The Nonbinary Physician Activist: “Do No Harm” Implies Equity as the Outcome

On my first day of medical school, the dean stood before our entire class and stated: “We no longer have the smartest applicants coming to medical school; but we have the ones who care the most.” These words have impacted me for over a decade, but I no longer find them true. Indeed, declining reimbursement and loss of professional autonomy devalue the M.D. degree, as a clinical practice is no longer as lucrative and trusted as it once was prior to the implementation of managed care.^12,13 As a result, talent in the STEM professions is being siphoned off to higher paying careers due to low employment satisfaction, which will likely be accelerated by the COVID-19 pandemic.¹⁴ Still a physician wields great—and often unrecognized—privilege in terms of power, wealth, influence, and authority. For example, a psychiatrist has the legal ability to temporarily remove a person’s basic human rights.¹⁵ Regardless of the intention to protect that person from harming themselves or others, this is a power that may only be paralleled by imprisonment. However, no crime has been committed, just foretold by the provider. And the provider, like the rest of us, is a fallible human.

Historically, I do not see this professional authority as being used responsibly. From early psychiatric institutions placing chained patients on display in return for payment to the Tuskegee syphilis experiments, the harm the medical community has perpetrated on the disabled and black communities has been substantial.^16,17 Now, we have LGBTQ physicians volunteer to tokenize themselves and work unpaid to create diversity, equity, and inclusion initiatives to end their own oppression within their institutions, which in turn increases that institution’s wealth, influence, and authority at minimal cost and resource expenditure.¹⁸ The normal biological diversity of sex and gender are not represented accurately in the medical profession, and the terms are often conflated with each other in original research publications, in contrast to what we know is biologically accurate as scientists.^19,20,21 These microaggressive mistakes continue to slip past peer review, even though they are a couple of the most commonly-used, categorical demographic variables in healthcare research.

These scars on our humanity remain clearly visible to this day in our healthcare and research institutions’ long-standing structures.

On my first day as a student in training as a certified peer specialist, we discussed how clients are disenfranchised within the healthcare system. We learned how clients can lose their rights if we do not advocate fiercely for each other. Bravely candid self-disclosure is taught as a tool to aid in healing, and not a sign of weakness to be avoided. And often, a peer with similar lived expertise can help a fellow human in ways no amount of medical training can provide.

On my first day as a student in social service, I noted that pronouns were normalized in practice, and there were many transgender and nonbinary peers in my classes. We discussed justice and equity as important outcomes. Non-binary identities were included in discussions of gender.

I learned about settlement houses and how social workers chose to work in some of the harshest conditions to provide services to clients who were ignored or lost to the healthcare system.

I create these comparisons, not to undermine the benefits and good that modern science and medicine can provide to our species. Instead, my intention is to deconstruct the “hierarchy of professions,” which are based on outdated standards of colonization, white supremacy, and patriarchy. The power, privilege, and authority within medicine is hoarded too much within the hands of the few. Where are the nonbinary voices in academic medicine and research? 

I dream to follow the lead of progressive-minded giants within our activist communities who championed their intersectional identities. Some of the bridges we need to continue to build include those: between neurology and mental healthcare, between social service and medicine, between peer and professionalism, between ethical representation and clinical research, between patient autonomy and advancing medical science, between activism and professional duty, between psychiatric survivor and neurodiversity movements, between values and action in healthcare and research practice.