By Claudio Violato

As a professor and researcher studying the experiences of physicians, including international medical doctors (IMDs), I have interviewed and studied many hundreds of doctors.  These doctors have come from over 35 countries from every continent in the world speaking more than 50 languages. I have heard their stories, why they left their home countries and faced many challenges trying to enter the medical profession in Canada or the United States…

Some IMDs are refugees from war-stricken countries.  Some feared kidnapping or religious persecution.  Others have come under less stressful conditions like ordinary immigrants that have been coming to America for centuries.  Some were practicing medicine here, but most were still trying to do so – some for more than 15 years without success.  Many had taken survival jobs to support themselves and their families – jobs like cashiers, cab drivers, pizza delivery, etc.  There is often great strain on their families as they work and study.  IMDs greatly appreciate basic things we often forget or take for granted, things like freedom, safety, a clean environment and future opportunities for our children.

Among the many stories one stands out.  Farah, a female surgeon now 35 years old, arrived from Pakistan, with her husband 4 years ago.  Like other IMDs she has worked toward entering a residency program here.  Like so many others before her, she came for a better life.  In addition to the challenges all IMDs face (cultural, professional, linguistic, economic), she is now fighting a new challenge of her own.  In Pakistan, outside her home she wore a niqab, a scarf that covers the face and head leaving only the eyes exposed.  She is determined to wear the niqab while practicing medicine. This will likely make it next to impossible for her to be successful. Patients and the medical profession itself will not be sympathetic or accepting of her wearing the niqab because of the way it does not fit the cultural norms of doctor-patient interaction in the United States.

Farah spoke about her background, beliefs, and intentions.  She had faced her own family’s disdain back home as a teenager when she started wearing a niqab as a “good Islamic woman”.  She felt the niqab also protected her from the staring eyes of men.  Her own mother objected to this practice, but Farah wore it anyway.  Later she wore the niqab working as a surgeon which was commonplace in Pakistan.  In the United States she has faced suspicious looks and many negative comments from strangers on the street, people calling her “terrorist” and other insults.  Her husband – also a doctor – suggested that she should no longer wear the niqab.

Farah remains adamant, though, that she has the right to wear a niqab.  Farah is articulate, warm, kind, and very intelligent.  Her motivations are religious and personal, and she would like to see public attitudes change.  She would like people to understand that this is mainly a religious decision, one that distances the sexes, and that she poses no threat to anyone.

Her initial encounters with the medical profession here taught her that this will be a difficult struggle.  Residency program directors repeatedly, albeit gently, advised Farah that the medical profession will not allow her to practice medicine with a niqab.  American patient centered medicine includes many rights and expectations of patients that trump those of the doctor.  The patient should be able to see their doctor’s face, and receive a smile of reassurance.  But Farah has remained adamant:

“It’s my freedom, give it to me. If you are allowing people to wear everything, if you are allowing people… to have all sexual practices… If a society allows all those things and puts a ban on one certain thing, what kind of free society is this?”

Can she fight this battle and win?  She is a competent surgeon and caring doctor who will likely have great difficulty, perhaps even find it impossible, to find a home to practice medicine in America.  Can Farah find a way to reconcile her religious and professional beliefs to practice medicine here?

Claudio Violato, PhD, is professor of general internal medicine at Wake Forest School of Medicine. He is the author of numerous publications on the development of professionalism in medical education.