find different levels of tolerance based on how a person looks or their cultural background. Often that results in a Black person being treated differently than someone who is white, he said.

"There can be, right from the outset, a sense that this person simply can't handle it, they can't do it, they cannot deal with it based upon the colour of their skin," said Ruck.

It can also play out in an opposite sense, said Ruck, when someone of colour attains success and they are somehow held up as an example to be emulated for their race.

"Individuals don't look at that person as being individual anymore, but as somehow they're being an exception to the rule," he said. "In other words, somebody made it through that morass of inequities and you're now better than the rest of your race."

These things can often be unintentional, said Ruck, but they're ingrained through learning and so they become the norm. For the problem to be corrected, people need to be shown that it is a problem, he said.

Grant said the recommendations that come from Ruck's team will be made public and will help "better position the college to regulate racism out of medicine."

For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.

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