As children, we learn, albeit on a smaller scale, many of the fundamental skills we need to navigate the world. We are taught how to share, to treat others with kindness and respect, and crucially, we are taught how to apologize. Choruses of “I’m sorry. I won’t do it again” fill the soundtrack of our days, and we undoubtedly sound like broken records. Yes, we make a lot of mistakes, but we do our best not to make the same ones twice. As adults, we continue to call on much of what was taught to us at a young age, often times without conscious effort. Unfortunately, this is not always true when it comes to making meaningful apologies.

This idea has weighed on my mind with the recent passing of Intersex Awareness Day and the focus on several notable apologies from the medical field addressing past wrongdoings that have harmed the intersex community. Intersex Awareness Day is recognized on the 26th of October and marks the anniversary of the first public demonstration by intersex individuals in the US (1996). They protested the accepted practice of performing unnecessary genital surgeries on infants and children in order to better match them into binary sex categories. The prevailing argument is that these children could not and cannot provide meaningful consent, and the only procedures that should be performed in this case are those that are medically necessary.[1] In the decades since this demonstration, many individuals and several larger bodies have spoken out against the harm inflicted upon the intersex community by the healthcare system. However, it wasn’t until this year (nearly a quarter of a century after the first public demonstration) that Lurie Children’s Hospital and Boston Children’s Hospital announced actual changes to their policies on performing genital surgeries on intersex children.[2]

These decisions could be a catalyst in the fight for intersex rights, prompting other hospitals and policymakers to follow suit. That said, it is important for us to realize that advocates aren’t just protesting for an admission of guilt. An apology isn’t simply a statement of regret or a request for forgiveness. A true apology is a promise to do better, and the only way to do better is to know better. Knowing better means taking responsibility for past actions and learning from them. Although we are slowly making progress in the realm of recognizing past mistakes, we are nowhere close to where we need to be when it comes to learning from these mistakes and taking action to rectify them, evidenced by the fact that the first study on intersex adults in the United States wasn’t published until October of 2020.[3]

At this very moment, we are on the cusp of truly meaningful change for the intersex community. This is a pivotal moment in which the decisions of the medical community have the potential to propel us down a path of righting past wrongs and ensuring that they do not happen again. While these monumental announcements are reason to celebrate, they are not the end of the road. In terms of forgiving and forgetting, we may see a day when the medical community has enacted significant change that warrants forgiveness, but we ought never to forget these, or any other, injustices committed. A forgotten history is a soon repeated one.

The scope of wrongdoing in our healthcare system is vast, and I would be naïve to believe that the collection is finite. There will always be growth to be had and progress to be made. In that journey, we will make mistakes, but it is our responsibility to acknowledge those mistakes and learn from them. We must know better, and we must promise to do better.

[1] Intersex Awareness Day History. (2020, October 24). Retrieved October 25, 2020, from [2] Luthra, S. (2020, October 22). Boston Children's Hospital will no longer perform two types of intersex surgery on children. Retrieved October 25, 2020, from [3] Rosenwohl-Mack, A., Tamar-Mattis, S., Baratz, A. B., Dalke, K. B., Ittelson, A., Zieselman, K., & Flatt, J. D. (2020, October 9). A national study on the physical and mental health of intersex adults in the U.S. Retrieved October 25, 2020, from

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  • Michelle Huang

As a student pursuing the field of medicine, I have one of the classic pre-medical student narratives: I have been wanting to be a physician ever since I was a young girl, and I could not imagine considering another career. In recent years, as more and more women have joined the medical field, and the presence of women has expanded across all aspects of medical practice, women like me to continue to be inspired to seek this career path. In 2014 alone, women already dominated some medical professions, accounting for more than 70% of physician assistant students, 62% of practicing PAs, and 57% of faculty in PA programs (Essary, 2014). Half of all US medical students, 30% of actively practicing physicians, and 37% of faculty at academic medical centers are female, and the number of women in the profession has only been increasing (Essary, 2014).

Growing up, I never had a doubt in my mind that I belonged in the medical field, and even as a woman in STEM, I never once stopped to reconcile the idea that my gender could prevent me from realizing my aspirations in medicine. However, even as more women are participating in the medical profession, inequalities in pay, leadership, and respect still run rampant in the practice, causing many women to reconsider their places as physicians. The representation of women in the field of medical practice is rapidly increasing, but society needs to change the allotment of resources, social attitudes, and bureaucratic control in order for women to truly have an equal influence in medicine. By neglecting female healthcare workers and denying them equality, the healthcare system also neglects to recognize the importance women have in the representation of patient populations, hindering the care that patients can receive.

On average, women earn about $30,000 less per year as a physician than men in the same position (Essary, 2014). This wage gap is something women experience in countless professions, and in medicine, it indicates how more competitive, higher-paying specializations are occupied disproportionately by men, especially as women are thought to drop out of those positions once they have children. Not only is this a strong misconception as women are actually more likely to return to their full-time practice and increase their hours after having children, but it is fundamentally rooted in the patriarchal idea that women must be the primary actor in raising a family (Ross, 2003). Even if the woman has no interest in raising a family, they are still automatically assumed to want one in the future and thus thought to be unfit for high-paying physician jobs. The lack of equal pay opportunities female physicians encounter is only one of the many inequalities they face and something that requires a great deal of change.

Women in medicine are also often criticized for not taking their share in leadership roles, but when female physicians do demand equal pay and leadership positions in healthcare, they are thought to hit a so-called “glass ceiling”— a very real, invisible barrier that prevents women from achieving the leadership status that men achieve. Female healthcare workers with the same credentials and abilities as male healthcare workers are found to have harsher resident milestone evaluations and less access to leadership opportunities, limiting them in the paths they can take in medicine.

In addition, the increase of female physicians in the field has led to the belief that the medical profession is being “feminized” and that it has become a “pink collar career,” losing the respect and monetary compensation the career usually carries (Ross, 2003). Why must a profession become less distinguished when women hold positions in it? The idea that women entering medicine decrease its prestige is a clear reflection of the view people have on women themselves, seeing the jobs they occupy as less revered because women themselves are less respected. The decrease of monetary compensation in the field is also directly related to the lack of leadership roles and high-paying opportunities female health workers have access to, perpetuating the inequities women experience in medicine.

The increase in women in medicine should not represent the decrease of prestige or respect in the profession, rather an increase of diversity and representation in the field. More women in healthcare means that more female patients are being listened to and receiving the representation and attention that male physicians often fail to provide them, and female healthcare workers inspire younger generations of girls to pursue the medical profession. There needs to be a change in the social beliefs and attitudes surrounding women, and only then will they receive the compensation, opportunities, and respect they deserve. Medicine is a profession that aims to serve the public, and until there is equality in medicine, the medical field will not be serving its patients in the best way possible.

  1. Essary, Alison C, and Coplan, Bettie. “Ethics, equity, and economics: a primer on women in medicine.” JAAPA : official journal of the American Academy of Physician Assistantsvol. 27,5 (2014): 35-8. doi:10.1097/01.JAA.0000446231.08425.6d

  2. Ross, Shelby. "The Feminization Of Medicine". Vol 5, no. 9, 2003. American Medical Association (AMA), doi:10.1001/virtualmentor.2003.5.9.msoc1-0309.

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  • Jennifer Nguyen

If you do not know how to speak English in the United States, you are as good as dead — at least that is the case in healthcare. The COVID-19 pandemic has magnified this tragic trend.

A limited English proficient (LEP) woman entered a hospital with coronavirus in March and the staff mistakenly placed her with non-coronavirus patients. Due to her cough and fever, a doctor transferred her into a coronavirus unit, cautioning other physicians: “Good luck. She speaks Hungarian.” The medical resident treating her noted that no one wanted to arrange an interpreter to record her medical history. The resident proceeded to call the interpreter service as his N95 mask muffled his voice and his helmet blocked his ears. After spending five minutes yelling “Hungarian!” on the phone to get the appropriate interpreter, the service representative still thought he said “Spanish.” She died the following night.

Deficiencies in providing quality translating and interpreting services in healthcare have left LEP patients with worse outcomes: longer hospitalizations, more readmissions, and more medical errors. Yet the Trump administration reduced free access to language services and thereby explicitly undermined civil rights laws. The Civil Rights Act of 1964 established LEP individuals’ right to receive free language assistance. In 2010, the Affordable Care Act (ACA) clarified that language assistance must be meaningful—a standard evaluated by timeliness, accuracy, and efficacy. The Centers for Medicare and Medicaid Services (CMS) was authorized to assure these rights in 2014. Too bad they were all talk and no action.

CMS teased that by 2016, LEP patients would receive information about language services and have access to qualified interpreters. But that year, nearly a third of U.S. hospitals still failed to offer interpreters. Without normalizing the use of language services in patient treatment, physicians risk n

eglecting their patients. Clinicians mistakenly accept nods and smiles as the equivalent of health literacy, when patients actually nod in fear of burdening their physician. They do not know they have the right to communicate with their health providers, no matter their English fluency. I did not even know this myself.

I am a Vietnamese American immigrant. Yet until I took a science law class during my freshman year of college, I did not know that my grandpa deserved to hear his paralysis diagnosis in Vietnamese. Does this mean I did not have to play doctor, interpreter, and the bearer of bad news for my family members? It only took 15 years in the states and a fortune in tuition to figure out the answer: No.

But the availability of medical interpreters and funding is deficient. Even when facilities provide language assistance, the shortage of professional interpreters delays procedural practices. However, medical facilities’ non-compliance is not completely intentional. The government mandates language access for LEP individuals, but provides the minimum in resources. Only 3% of medical facilities receive reimbursements from the government or Medicaid systems for language services they provide. Thus, hospitals treat language services as another item on the budget. In an attempt to reduce expenditures, healthcare facilities rely on untrained family members and bilingual staff to bridge the communication gap, resulting in the improper use of medications, incomplete medical histories, and poor adherence to post-operation instructions.

The health system has failed to acknowledge the severity of the language barrier as a challenge to quality health care. Thus, the integrity of healthcare for LEP individuals has been deteriorating for decades, and the pandemic has exposed this inequity. The Hungarian woman may have died even if she spoke English, but her experience exemplifies how LEP patients suffer from poor quality of care. Healthcare workers have adapted to the pressure with a utilitarian approach whereby the patients presenting minimal challenges to care are the ones who receive the best care. No one expects fluent English speakers to comprehend the extent of COVID-19, so how are LEP individuals expected to without language assistance?

Even though COVID-19 collapsed America’s healthcare system, Donald Trump decided to exacerbate the condition for marginalized communities. He justifies his xenophobia because of “high costs.” In reality, when hospitals consistently use language services, they offset interpreting expenditures with the money they save from fewer hospital readmissions.

It is futile to expect change from a government that continues to systematically oppress its people. Clinicians, take it upon yourself to normalize informing patients of language services and using those services. Check in with the patient and interpreter to ensure vital information is absorbed. If you cannot communicate with your patient, then you cannot provide care.

Community-based organizations are also critical in connecting LEP patients to physicians by reducing fear of health institutions and standardizing language and cultural competency. If the health sector does not meet the needs of the expanding demographic landscape, ten percent of our American population is as good as dead.

Works Cited

Burkle, C. M., Anderson, K. A., Xiong, Y., Guerra, A. E., & Tschida-Reuter, D. A. (2017).

Assessment of the efficiency of language interpreter services in a busy surgical and

procedural practice. BMC health services research, 17(1), 456.


Center for Medicare and Medicaid Services. (2014). Strategic Language Access Plan (LAP):

To Improve Access to CMS Federally Conducted Activities by Persons with Limited English Proficiency [Brochure]. Baltimore, Maryland: Author. Retrieved September 23, 2020, from

Das, L. T., Gonzalez, C. J., & Kutscher, E. J. (2020, July 29). Addressing Barriers To Care For

Patients With Limited English Proficiency During The COVID-19 Pandemic. Retrieved

September 23, 2020. https://doi/10.1377/hblog20200724.76821

Kaplan, Joshua. “Hospitals Have Left Many COVID-19 Patients Who Don't Speak English

Alone, Confused and Without Proper Care,” March 31, 2020. https://


Karliner, L. S., Pérez-Stable, E. J., & Gregorich, S. E. (2017). Convenient Access to

Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated

Hospital Expenditures for Patients with Limited English Proficiency. Medical

care, 55(3), 199–206.

Levinson, D. R. (2010). Guidance and Standards on Language Access Services: Medicare Providers [Report].

Steinberg, E. M., Valenzuela-Araujo, D., Zickafoose, J. S., Kieffer, E., & DeCamp, L. R.

(2016). The "Battle" of Managing Language Barriers in Health Care. Clinical

pediatrics, 55(14), 1318–1327.

The U.S. Department of Health and Human Services. (2020, June 12). HHS Finalizes Rule on

Section 1557 Protecting Civil Rights in Healthcare, Restoring the Rule of Law, and

Relieving Americans of Billions in Excessive Costs [Press release]. Retrieved September

23, 2020, from


Wasserman, M., Renfrew, M. R., Green, A. R., Lopez, L., Tan-McGrory, A., Brach, C., &

Betancourt, J. R. (2014). Identifying and preventing medical errors in patients with

limited English proficiency: key findings and tools for the field. Journal for healthcare

quality: official publication of the National Association for Healthcare Quality, 36(3), 5–


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