Last month I attended a psychiatrist appointment as part of the process to access accommodations both through ODSP and through my university accessibility office. This was my third appointment with the clinic and my first with the psychiatrist. This appointment ended in my storming out of the office twenty minutes into the appointment and heading home shaking and in tears. I wrote this e-mail to the social worker I worked with throughout those appointments on why it had ended the way it did. I have chosen to leave out the last names of both the social worker and the psychiatrist, along with the hospital or clinic names to preserve their privacy.
I feel I ought to give you an explanation for why I was so upset when I met with you and Dr K last month. I sat down to write this e-mail to you the day after I left your office, but I have still been so angry and so devastated that I could not trust that what I was saying would not also have some malicious intentions behind them. I want you to know that I do not owe you this explanation; but rather, I want others to avoid feeling the way I do right now. The truth of the matter is this was but one of a long history of being dismissed by white doctors who have been less than subtle about their disinterest in my long-term health.
On our first appointment, I arrived ten minutes late for our appointment. This is something that I have struggled with all of my life and one of the initial reasons that I decided to even seek treatment. But when I arrived, you accused me of being far later than I was before we had even gotten out of the waiting room. When I reminded you of the time that you had given me over the phone twice before our actual appointment, your entire demeanour changed from dismissive to oops, mistakes happen. This would be an incident that would repeat itself when I returned for our final appointment. I have the appointment slip that you personally gave me that says my appointment was at 1:30. However when I arrived early for my appointment, I was scolded once more for already being late. My appointment was actually at 1:15.
This isn’t just about your disorganization. That only alluded to your disregard and disrespect to your patients, or at least to myself. Your carelessness may be an endearing trait to family and friends, but to your patients it could mean losing access to social assistance, educational accommodations, and access to further medical health benefits. And you are part of a system that has regularly and historically disregarded and dehumanized marginalized populations and identities.
While you did not act remorseful about being disorganized with my healthcare, you did seem to think that after a few hours with me, you had enough information about me to dismiss my own insight and experiences to another medical professional. Dr K acted only out of the information that you relayed out to her, because of course you still had not retrieved the medical records from a previous psychiatrist despite several months passing between our initial appointment when you promised to retrieve those files and this final one. She did not even have an inclination that I had already received an initial assessment elsewhere. Not only were my reasons for attending your clinic dismissed, but there was also a strong implication that you believed that I was seeking medication for a recreational use.
You also seemed to have neglected in your notes that I didn’t identify as a woman, I didn’t use my birth name, and I didn’t use she pronouns. Despite you supposedly noting down this information, you consistently misgendered me in front of me to her.
You are contributing to systems that have already led to trauma in medical and educational settings for racialized and gender nonconforming children. These systems have allowed racialized and female-coded individuals to have delayed diagnoses that lead to the disruption of any kind of stable adult life. Fighting for diagnoses just to receive treatment is a regular task for racialized individuals to experience when navigating healthcare spaces. You were not only trying to take away access to medication (which is already limited by financial circumstances), but my ability to receive funds for equipment I desperately need in order to pass my courses. My education had been hinged on getting access to these accommodations.
If you cannot show compassion, thoughtfulness, and a commitment to staying informed in your own field, this is not the career for you. You are in public healthcare. That means that the people coming to you mostly have very little other options available to them. Many of us can’t access private healthcare. Psychologists and therapists are inaccessible to low-income, underemployed people. And marginalized communities make up disproportionate numbers of Toronto’s unemployment and those in unstable housing. If you are not prepared to acknowledge how you play into the oppression of racialized, trans, and/or disabled patients that come to see you, then you are not suited to work in the public sector. The fact that you have so much power over what resources people can access, whether or not they reach diagnoses, and the fact that it is your opinion that is valued over their actual lived experience when it comes to the psychiatrist.
You are hurting people. If your patients really matter to you, you would work to create an inclusive and healthy environment. You would actively be working at breaking down barriers to not only survival but the prosperity of your patients. You have to be advocating on their behalf, not acting as a barrier yourself. But this is what is wrong with healthcare. It isn’t about the patients, it’s about exerting power over people who clearly mean very little to you. It is hard to trust a mental health worker who unironically suggests yoga and meditation to a South Asian descended person twice, without even considering that I may have cultural or religious connections with those practices. Please consider following a path better suited for you: something private, something where you do not have power over racialized and lower income people.
I’ve included some links below to help you with your education. It shouldn’t be on your patients to educate you but I would rather take it on rather than allow you to continue marginalizing already marginalized people. Please use these links as a starting point to educating yourself further on how to be equitable and inclusive in mental healthcare.
Racism in healthcare:
Racism in autism diagnoses and treatments:
Racism and ADHD:
Sexism and autism:
Yoga and cultural appropriation: