The TEDWomen presentation in 2016 by Harvard educated Doctor of Jurisprudence, civil rights advocate, and Columbia Law School professor and innovator, Ms. Kimberle Crenshaw, is titled “The Urgency of Intersectionality.”  Ms. Crenshaw is a leading authority in civil rights, and is well known for her work in race, racism, and the law, and is credited with coining the terms “critical race theory” and “intersectionality.” Her TEDWomen presentation is devoted to sexism and racism or gender and race. And while so many people face either sexism or racism individually, Ms. Crenshaw states that when persons are subjected to the combination of sexism and racism in tandem, often the effects of that double whammy is either discounted by legal professionals or deemed to not be significant because it may be difficult to prove the existence of that subgroup that is affected simultaneously by two differing forms of discrimination. This leading civil rights advocate and educator tells us that we need to be able to see how social problems affect all members of a targeted group and not just some members of that group. For example, we may be able to identify gender discrimination against a woman, just as well as we may be able to identify racial discrimination against a black person. But how difficult is it to identify someone with two causes of action, for
example, existing discriminatory hiring practices against a black woman; when the employer readily hires blacks, just as readily as it hires females – even though it does not hire blacks who are women. Ms.
Crenshaw says that we must be able to see a problem before we can fix a problem and we must move from mourning and grief to action and transformation. I am transformed by the presentation of this “pioneer
in critical race theory.”

            I am inspired to talk about the urgency of intersectionality of “poverty and disability” in medicine. What
follows are but my opinions, and thus I expect these ideas to not be acceptable to everyone. If anything, I am hopeful that my post will spark discussion, and push the narrative that no matter what we believe to be our reality, as heroines (and possibly heroes) in training, we must be particularly cognizant of the needs of the voiceless, the troubled, the young, the innocent, the poor, the disabled, the silenced, the minority, the disadvantaged. As Ms. Crenshaw says in her TEDWomen presentation, “when people (or patients) do not fit with the available frames,” we absolutely must see them, particularly since it may be easy to overlook the intersecting impact of two or more forms of disadvantageous attributes on the individual.

            Poor people are faced with the demands of simply surviving, staying safe, finding adequate shelter and warmth. Taking care of their health (although health is our most valuable asset) is
usually not a priority. The poor are more likely to ignore minor illnesses and only seek medical attention when their health problem requires critical care. Even when the poor realize that they absolutely have to seek medical help, they may not have the resources to contact a medical office, or even if an appointment is made, the
poor may not be able to afford the transportation costs to get to the medical facility. It is not that their health is not important to them, it is simply that given all the other daily requirements they are struggling to address, engaging in self-care, and seeking medical attention is a luxury that many do not have the time and money to
afford.

            Since our first day in this course, we have been nudged to be open-minded, to not think that we are better than other people, to not naively hold onto the belief that being educated will give us the right to make unilateral decisions about patient care, or heaven forbid, think that income somehow equates to intelligence or
credibility or some other form of specialness. We have read numerous articles on how the normative of disability can and should be transformed, despite the push-back from “normal” individuals, some of whom seem to think that giving the disabled more tools to lead happy, productive lives will somehow detract from the rich and rewarding lives of the “normal” person. We are being shown over and over, and yet again, that conferring more rights and opportunities on a targeted group (the disabled specifically) does not mean that the privileges of the “normal” population will somehow be lessened. Yet still, so many of my peers insist on holding onto the belief that physicians are special simply because they are physicians (I am left to wonder what a rocket-scientist thinks of a physician!). We have learned that the disabled face so many unique challenges, not least of which is knowledge that they are subjected to much discriminatory behaviors from the “normal” population. The disabled are often tired not from the challenges of their disabilities, but from the discriminatory practices adopted by “normal” people.

            When poor, disabled people seek medical attention, as medical practitioners, we have to be especially considerate of their needs and not impose our will, our opinions without first considering what is in the best interest of the poor, disabled person. When there is injustice in how this sub-group of people receive care, then we as physicians must recognize it, then fix the injustice. Hindsight gives us 20-20 vision. However, we must strive to be visionaries who are bold enough to identify injustices and who will address those injustices, especially injustices meted out against poor, disabled patients. As the famed Ms. Crenshaw says, “we must be willing to bear
witness and create a cacophony of sound.”

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