When Silence Speaks Louder: Navigating Power, Identity, and Resistance in Medicine
By KevinMD Editors
“They never said it outright. Not at first. They didn’t have to.”
These initial lines, quietly piercing and meticulously written, ground a deeply personal yet widely relatable reflection from Dr. Atharva Joshi, a family physician battling not just illness, but the unspoken forces of institutional bias that threaten to render invisible those who don’t conform to the standardized image.
In an impactful essay that intertwines personal story, critical analysis, and a rallying cry for change, Dr. Joshi recounts the experiences of being subtly labeled—not for malpractice or lack of skill—but for cultural incongruence. His path illustrates not merely an individual’s struggle but the intricate system through which many marginalized doctors must maneuver to survive, let alone flourish.
Beyond this personal battle, Dr. Joshi outlines five strategic frameworks aimed at resisting systemic oppression. However, to truly grasp these tools, one must first comprehend the environment that demands their use.
The Hidden Tribunal: Racism in the Veil of Bureaucracy
Dr. Joshi operated at the fraying margins of a healthcare system—caring for individuals overlooked by the medical machinery. While many stealthily escaped underfunded, overwhelmed environments, he persevered. This dedication rendered him both essential and, paradoxically, suspicious.
He did not encounter a blatant claim of negligence. Rather, he found himself summoned to a tribunal where his “culture” was noted as a concern—neither evaluated nor defended, merely documented. In these instances, he recognized what many professionals of color intuitively perceive: Systems don’t always need to directly challenge your actions to penalize you. They can simply dismiss your existence.
The tribunal’s proceedings weren’t focused on delivering justice. They were centered on reaffirming dominance. And in his own words, “not about behavior, but about culture.” This represents the treacherous shift—from accountability to ethnocentric gatekeeping.
The Quiet Part Out Loud
While most organizations mask bias with layers of HR-friendly language, Dr. Joshi’s experience stood out because one entity within the system inadvertently revealed the truth: that his worth was questioned due to his identity. Even then, there was no judge banging a gavel, no cries of outrage—only muted confirmation and chilling documentation.
However, what distinguishes his account is not just its occurrence—but that it persists, silently and repeatedly. For every Joshi who enters that hearing room, countless others linger at the threshold. Black physicians mistaken for custodians, Arab doctors doubted in front of patients, Native healers disregarded in Western hospitals—the echoes remain constant.
Systems of power seldom confront diversity with overt violence. Instead, they gradually erode it—through neglected promotions, excessive credential evaluations, “cultural fit” assessments, and unwarranted process audits.
Strategies of Resistance: From Endurance to Empowerment
Dr. Joshi doesn’t simply recount his battle. He provides others with a tactical framework—a guide to resisting insidiously hostile institutions.
Here are the strategies he presents, each rooted in survival yet evolved into subversive resilience:
- The Chameleon Principle
Power safeguards what it relies upon. Dr. Joshi encourages becoming “irreplaceable” not through ostentation, but by being necessary. Master unique processes. Grasp institutional knowledge that others shy away from. Become integral. This visibility by means of utility grants subtle protection. - Weaponized Absence
When forced out or let go, leave a void. Do not protest. Just vanish—and reveal the emptiness they’ve created. Allow patients, colleagues, and workflows to falter in your absence. The system learns to respect not from your pleas, but from its own suffering. - Reputation Obfuscation
They cannot strike what they cannot label. Avoid being a single identity. Be a physician, mentor, analyst, writer—and transition fluidly among them. This fragmentation shields your core self from institutional erasure. Adapt as needed; master various fields. - Narrative Supremacy
Your narrative acts as your armor. Document everything. Publish. Educate. Archive your contributions and grievances alike. If you do not control the story, someone else will weaponize a distorted version. A careful recounting of truth serves as the ultimate protection against defamation. - Yamdoot Doctrine
Named after the Hindu messenger of death, this ultimate strategy is only to be employed when all else has failed. Gather evidence. Accumulate instances of injustice. When confrontation is unavoidable, reveal everything with precise clarity. Not in vengeance, but with disruptive insight. The aim is not retribution—but to make further targeting unattainable.
A Reckoning Long Overdue
Dr. Joshi declines to conclude with a lament. Instead, he issues a rallying cry for minority physicians navigating this silent struggle. His words stem not from resentment, but from a place of strategic necessity.
The challenges he describes are genuine. But so are the strengths: cultural adaptability, community trust, and resilience.