“Where are you from?”
Every time I hear this phrase, I still experience a visceral reaction of confusion, surprise, and comical disappointment. After approximately 150 years in the United States, people of Asian descent across the country continue to encounter this marginalizing question. Asians have been present here for over half of the nation’s lifespan, yet it often feels as though people will never look beyond the “Asian,” in “Asian American.” Like millions of Asian Americans and Pacific Islanders, I was born and raised in the States, but to the general American public, I might as well have just arrived from Asia yesterday.
This sentiment pops up frequently during interactions with patients. Within seconds of introducing myself to new patients, I am often greeted with, “where are you from?” or “your English is so good." Sometimes, I get the ‘politically correct’ attempt of “what is your ethnic background?” Other times, people are bold and instead just bluntly ask, “Are you Chinese?” And on more than one occasion, after clarifying that my parents immigrated from South Korea, I have received the non-sequitur response of, “I visited Japan once!” I wish I was joking, but unfortunately, this scenario has become all too familiar.
So what is the proper response here? This certainly was not discussed when I was learning how to take a history during my preclinical years. When I did bring it up to my non-Asian colleagues, they simply brushed it off, saying, “patients can say a lot of nonsense. Don’t take it personally.” Unfortunately, that kind of dismissive attitude has been particularly detrimental to Asian Americans, who historically have been swept to the peripheries. Culturally, Asians tend to handle negative emotions by ignoring them and simply enduring. They often do not seek help in an attempt to save face.
Does that attitude sound familiar? Unfortunately, residents also tend to not seek help. “Wellness” and “resiliency” are huge buzzword topics that have undergone a kind of renaissance in recent years, seemingly in response to the growing clamor of burn-out and mental illness among physicians. And what certainly has not been helpful for wellness is having to deal with frequent racial ostracization.
Most recently, the ‘othering’ of Asian American healthcare workers came to a head with COVID-19. During the COVID pandemic, Asian American healthcare workers were fighting a war on multiple fronts. The very patients who they were trying to help would often lash out against them, citing Asian Americans as the source of the so-called “China Virus” or “Kung Flu." By some estimates, there was a 1900% increase in anti-Asian violence and hate crimes in 2020. Now, the inappropriate questions of “where are you really from?” or “what’s your background?” seemed so innocuous compared to the more belligerent forms of racial abuse spurred by the pandemic.
Fortunately, some of that xenophobia has quieted down as the pandemic seems to be waning. Fortunately, many larger organizations have made efforts to address the secondary pandemic blighting Asian Americans. However, this should not lead to complacency, especially at the local level.
So how can you help your Asian American colleagues in medicine? Make them feel seen and heard. Proactively reach out to them, and I mean, really reach out to them. Remember, it is culturally engrained in Asian Americans that negative emotions are not allowed and that asking for help is forbidden. In light of this, asking an open-ended question like “how are you feeling?” may actually inadvertently become an emotional burden to someone whose culture has historically suppressed emotional reflection. Instead, listen to their stories and the kinds of interactions with patients (or even out in the community) that they experience. Acknowledge the distress from being ‘othered.' Speak up and stand up for them when anti-Asian micro- and macroaggressions do arise. Call the perpetrators out! From a history of being pushed to the margins, Asians often have a hard time speaking up for themselves. Especially if you hold some position of authority, such as an attending or a senior resident, please intervene. Your advocacy and support are invaluable and can make a world of a difference. Lastly—and this might sound silly— food is Asians’ love language. Do the aforementioned things first, but providing a meal or offering boba milk tea will likely not hurt.
As for an appropriate response to “where are you from?” I still haven’t found the perfect one, but I must admit that I do get a kick out of saying, “Well, you see, I’m not from around these parts… I’m from California.”
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