I am racist. I would love to believe otherwise and can find evidence that I am not — my career dedicated to caring for underserved women of color, my support of colleagues and trainees who are people of color, my score on the implicit-association test.1 My mission as a white physician is to be humble and respectful toward my patients, not only as an act of compassion but as a revolutionary act against racism, elitism, and hierarchy. And yet I am racist, shaped by the sometimes subtle tendrils of white supremacy deeply embedded in our culture. I mean this not as a sanctimonious admission of guilt, but as a call to self-reflection and action for us white physicians.

Appalling racial inequities in health exist in nearly every realm that researchers have examined.2,3 These inequities are a dramatic manifestation of the structural violence that plagues our society. So what am I, an obstetrician, doing about the disproportionate burden of maternal mortality and other poor reproductive outcomes among black women?4 How am I confronting the underlying forces that facilitate increased suffering and death among certain groups because of their skin color? Although it’s necessary, it is not enough for me to provide respectful health care to pregnant women of color.

If I truly want to be part of the solution, I need to explore those parts of me that are most unwholesome, embarrassing, unflattering, and generally not discussed in the context of one’s career. My goal is to dismantle the insidious thoughts that reinforce a hierarchy based on race, education, and other markers of privilege that separate me from others. These thoughts, fed by implicit bias, are more common than I find easy to admit. Although I know not to believe everything I think, I also know that thoughts guide attention, and attention guides actions. Until I bring to light and hold myself accountable for my own racist tendencies, I am contributing to racism in health care.

I’m tempted to run in the other direction — or pat myself on the back for my introspection and good deeds. Instead, I invite myself to notice the moments when I’m inclined to do more for a white patient than for a patient of color. Moments when I spend a bit more time and effort educating a white patient, or objectify a black patient, or connect more deeply with a patient who looks like me. Are my flashes of implicit racism just fleeting thoughts, or do I act on them? I recently scheduled an appointment during a nonclinic day for an educated white woman whose baby I delivered. Would I have done so for a less well-educated black patient? The other day, I noticed myself sitting farther than usual from a black patient in her hospital bed. I once mistook one black resident for another resident who is also black. I would guess that before my division instituted a consistent protocol for urine toxicology screening, I ordered such screens more often for patients with preterm labor who were black. Having an intention to treat all my patients and colleagues the same is a key first step, but that intention is ultimately irrelevant if their experience of obtaining health care or working with me varies according to the color of their skin.

Meeting our shadow requires courage. Not dealing with our racism is a manifestation of our privilege and reinforces a system that allows white physicians to dip into the waters of self-inquiry only when it feels safe. This fragility keeps us fundamentally weighted down by our own limitations and compromises our effectiveness at upending racism.5 In the meantime, health care is not safe for people of color as long as the overwhelming majority of U.S. physicians are white and we avoid examining where racism lives within us and how it lives through us.

Though implicit bias is unconscious by definition, it is a treatable condition. As I become more aware of my biases, they begin to loosen their grip. When I realized I was sitting farther than usual from my hospitalized patient, I moved closer. I am now aware enough to know that I will need to pursue a lifelong, iterative process of exploration, education, and realignment. Aware of my capacity to be racist, I can notice when that part of me threatens to influence my actions. When I notice my actions have been affected, I can make amends and get back on track. I can bring more empathy to my encounters with patients whose reality is different from my own.

I find that dwelling on my shame is counterproductive, that compassionate self-examination allows me to go deeper. I acknowledge my privilege; I recognize that the system that benefits me causes others to suffer. I openly and humbly acknowledge that my racism is harmful. And I commit to a process of uncovering and exploring my biases wherever they lie, lest they wield power and I abet a culture of racism. If we white physicians are to heal others and ultimately the health care system, we must first heal ourselves.

The first step, I believe, is to train ourselves to question ourselves and each other reflexively, consistently, and with curiosity: How am I perpetuating systemic inequities for patients? What am I doing to ensure inclusion and promotion of physicians of color? What are my practices for checking myself? And how can we acknowledge the racism within us without making it a character judgment that precludes behavior change?

At the same time, how can I cultivate relationships with others who will hold me accountable and remind me to realign with my values? Although dealing with racism requires solo introspection, it is ultimately a community undertaking in which we listen deeply, humbly, and gratefully to the people who are most affected by racism — without burdening people of color with the responsibility for educating those of us who are white. As I wrote this essay, for example, I consulted many people, mostly people of color, working in the social justice arena, as well as friends and colleagues. They reminded me to prioritize references by people of color, questioned my ego-driven motivations, and prodded me to explore and express myself more transparently.

Humans are inherently adaptable. If we approach this monumental responsibility with humility and hold each other accountable, we can change. In fact, we must change.