ADVOCACY: Discrimination in Medicine

BY: MICHELLE COHEN, CWIM Advocacy Committee

On June 12, 2020, CWIM submitted a letter to the Faculty of Medicine, Memorial University of Newfoundland, the College of Physicians and Surgeons of Newfoundland and Labrador, and the College of Family Physicians of Canada, voicing concern over the online conduct of resident physician Dr. Zachary Kuehner. The full text of the letter is below:

June 12, 2020

TO: Faculty of Medicine, Memorial University of Newfoundland
College of Physicians and Surgeons of Newfoundland and Labrador
College of Family Physicians of Canada

RE: Racist and unprofessional conduct by a resident physician

We are writing to express our profound concern over the online conduct of Dr. Zachary Kuehner, a family medicine resident at Memorial University of Newfoundland (MUN). Recent postings by Dr. Kuehner on social media are highly inflammatory and of an explicitly racist nature that cannot be overlooked. We call on MUN, the College of Physicians and Surgeons of Newfoundland and Labrador
(CPSNL) and the College of Family Physicians of Canada (CFPC) to investigate this situation thoroughly in concordance with their mandates to protect the health of the public and the integrity of the profession.

Canadian Women in Medicine (CWIM) is a grassroots organization representing female physicians from across Canada. We are committed to promoting equity and diverse representation in medicine, as well as action on the part of the profession to understand and address its role in perpetuating health
inequities. In 2019 and 2020 we worked with the University of Toronto(1) to address a 16 year long pattern of open gender discrimination within its faculty, and we maintain open lines of communication with the university as they move forward with new policies to take action on equity.

The screenshots of Dr. Kuehner’s social media conduct that have been reported in the media(2) are disturbing and call into question his independent judgement and ethics. His recently deleted Twitter account identified him both as a “resident doc” and an “islamophobe” and featured his real name along with a photo. Comments he made towards medical students on Facebook during a discussion on Black Lives Matter protests seem to mock the phenomenon of discrimination: “I’ve learned so much after all…though I always knew I was racist… and a sexist… likely an ableist too”. He uses the same dismissive tone to imply that his conduct is above remediation: "Whichever of the herd above mentioned speaking to my employer, feel free to talk to Eastern Health, PGME, faculty of medicine... whatever suits. We'll see how the suggestion of sensitivity training goes."

Dr. Kuehner has also written in mainstream press about the Indigenous health curriculum he studied during his undergraduate medical training at the Northern Ontario School of Medicine (NOSM). Recounting a seminar on colonialism(3) and its impact on Indigenous health, he calls NOSM “hell-bent” on graduating “physicians comfortable self-flagellating for deeds they did not commit.” Of the social and health problems facing Thunder Bay,(4) Dr. Kuehner writes that the city “is the closest major urban centre to some of the most isolated and dysfunctional Indigenous communities in the country”, calling them “a cross that no other city, proportionately, has to bear.” He dismisses the “common narrative” of “a city
suffering from an epidemic of racism”, instead shifting focus to what he calls the “sheer hopelessness and discord that define life” in the Indigenous communities of northwestern Ontario.

In labeling himself with a term unambiguously associated with anti-Muslim bigotry and openly rejecting in mocking tone the core precepts of Indigenous health, Dr. Kuehner has shown himself to be unsafe to provide health care to Muslim or Indigenous patients. As someone about to begin an emergency medicine fellowship he will be in a position of authority over medical students and residents, which not only causes harm to trainees who are racialized, it normalizes and perpetuates his racist views within the medical establishment. And by allowing racism to flourish unchallenged, harm is done to the wider profession as a whole.

MUN Faculty of Medicine’s Statement of Professional Attributes(5) requires that “professionals demonstrate consideration and respect for others” and “accept all people equally regardless of…race”, notes that “a resident, whose behaviour violates the ethical and professional standards of the medical profession, may be deemed unfit for the practice of medicine in general.”

The Canadian Medical Association’s Code of Ethics and Professionalism(6) lays out expectations that physicians “commit to collaborative and respectful relationships with Indigenous patients and communities.” This comes alongside broader requirements to “accept [any] patient without discrimination” and “never participate in or support practices that violate basic human rights”. The CPSNL’s practice guideline Physician Use of Social Media(7) states that “the College expects physicians to be vigilant in avoiding online situations which may be harmful to patients or professional colleagues and/or harmful to the reputation of the medical profession.”

Dr. Kuehner will soon complete his family medicine residency and obtain the privilege of calling himself an active member of the CFPC. In light of the CFPC’s numerous(8) policy statements(9), in support of the actions proposed by the Truth and Reconciliation Commission, we expect the college cannot sit idly by while a family physician publicly denigrates Indigenous communities and derides NOSM’s Indigenous health curriculum. As well, an institution that recognizes how “racism in the Canadian health care system can be fatal” must address a resident member who publicly labels himself as anti-Muslim and consider if this individual meets the standards of CFPC membership.

Recent civil unrest and protest against systemic racism in law enforcement have highlighted the importance of addressing racist discrimination in all our major institutions. Now more than ever, the medical establishment in Canada needs to take a clear stand for equity and against bigotry. Words in praise of diversity and representation must be backed by concrete actions.

CWIM will be closely following the outcome of the complaint against Dr. Kuehner to MUN, as well as monitoring whether his conduct is addressed by the other medical authorities tasked with maintaining standards of professionalism. Our organization represents nearly one thousand Canadian physicians who are keenly aware of the omnipresence of discrimination in medicine. As such we are watching this situation unfold not only as members of the wider professional community but stakeholders on the issue of bigotry in medicine.

We look forward to your replies and will endeavour to maintain open lines of communication and collaboration.

Michelle Cohen, MD, CCFP
Co-Chair, Advocacy Committee
Canadian Women in Medicine

1 Glauser, W., 2020. University Of Toronto Investigation Says Learning Environment At Two Hospitals ‘Favoured
Men.’ [online] The Globe and Mail. Available at: https://www.theglobeandmail.com/canada/article-university-oftoronto-
investigation-says-learning-environment-at-two
2 Ryan, C., 2020. MUN Students Pen Letter Of Complaint Against Self-Professed 'Islamophobe' Doctor. [online] CBC
News. Available at: https://www.cbc.ca/news/canada/newfoundland-labrador/zachary-kuehner-mun-medicalschool-
dean-margaret-steele-1.5602810
3 Kuehner, Z., 2019. Academic World Lets Identity Bullies Run Wild. [online] The Chronicle-Journal. Available at:
https://www.chroniclejournal.com/opinion/columns/academic-world-lets-identity-bullies-runwild/
article_5fe0a504-a3ff-11e9-b027-331adbbaf761.html
4 Kuehner, Z., 2019. Thunder Bay: Scapegoat Of A Nation. [online] The Chronicle-Journal. Available at:
https://www.chroniclejournal.com/opinion/columns/thunder-bay-scapegoat-of-a-nation/article_1ba7a39c-9e9b-
11e9-965d-7f01c328e9f5.html
5 Memorial University of Newfoundland, 2013. Statement Of Professional Attributes.
6 Canadian Medical Association, 2018. CMA Code Of Ethics And Professionalism.
7 College of Physicians and Surgeons of Newfoundland and Labrador, 2018. Physician Use Of Social Media.
8 College of Family Physicians of Canada, 2017. The CFPC's Actions On The Truth And Reconciliation Commission Of
Canada.
9 College of Family Physicians of Canada, 2016. Health And Health Care Implications Of Systemic Racism On
Indigenous Peoples In Canada.


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