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In this episode, psychiatrist Chika Oriuwa discusses her KevinMD article, “How a psychiatrist rebuilt trust with a patient in crisis.” She also reflects on her book Unlike the Rest: A Doctor’s Story, sharing an emotionally charged encounter with a patient in crisis. Chika explores the challenges of racial bias in psychiatry and the power of empathy in rebuilding trust. She provides actionable strategies for health care providers to foster rapport, ensure equitable treatment, and advocate for systemic change.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Chika Oriuwa. She is a psychiatry resident, and we’re going to talk about her book. It’s titled, Unlike the Rest: A Doctor’s Story. There is an excerpt from that book on KevinMD titled, “How a psychiatrist rebuilt trust with a patient in crisis.” Chika, welcome to the show.
Chika Oriuwa: Thank you so much for having me. It’s an honor to be here.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Chika Oriuwa: Absolutely. So, I am currently a psychiatry resident on my maternity leave and soon to be returning back to my residency. But a little bit about my backstory.
So, I attended medical school at the University of Toronto and I’m currently also doing my residency there. I kind of rose to public consciousness, I guess you can say, when I was doing a lot of advocacy work in my medical school. I was the only Black medical student in my class of 259 starting in 2016 at U of T.
And I really became quite a vocal advocate for improving and enhancing equity in medical admissions and medical education. And that kind of spun into this entire realm of advocacy and public speaking for me, where I now have the opportunity to venture into different industries and sectors and talk not only about leadership, but also about the importance of authenticity and really how to bring the best out of every team and organization that we have the opportunity to lead.
Kevin Pho: All right, so 2016 was nine years ago, and has the needle been moved when it comes to diversity and equity in the medical education setting?
Chika Oriuwa: I would say that, overarchingly, I would say yes, but I also think it’s very case specific, and also, with a little caveat, that we’ve come so far, but there is still so much more to do.
I can speak to, specifically, the environment at the University of Toronto where what it looks like now versus what it looked like nine years ago when I started medical school is vastly different. They have made remarkable strides to improve the equity within the admission system but also within the actual medical education.
When I started medical school, there weren’t a lot of opportunities to have discourse around the diversity amongst health care professionals and how that can really create a different filter or a different lens as to how we engage with medical education. Now, I know that U of T has a Black health theme lead.
They have really built it into the curriculum and into the institution such that there is much more support for students who are from historically marginalized groups. And then, of course, they also have the Black Student Application Program, which has significantly changed the entire culture of the medical environment, but also, overarchingly, has improved the quality of medical education provided to all medical students.
Kevin Pho: All right, well, let’s talk about your book, from which there is an excerpt on KevinMD. That excerpt is titled, “How a psychiatrist rebuilt trust with a patient in crisis.” So for those of you who didn’t get a chance to read that excerpt, tell us about that particular story.
Chika Oriuwa: Absolutely. So, this story is a fictionalized story because, of course, due to patient confidentiality, I can’t use the exact situation that occurred.
But in this fictionalized rendition of what happened, there is a patient who comes into the psychiatry department, and this patient is of Nigerian ancestry. They also present with their younger son. It is a Nigerian male who comes in exhibiting symptoms of psychosis. This individual and their son are both quite concerned about the quality of the care and the treatment that this patient is going to receive.
Of course, being a psychiatry resident in this circumstance, we are taught how to deal with patients who are exhibiting psychosis and agitation, but there’s this particular overlay when it comes to the racial dynamics at play. We know that certain individuals, such as Black men, are more likely to receive, for example, sedating medications within the psych emergency department because of some racial biases that might be at play. They are also more likely to be involuntarily held within psychiatric institutions, experiencing differential treatment.
So this really played into the dynamic with this patient and his son, who was there partially not necessarily as a caregiver, but certainly to provide support. Being able to be cognizant of the ways in which a patient’s fears and concerns can subconsciously affect how they are presenting was something that was really important for me to flesh out in this, because the patient and his son—particularly the son—wanted to drive home the point that, although his father might appear to be psychotic, unwell, agitated, and more of a danger than he actually was, he wanted to ensure that his father was receiving the same kind of care everyone else would.
That is where I was really able to pick up on the racial nuances at play. Of course, being a Black physician myself, I was able to decode some of that language and ensure that the patient and his son felt adequately supported with their needs in that particular environment—and really ensure that trust was baked into that patient encounter.
Kevin Pho: You mentioned being cognizant of these biases is definitely key to addressing them. Sometimes during the encounter, especially in the psych emergency department, a lot is going on—there’s a lot of pressure, a lot of stress. Talk specifically about how we can be more cognizant. What are some specific questions one must ask themselves in order to be cognizant of these biases and at least be aware of them? So, what would that look like?
Chika Oriuwa: Absolutely. I think that when it comes to the work that physicians and health care workers need to do, a lot of that occurs outside of the hospital. A lot of that occurs with actually being able to build our empathetic muscles, our compassionate ability to mentalize what it is that a patient might be going through—specifically within psychiatry. We have a formulation, right? That’s how we approach many patient encounters. When we’re formulating a patient, we have to ensure that we’re integrating that psychological and social component, but we’re also looking at it through the lens of racialization. How is it that this person’s race and their experiences with race might be affecting their mental and physical health?
A lot of that comes down to educating ourselves outside of the clinical environment, particularly because, when we are inside of the clinical environment—and as you mentioned, psychiatry and psychiatric interventions or encounters can be quite stressful—it might be that, in that stressful environment, you don’t access what it is you intellectually know, and you instead default to a subconscious bias.
It is important that you’re doing the work outside of the clinical encounter so that when you are within the clinical encounter, you can draw upon your knowledge and understanding of how someone’s racial experience or nuance might be at play. That’s far easier to do if someone has spent that time educating themselves outside of the clinical encounter.
Kevin Pho: Let’s go back to that hypothetical scenario you mentioned. In an ideal circumstance, where the clinicians have undergone that training, how would that encounter look to prevent something like a biased approach or unnecessary sedation? What would an ideal encounter look like?
Chika Oriuwa: Say, for example, in that moment, it would behoove the physician to also check in with themselves because if you recognize that maybe your heart is racing, or you’re feeling as though there is more of a threat than there might actually be, you would check in with yourself and ask, “OK, what is at play here? What subconscious biases might be at play here?” Then also recognize and extend that same compassion back to the patient by realizing that they might feel scared or threatened, and label that—actually give language to what is transpiring there, letting the patient know, “I can see that you’re feeling scared. Can you let me know what is leading you to feel more scared? Do you not feel safe in this environment? How can I ensure you feel safer in this environment?”
So it’s really taking that opportunity to put language to what might be unsaid in that space but that can directly affect patient care. Once you do that, you’re much better able to deescalate these encounters without adding unnecessary interventions. Maybe it is such that the person might benefit from taking a little bit of Ativan, or maybe they would benefit from an admission, but at least now you know that you’ve ruled out some of the things that might be affecting your clinical decision making that are subconscious to you.
Kevin Pho: Now, you’re in the midst of training. Is that type of education happening where you are?
Chika Oriuwa: Absolutely. I think that at the University of Toronto Department of Psychiatry, I definitely have received this kind of training—especially in my first year, the first month of residency. There was a lot of emphasis on talking about these kinds of issues within my program. So I absolutely believe that I’ve received adequate education on this. Of course, there’s always room to improve and enhance, and I don’t want to take away from that, but I do think that the University of Toronto is doing an exemplary job thus far.
Kevin Pho: This excerpt is from your book. It’s titled, Unlike the Rest: A Doctor’s Story. Tell us more about the book and the events that led you to write it in the first place.
Chika Oriuwa: Absolutely. This book, I often say, is a story of one—it’s my particular story—but it’s a tale for all, one that I think everyone will be able to identify with in certain elements. By the time they close the book, they may feel that they have seen themselves reflected in some way. So it does discuss my experiences being a Black medical student—being the only Black medical student at the University of Toronto from 2016 to 2020—but it really explores many different themes.
It talks about the formation of a physician and what it takes for us to actually go through medical school. There are interstitials that dive into the anecdotal experience of patient encounters that really have to do with my own formation as a physician. So I think it gives a lot of insight into the development of becoming a doctor that many books or memoirs might not necessarily dive into, because a lot of these memoirs talk about what it’s like to be a doctor rather than the path to getting there.
It also ties into my own personal experience—my cultural experiences as a second-generation Nigerian Canadian woman—and it talks about my experiences with mental health and disordered eating and how that affected the lead-up to medical school and the initial years of medical school. There are a lot of different topics and themes sprinkled throughout, such that I believe any reader who picks it up will see a bit of themselves reflected in the story.
Kevin Pho: Talk briefly about some of the challenges and obstacles that you faced as the only Black medical student at the University of Toronto. How you overcame those challenges, and how it influences you now as a physician.
Chika Oriuwa: Absolutely. I would say that throughout medical school, I encountered a variation of micro and macro aggressions. That came from patients, sometimes from attendings, from peers, from individuals in the public who heard my story—because I did a lot of public-facing advocacy—and they felt the need to extend vitriol back to me in the form of racism for the work I was doing.
I remember my very first day of medical school, being asked by one of my peers whether they made it easier for me to get in because I was the only Black student—whether I required a lower GPA. So I really had to confront this imposter syndrome that was compounded by being a Black woman in medicine and explicitly having my capacity and intelligence questioned, and my merit in earning that spot.
That really evolved throughout the years in terms of the different kinds of racial traumas and slights I experienced. Some were more of the microaggression fashion, as I mentioned—patients repeatedly asking me if I was Canadian, if I was born here, if I trained here, whether I was used to Canadian winters—and others were more explicit, like people online who said I didn’t deserve to be a doctor, that they would never let me treat them or their children, that I should be kept away from every hospital because Black doctors aren’t smart. Some thought I had ulterior motives for trying to champion equity within medical admissions.
So there has been a tapestry of racial insults and harms that I’ve had to grapple with throughout medical school. But I consider myself incredibly fortunate that I’ve created this community of support around me that includes family, friends, mentors, and lots of therapy—which I think is a central component to mitigate some of that trauma. I recognized that I couldn’t do it alone, nor should I. Doing that work within myself has allowed me to emerge back into my role as a doctor feeling confident, self-assured, and resilient against some of these forces that try to bar me from this career, which has been my dream since I was three years old. It is a life calling.
Kevin Pho: At the beginning of medical school, some of your classmates literally questioned why you were there and questioned your merit. What exactly would that conversation look like?
Chika Oriuwa: Right, so I actually detail this conversation in the book as well, where I say that I was standing in line waiting to get my med school backpack, and someone came up to me. After some pleasantries, they just very bluntly asked, “Did they make it easier for you to get in here? Did they have to lower the criteria in any way? I notice you’re the only Black student. Was there a separate stream? Was it easier for you?”
I immediately remember this flash of indignation within me and embarrassment, as it was said in front of a group of people. I had to say, “No, I had to meet the same criteria, same GPA, same MCAT scores,” rattling through my résumé of why I deserved my spot in medical school. The person was just like, “OK,” and moved on. But it planted a seed of doubt in my own capacity, and also fear around what other people were thinking—if they thought I wasn’t smart enough, if this person felt so emboldened, what were others thinking? Then I placed these unrealistic standards of perfection on myself, so that if anyone questioned whether I was smart enough to be there, I could show them my transcripts, show them my grades, proving I deserved to be there.
I talk about the mental health fallout that came from placing that standard on myself and how unfair it was for me to be in that position. But it was definitely a very poignant moment—a microcosm of what was to come in the ensuing four-plus years.
Kevin Pho: Do you have any piece of advice for people who are in your shoes today—Black medical students who might be undergoing these microaggressions? What advice do you have for them?
Chika Oriuwa: I would say, first and foremost, recognize the power of your voice and use it, even if it’s a whisper and even if it shakes. It’s also incredibly important to have this unshakable understanding of exactly who you are. There are different ways to arrive at that understanding. For me, it was through therapy—of course, I’m biased because I’m in psychiatry, but I think everyone can benefit from it.
Having that internal understanding that you are the author of your own life story—that you define yourself before anyone else can define you—and holding firm in that, so you can boldly and unapologetically occupy powerful spaces. Medicine is a powerful space, and every time you show up authentically, boldly, and proudly in the skin you’re born in, fully aware of your capabilities, it not only liberates you, it enhances you. You become a better, more compassionate doctor, and it preserves and protects the sanctity of your mental and physical health. That’s the advice I’d give to Black medical students.
Kevin Pho: We’re talking to Chika Oriuwa. She’s a psychiatry resident. Her KevinMD article is “How a psychiatrist rebuilt trust with a patient in crisis,” and that’s an excerpt from her book, Unlike the Rest: A Doctor’s Story. Chika, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Chika Oriuwa: Absolutely. The first message is to unapologetically occupy powerful spaces. The second message is to lead with authenticity and compassion. And the third key message is to educate yourself to build that empathetic muscle so you can be a more compassionate and astute health care provider.
Kevin Pho: Chika, thank you so much for sharing your story, time, and insight. And thanks again for coming on the show.
Chika Oriuwa: Thank you so much for having me.
