February 17, 2020

Known for Being Anonymous

By Josiane Joseph

Recently, I spent an evening at a professional development workshop designed to equip me to interact with confrontational patients. During this workshop, I encountered scenarios of people with racial or gender bias (both of which have affected me in- and outside my career training). Although it was informative to navigate the prejudices of others seeking care—what forced me to consider implications of diversity in the healthcare environment most was not my interactions with unreasonable people, but the survey administered before and after the event.

“It will be anonymous,” the workshop leaders explained; however, as I looked at the first few questions on the survey, it became clear that anonymity would be impossible. What the session leaders sought to know first was my race, sex, age, and my position at my institution. Sure my sex might have been represented in the room with about a dozen people. Even age could potentially have a range within the room; but when you are the only African American female who holds a training position in the entire city and a survey administrator asks for your race, the position you hold, and your sex—it becomes clear from whom the responses were generated.

At this workshop was not the first time I realized that I would not have the same privilege of anonymity as my peers. In the past I was asked to take a survey in a cohort of more than fifty people. The survey broached sensitive topics regarding harassment of any kind. Although the group was larger, the issue was the same. After the first few questions, the survey evaluator might guess that it was me responding. It would be simple for anyone to realize that of the three African American people in the cohort, I was the only one in my training role responding to the survey. The implications of this for people similar to me (minority women in advanced training or professional positions) are that we often are not afforded a safe space to share our viewpoints; because who in their right mind would truthfully share feelings of harassment if there is a clear avenue of retaliation?

As a rising scientist who respects efforts to obtain high-quality survey data that is representative of the population, the internal turmoil that some “anonymous” surveys might trigger is not trivial. Additionally, as someone well aware of the limitations institutions face in terms of understanding the experiences of minorities and using that understanding to create an inclusive environment, I am frequently tasked with weighing the risks and benefits of my responses to surveys. Most people sharing contentious views would be concerned about inappropriate disclosure of that information; it is unjust to orchestrate a scenario in which minorities completing surveys are more vulnerable to identity disclosure.

Lately, I have considered alternatives to this dilemma and I have not found many; simply because it helps to know if minority groups feel differently from other groups of people. The fact that no one in any of my two previous survey classes has broached this issue of preserving anonymity for minorities is surprising. (But not too surprising considering they were mostly taught by non-minorities.) Yet from my experiences, it is clear that this will continue to be an issue. I sometimes dream of a universe where training programs are more representative of the population of the United States and where this dilemma (along with many others) would be resolved. Minorities need their courage to face more threatening issues than being Ms. Anonymous-only-African-American-MD-PhD-student taking a survey. (They need their energy to, for example, deal with confrontational patients). Aside from this, institutions owe it to themselves to avoid expending resources that produce defunct results. I can usually move past my known anonymous identity because of my research training, but we should all consider the impact of those that can’t.


Josiane Joseph is a Haitian-American M.D.-Ph.D. student at Mayo Clinic. She was born in Miami, Florida and earned her B.S. at the University of Florida in 2015. During her free time she enjoys movies, writing, attending church, and learning about what makes other individuals unique. Josiane values discussions of meaningful issues and looks forward to sharing diverse views with others.

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