CPSO’s Commitment to Learning, Unlearning

Dr. Saroo Sharda is helping the College view regulation through an anti-oppression lens

As CPSO’s inaugural Lead for Equity, Diversity and Inclusion, Dr. Saroo Sharda understands how important dialogue and discomfort are as catalysts to challenge the inherent biases which we all hold — be they about gender, race, sexual orientation, disability, religion or socio-economic status. 

Her courage in challenging structures of oppression saw her receive Equity in Medicine’s 2022 Dr. Pauline Alakija Trailblazer award. This award acknowledges and celebrates the challenging and often unrewarded work of a person who blazes a trail for equity-deserving groups.

Below, we speak to Dr. Sharda, an Oakville anesthesiologist and CPSO Medical Advisor, about EDI work at CPSO, and the broader issues of racism and discrimination in health care. 

You refer to your own journey as a process of learning and unlearning. Can you elaborate on what you mean by that?
We all understand that clinical learning is a life-long process. We are continuously learning, and hopefully improving, through our interactions with patients, colleagues and the literature. The process of learning about equity, inclusion, racial justice and how to bring an anti-oppression lens to everything that we do is no different. In medicine, we’ve been taught that, as physicians, we are inherently neutral, objective and without bias. The unlearning happens as we become aware we all carry inherent degrees of bias in how we take care of patients, how we listen, how we develop systems, policies, processes. For many who are part of dominant groups, the privilege we have is often invisible to us. Acknowledging that privilege and unlearning the idea that health care systems are inherently fair and neutral can take time and be deeply uncomfortable. However, those who have been most marginalized in our health care systems have had to endure actual harm, which really pales in insignificance against our own discomfort.

You begin presentations by disclosing your own privilege. Why is it important for each of us to take stock of our unique perspectives in a similar manner?
Privilege, by its very definition, is something certain people or groups have because of their position or status. It is unearned and, as such, people who hold privilege are often unaware of it. An example is a cis-gender person, like myself, not having to worry about whether there will be a bathroom I can comfortably use in a public space, or an able-bodied person, again like myself, not having to ask if a doctor’s office can accommodate my needs. The systems which allow me to have those privileges, such as heteronormatism and abelism, are simultaneously disadvantaging others. Until we start to really examine these unearned privileges, we cannot be in solidarity with those for whom this is a daily reality.

How would you describe a physician’s responsibility to their patients in understanding their lived experiences?
Physicians have a responsibility to be aware of the empiric evidence on equity and anti-discrimination. And perhaps even more importantly, they have the responsibility of approaching the stories and lived experience of people and communities facing marginalization with humility and curiosity. 

Can you elaborate on how the issue of ableism affects you on a personal level?
I have an older sibling with a developmental disability and have grown up seeing how an ableist society has harmed him, including harm in the medical system. I have observed my own internalized ableism, especially as a teenager, when I longed to have a sibling who was “normal.” What I now understand is that society shapes the narrative of “normal” as those who do not have a disability.

One physician who was asked to do further learning actually sent a note, expressing his appreciation.

Developmental disabilities, especially, are not as frequently talked about as physical disabilities. People just don’t know how to interact with my brother. We will go out for coffee and the barista will ask me for my brother’s order, assuming he cannot order for himself, or they will look visibly uncomfortable if it takes him some time to express himself in the moment. In the operating room, I see how people with developmental disabilities are not provided the accommodations they need, not because health care professionals are not caring and compassionate people, but because our systems and processes are rooted in ableism, and most of us carry a lot of bias about folks who are neurodiverse.

Can you address why it is important to be looking at our work through an anti-oppression lens?
As the regulator, we have a mandate to serve in the public interest. This includes ensuring quality care is provided by physicians and guiding the profession regarding expectations of physician behaviour and practice. We also have an obligation to regulate in a way that is fair and balanced for both the physician and the complainant. For me, compassion and transparency are absolutely rooted in equity. How can we be compassionate and transparent if we do not understand the very basis upon which our systems, processes and policies are built? How can we move to a more equitable way of being and operating, if we do not engage with patients and physicians to understand what we are doing well and what we can be doing better? Most importantly, are we engaging with those who have been most marginalized by our systems?

Can you give an example of how we are doing a better job of engaging?
We have an ongoing conversation with Nishnawbe Aski Nation (NAN) — I have learned a great deal about what works for the NAN community with regard to their interactions with CPSO, and what does not. Another example is the stakeholder summit we held last year for our [Professional Obligations and Human Rights] policy review — we asked our Citizen Advisory Group for input, and we also went out into the community, and approached organizations and communities whom we know have the greatest barriers. The conversation was facilitated by a person independent of CPSO, and it was rich and enlightening and gave us much pause and much to reflect on. Giving space and voice to those groups and those stories is a way of letting those communities know we care and that they are seen.   

We are also using our different communication channels — Dialogue, our podcast series, social media, outreach presentations — to further address how implicit bias, and discrimination can result in health disparities for patients. 

EDI is not “extra” to everything we do, or the way we practise medicine — it is, and should be, foundational.

Many of the concerns regarding discrimination that come to the College may once have been described as a communication issue. But you believe it is essential that we dig deeper.
Discrimination is not always blatantly egregious, like a racial or homophobic slur. It is often more subtle than that, and almost always a felt experience by the person at the receiving end, but microaggressions are real. Individually, they may not seem like a big deal, but we know from the literature they can cause negative health care outcomes for patients/physicians, especially when they are chronic and not addressed. Microaggressions help to uphold and reinforce whole systems of oppression. We each have a responsibility to dismantle that.

This is where unlearning and learning have been most impactful in our work over the past year. We have been able to provide education on the importance of unconscious bias, how it may show up for physicians and patients, the realities of systemic racism in society — specifically in health care.

Culture is not just about race, or sexuality, or gender expression, it is much more complex, nuanced and individual

It’s important to note that this is not about being a good person or a bad person but rather about systems of inequality and how those manifest not just interpersonally but through policy and process as well.

Is the College aware of instances of discrimination against physicians?
We are, yes. From time to time, sadly, we receive communications which consist of nothing but the expression of discriminatory views or hate language towards a physician. Other times, as well, a complaint may not be on its face obviously rooted in discrimination, but the physician in responding to it may describe what they say was a discriminatory interaction with or bias on the part of the complainant. In those cases, the ICRC will carefully evaluate the information in front of it to decide on the most appropriate outcome. It should go without saying that protecting the public does not mean tolerating discrimination, hate or harm towards physicians.

As an organization, how have we moved closer to working from the perspective of cultural humility?
This is a really important concept and is one which is central, along with the concepts of anti-oppression and colonialism, in how we approach equity work. Personally, I prefer the term cultural humility to cultural competence, as we cannot ever be competent in another person’s experience. Culture is not just about race, or sexuality, or gender expression, it is much more complex, nuanced and individual, and if we can approach that complexity with humility and curiosity, and be aware of our biases towards cultures that are dissimilar to our own, then I think we are taking steps in the right direction.

Where are we in our journey?
We are in the early stages of a long EDI journey as an organization. Last year we focused on anti-Indigenous racism and implicit bias and our Council and committee members and a large number of our staff undertook San’yas Cultural Sensitivity Training. This year, we are focusing on anti-Black racism and LGBTQ2SIA+ health. We have introduced Rainbow Health Ontario’s Foundations course internally and many at the College have already taken the course. Dr. Natasha Johnson is joining us in the Fall to do similar work on anti-Black racism. We recognize all we are doing must be revisited, embedded and not seen as a one-time, “tick-box” exercise. The commitment of the organization as we address these issues is encouraging. This work is not only difficult due to the inherent complexity of organizational change, but it is also deeply emotional, particularly for those of us that have lived experiences of past and ongoing intersectional discrimination. However, it is essential that the status quo be shifted.