Enough. Or perhaps too much.

It’s been a weekend that has highlighted some of the baser instincts present in our society, hasn’t it? While so many of us want to believe that we as a country are better than this and are achieving our ideals, events like Charlottesville provide an incredibly harsh reminder that we aren’t even close yet.

It’s easy to look and think, “I’m not in Charlottesville, and I’m not in Virginia. This isn’t about me or my neighborhood and there’s nothing I can do.”

I’m going to challenge you and tell you that this is about your city, your state, your community and that there is PLENTY that you can do. Reading the news, seeing the remarkable photos from Charlottesville, I’m using this as an opportunity to double down on my commitment to peace with justice and inclusion, and trying to not just provide lip service.  We have GOT to move from words to deeds, friends. Or, as you’ve heard me say more than once in this space, we must #lovelouder.

While you need to do what works best for you, here’s what I’m doing.

  • I sent yet another contribution yesterday to the Southern Poverty Law Center. The SPLC was founded in 1971 and is doing some of the most important work today on civil rights FOR ALL. I hope that you will familiarize yourself with their work and that you will consider providing them with financial support. What they are doing makes a real difference and is so critical in a time when hate crimes and racism are so prominent.
  • I’m speaking up. Yes, I know, y’all are used to me saying something when people are unkind and unfair. I’m going to be even more tuned in to comments that show bias…and I’ll be letting people know that’s not acceptable.
  • I’m educating myself and my community. Earlier this year I did a pretty good job sharing #TuesdayTeachings on Twitter, which were items that provided more understanding of the underpinnings of various forms of discrimination. I’m recommitting myself to learning more and to sharing what I learn with you- and I’m trying my VERY best to get that information from members of the communities experiencing discrimination.
  • I’m looking at my circle of friends for diversity and inclusion.  I like to believe that my circle of friends is pretty diverse- immigrants, POC, LGBT are all well represented. But I’m looking again to see how I can expand my circle, and I’m seeking guidance from those friends on how to be more inclusive both personally and professionally.
  • I’m listening. While I may not agree with or understand everything that people put in front of me, I will do my best to respectfully hear them and learn from their experiences. Sometimes that is really, really challenging!
  • I’m promoting minority friends and colleagues. It’s unfortunately easy for us to put names forward for awards/ panels/ leadership roles of people who look like ourselves; I refer to this as nominating the “usual suspects.”  While I’ve long sought to make sure to include the not-usual suspects, again, I’m doubling down here. As an additional comment, I am carefully looking at the program we are developing for Surgery Education Week next Spring to ensure that our speakers, moderators, and panelists are diverse. I want everyone to believe #Ilooklikeasurgicaleducator
  • I’m walking the walk. If you have seen me in action, you know that all of the above are more than words on a screen.  One of the most important ways that we can influence those around us is role modeling the behaviors we want to see in the world. I won’t say I get it just right every single day because, as I have said before, I don’t know what it’s like to be a member of many of the targeted communities. But I can make a good faith effort, I can ask for feedback from people I trust, and I can apologize when I mess up (and not make the same mistake twice). For those of us trying to be strong allies, these are important concepts.

I’m going to challenge each of you who are part of my reader community to choose something- no matter how small you think it is- and make that your focus to #lovelouder this week.  If you want to share in the comments or in social media your intention to make you more accountable, that’s great.  If you want to write it down on a post-it and put it on your computer, that’s also great.

Words and deeds that diminish any of us ultimately diminish all of us. Remember that, and please act accordingly.

You find what you’re looking for

I can’t help but think there’s a word for the phenomenon when you get interested in a topic, start learning about it, then start finding things everywhere that enhance your learning process.  Okay, I Googled it.  It’s the Baader-Meinhof phenomenon.

In my case, I’m currently participating in an on-line seminar called “Art of Activism: Hard Conversations- Intro to Racism.”  This week’s lesson centers on structural/ institutional racism, and I am absolutely experiencing the Baader-Meinhof phenomenon.

The lessons in the seminar have been EYE-OPENING, I assure you.  And yes, that word merits all caps.  I consider myself to be relatively enlightened about the ways in which our social and legal structures reinforce racial inequality and serve as barriers to full social justice. And in spite of feeling like my knowledge in these areas is above average (recognizing that they are not experiential, of course), every day I am reading something or watching a video that challenges me. Some of them break my heart, some of them leave me angry, some leave me frustrated, and they all leave me realizing that we have so very much more to do to build the world that I want to believe we have and a world that we all deserve.

If you want to enhance your own understanding of structural racism, this is a great reading.

If you want to better understand the history of structural racism, here’s a brief video (with a link to a longer video, if you wish):

What do you know about disparities in the criminal justice system? Education systems? The financial system? Health care? How can you learn more about these things?

I’ll summarize for you: The disparities are huge, they are institutionalized, and they are real. Every single time that one of us denies that part of the issue is systemic and we blame individuals, we’re continuing as part of the problem rather than the solution. Equip yourself with facts, and listen deeply to the stories of those with first-hand experiences of discrimination.

I don’t know how many of you are familiar with the Angola 3, one of whom (Albert Woodfox) was kept in solitary confinement for over 40 years in Louisiana’s penal system. This article in this week’s New Yorker introduces you to Albert Woodfox and his story.  I’ll comment that he is a truly remarkable human.  Reading about him helped me to develop a deeper empathy for the Black Lives Matter movement than I’ve previously been able to muster.  And, as I lead with, this was something I would have read less deeply were I not engaged in this seminar.

For my readers who are people of color and who are LGBTQ+: I want to know how those of us who are white and/or cis can be the most helpful in fostering change. I need to understand what that change is not from my perceptions but from your lived experiences. I don’t know and can’t know what it’s like to wake up every day as a Latina, or a black man, or someone who is gender binary. And without your experience, I don’t know how to use the influence that I have to insure that you are included as you deserve to be.

If you are a male reader, I hope that you’ll also include women’s experience as something you seek to hear, understand, and improve. I’m happy to discuss both explicit and implicit gender discrimination with anyone who is willing to hear.

One last resource before I issue a challenge to you.  This Catalyst document has some excellent tips for engaging in conversations about gender, race, and ethnicity in the workplace (again, something a resource I came across serendipitously today; thanks, Twitter). I hope you’ll find ways to use it.

I’ll close with a challenge to each of you: Can you think about what is good or important about discussing inequality? What is hard about it? And how can you manage the hard parts to enjoy the good/ important aspects?

Let’s do this together, friends.  It’s going to require each one of us to find solutions, to reach out, to make a difference.





The need for enlightened men

Last week I was involved in an email exchange with two colleagues (we’re working on a subversive project together…more on that eventually) when one of them pointed out that a 2017 meeting of a major surgical organization has exactly zero women scheduled as a keynote speaker.  Yes, you read that right.  Zero.

This isn’t a a specialty organization I’m a member of because it doesn’t meet my clinical or professional development needs, but both of these colleagues are members. And while I know some of that organization’s higher echelon leadership fairly well from other organizations, I’m not really in a great position to point the issue out to them since I’m not a member.

Fortunately, our third colleague involved in the Subversion Project is a man. Most importantly, he’s a man who does not hesitate to speak up about failure of inclusion, and he also happens to be a member (and leader) of the organization in question. He’s asking lots of questions about diversity and inclusion, and I made it a point to thank him for doing that tonight.

This series of events was buttressed by an HBR piece last week on men who mentor women. While this particular instance is less about mentoring and more about “doing the right thing,” it’s behavior that tells me that this individual is also likely a remarkable mentor and sponsor to women surgeons. And he’s engaging in the first behavior identified in the HBR article, using his authority to change workplace culture.  While he’s not in one of the BIG leadership changes to force change about inclusivity in the organization in question, he is using his voice to ask important questions and make sure that the issue isn’t ignored. He’s being an ally, and that’s something that none of us can underestimate the value of, even as we’re about to enter 2017.

Patricia Numann has long used the phrase “enlightened man” to describe the allies who have helped to advance women in the surgical profession. In interviews I did in 2014-2015 about barriers to academic careers, the preponderance of the mid-career and senior women surgeons I interviewed described at least one male mentor who was instrumental in their career development. Until we achieve a critical mass of women in academic surgery, meaning we’re 1/3 or more of those at the table, this isn’t going to change much in the absence of spectacular help.

You know, the kind of help that raises its hand and says, “Hey, we can do better to represent our membership in general,” then gets to work making sure that actually happens.

(Additional reference for men who want to learn how to be better allies for women in male-dominated fields is the man-focused chapter in Feminist Fight Club.  When I read it, I thought immediately of several men I know who could have written it and definitely live it.  Thank you if you’re among them.)


Unconscious Bias #AWSChat- May 24, 2016

May 2016 Association of Women Surgeons Tweetchat


Say something

This morning I got a text from a mentee (I’ll call her M) describing an experience she had that reminded me of one of the most important things we can all do when addressing bias and trying to help us move toward a perfect world where anyone can look like a surgeon.

We need to speak up.

It seems that a patient acknowledged M as the nurse, and M’s attending promptly and politely redirected the patient to let them know that no, she is a physician working with him.  The attending who did this is someone I have respected from afar for a long time; I appreciate that he reinforced my positive impressions of him.

This is an incident that on the surface may look like a small one; nevertheless, it is representative of the fact that people still have expectations of who looks like a physician or surgeon.  When M was my medical student, we had an interesting episode in which a patient saw her in his room with the rest of the team and said, “Get her out of my room!  No Mexicans in here!”  I calmly looked at him and said, “She’s not Mexican, and she is part of your care team.  She’s staying here to help.”  Full disclosure here: M is Hispanic, but her family is not from Mexico…so I wasn’t lying, per se.  I gave M a great deal of credit for her courage over the next several days when she took this patient on as her primary responsibility, doing her best to win him over with her compassion and her skill as a young physician-to-be.  I have to confess that I don’t know that I would have voluntarily stepped into that situation if I were her.

I didn’t even think about until today the impact my saying something had on M; I was simply setting the ground rules for my “house” and letting him know that discrimination is not tolerated here.  And while it’s a more extreme example of what her attending did for M today, he also set a certain tone by not letting the patient’s referral to M as a nurse go without comment.

A few weeks ago I issued some challenges to us as a surgical community to make the energy behind #ILookLikeASurgeon sustainable and for the effort to make a difference.  I want to add this idea to the slightly loftier list there:  Say Something.  If you are a trainee, find your script for what to say when people either mistake your role because you don’t fit the stereotype, or when they flat out make a disrespectful comment about your gender/ ethnicity/ haircut/ place of origin.  Remember that your job is to educate and to do so respectfully- if you are confrontational, you aren’t helping yourself or anyone else.  One of my favorite responses from a young woman surgeon when the patient called her a nurse was simply, “Our nurses are amazing and I couldn’t do what they do.  It’s hard and they’re highly educated.  I am one of your surgeons.” I love this because it respects the nurses (who we are lost without!) and still re-directs the misguided person.

If you’re in a “boss” role, be that a senior resident or any faculty role, be ready to say something on behalf of your trainees.  If someone is misidentified, reintroduce them in their actual role. If someone makes a comment about someone your team being a purple unicorn, you can simply respond with, “Yes, he is a purple unicorn, and we are so fortunate to have him here to work with us!” The important thing is to have a script- something you have thought about in advance so that you won’t come at the issue from a place of frustration.  We can not be too kind when we are educating people about the diversity that we want on our teams, and we want to help them understand that we are celebrating that diversity.

Go ahead.  Be courageous.  What is your #SaySomething going to be?


The times, they are a-changin’

With an announcement about Sandra Wong becoming the Surgery Chair at Dartmouth (congratulations, my friend!), we’ve reached a milestone for women surgical chairs:  She makes #10 currently. Ladies, we’ve hit double digits!

I started this post last week and needed to let the ideas percolate a bit, and now the time is perfect.  I wanted to talk a little bit about #ILookLikeaSurgeon and its impact, but what I really wanted to address is the commitment that we all need to make for the groundswell from #ILookLikeaSurgeon to make a real difference for our profession.

And here, I believe is the secret:  We need to learn to actively engage, even embrace,  those who are somehow different from us in our profession.  When I say different, that can mean almost anything- scholarly focus, age, hair color, gender, socioeconomic background, football allegiance, ethnicity, sexual identity, cat-owning status, the list is infinite.  You’ll notice I threw some less “serious” ones in there, and I did that quite deliberately- not to make you laugh, but to make you realize that when we commit acts of bias, they may or may not be well founded.  We should treat the fact that Joel is obsessed with sandwiches no differently than we treat my obsession with shoes.

Anyone who has worked with me knows that I’m a believer in “manageable” interventions.  While the outcome of what we do may result in something absolutely amazing, I will always ask my team for an incremental intervention (or two or five).  What are some incremental interventions to increase inclusion in surgery?  Here are a few, and none of them are that complicated.

  • Actively encourage women and minorities to apply for leadership roles and awards; it’s been documented in many fora that accomplished women and minorities simply don’t put their own name forward.  Leaders can directly lobby and promote high-quality candidates for various roles.  In addition, those leaders’ mediation of the process helps mitigate concerns that applicants may have about the perception that they are “pushy” or “bossy.”
  • Creating programs to support the career development of all surgeons.  Making sure that everyone has access to the same “rule book” about how to succeed in training and in academia or private practice, depending upon their choices.  What sort of specific activities would this include?
    • Transitions Q&A at various meetings for individuals moving from one career phase to the next
    • Topical and timely career issues fora
    • Networking venues, especially for mid-career folks (this can be a tough transition!)
    • Travel awards to get underrepresented groups to meetings and to the table
  • Holding meeting planners/ program committees accountable for insuring diversity in speakers.  There is no reason in this day and age for any surgical meeting to have a panel of only white males.  None.  For those on program committees, please commit to looking at your speaker lists and making sure that it is inclusive.  For those who are not on program committees and who notice at a meeting a lack of inclusion, say something (nicely, of course).
  • Education and advocacy on diversity and inclusion, something that #ILookLikeaSurgeon has started for us.  In particular, education about unconscious bias needs to be front and center. If you haven’t done any reading on this topic, I strongly encourage you to do so.  While we can’t get rid of bias, if we are cognizant of our biases, we can at least manage them.


I’m proud of the fact that when I look at my list of mentees it is incredibly diverse, and I want to believe that those numbers actually count (thus my emphasis on inclusion rather than diversity).  Part of that has been accidental and is truly based on who I am and how I was raised, and I’m grateful to my parents for that.  Part of that is because I love being challenged by people who hold different ideas and perspectives than I do because they make me better at what I do and how I do it.  And I’ll admit, part of it has been absolutely intentional.  I’ve looked for people who I believe are talented and taken them under my wing- and they have almost invariably proven to me that with the right support they can excel.

My challenge to you is to make a commitment to choose one small thing that you can do to help promote inclusion in surgery.  If you’re a resident, it may mean looking for a medical student to mentor.  If you are junior faculty, look for a resident to bring along and to sponsor.  If you’re mid career and above, we’ve got to be the BIG part of the solution- and that means creating and sustaining programs to make us all better.