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.

It’s lonely at the top

Some of you may be aware that I’m about three years into a two year project** examining barriers to careers in academic surgery; in its current form, the project focuses on women in academic surgery.  In what isn’t likely to be a spoiler alert, while some gender-specific factors are identified, the preponderance of what we’re seeing is both systemic and cultural, therefore impacting the pipeline in general, not just for women.

The major gap in the information that we have to date involves hearing the stories of those who choose to leave academic surgery. I’m aware of this limitation and have plans to address it, which means that this Sunday Review from the New York Times struck a special chord with me. The glass ceiling is real in business and in academia, and while the need to fix it is widely acknowledged, we still don’t entirely understand its etiology. What we do know is that theoretically it should be less of a pipeline problem than it was 20 years ago. In spite of more women entering surgical training, a recent study shows that gender parity in academic surgery will not happen in my lifetime.

Advice on how to get ahead, while well-meaning, doesn’t serve to fix the deeply embedded cultural issues. Preaching to already high-achieving women about how to fix themselves is likely too little, too late, and engages to a degree in the “victim blaming” I’ve been known to rail against when discussing burnout.

Interestingly, there’s a tie between the loneliness described by the high-achieving women in the Sunday Review and burnout. While the basis for loneliness is complex and is only in part attributable to a sense of “other-ness” in those who aren’t historically represented in leadership roles, it quickly becomes obvious that it plays a substantial role in burnout…burnout can result in exit…exit results in loss of (diverse) talent…you can see the downstream effects here.

I’m offering myself some thought challenges that I want to extend to each of you (yes, you, as you say, “I’m not a leader!”).

  • What if today you tried today to bring more compassion to your team through a kind word or supportive act? Hint: “Thank you” counts as a kind word. If you can be specific in that thanks, it’s doubly valuable.
  • What if today you worked to get someone connected into a network of some sort? Confession: being a “connector” is one of my FAVORITE things to do!
  • What if today you helped someone celebrate a “win,” no matter how small that win feels- or if you celebrated your own? If you’re on Twitter, please share your own with #WednesdayWins.  We need for this to become a “thing” to remind ourselves of what’s going well.


**Not actually joking about the time line.  Anyone who has experienced the joy and misery of qualitative research and grounded theory understands exactly what’s going on here. 

What if it’s not our fault?

“If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place.” – Margaret Mead

In the last week I have found myself in the midst of two interesting Twitter conversations, both with a similar underlying theme regarding the impact of culture and how we seem to underestimate its impact on the individual.

Here’s conversation #1 (remember to start reading at the bottom):

I particularly loved the empathy behind the idea that the term burnout implies that it’s a personal choice. While we’re getting smarter about identifying organizational factors that drive burnout (ahem…my group’s call schedule), there still seems to be this idea that if you’re struggling with burnout, you’re simply not resilient enough. Reality check: I’ve witnessed some people who are remarkably resilient struggle with burnout, and without exception they have been in a work environment in which they had little to no control. Yes, I understand that individual characteristics may predispose people to burnout or may limit the impact of a dysfunctional system upon the individual…but at the end of the day, victim blaming and pretending it’s ALL about resilience?  That’s simply feeding the dragon.  It’s not helpful.

On to Twitter conversation #2:

(The link that you can’t see from here is this recent piece in the Atlantic.)

So, maybe it’s not about biological clocks or because we’re not ambitious enough.  Maybe, just maybe that ambition is situational…and that if we’re in an environment where we see other women hitting their heads repeatedly against the glass ceiling,  or we experience that ourselves, we adjust our expectations accordingly. Or we leave when we realize that we shouldn’t have to adjust those expectations because there isn’t anything wrong with them.

It’s time to stop telling us to try harder, or telling us that we can’t be mothers and academic surgeons, or telling us that we don’t measure up because we don’t know the 100 extra double-secret and unwritten criteria that you’re using to evaluate us. Most importantly, it’s time to create a culture in which we feel valued and supported, not because you tell us that we should, but because we actually are.

What if it’s really not our fault?

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.





Resolved: We need to be able to have dialogues and debates

With my recent post encouraging us to seek the Other, it seems like an important time to dive into debate and dialogue as tools we use in communication. One of these is, by definition, a better way to deeply listen to someone with a different viewpoint.

Quick question for you: What comes to mind with dialogue?

I personally tend to think of open mindedness, seeking common ground, and a willingness to change in belief or action based upon what one hears.  I see dialogue as not being zero-sum.

What about debate?

It feels more confrontational, critical, difference-based, focused on winning and losing.  Debate is usually VERY zero-sum.

We know that one of these things is the place we should go when we’re dealing with people and ideas who are different from us.  But dialogue requires a lot of work. And energy. And attention.

Is debate inherently “bad”? Definitely not, and it can be used very effectively.  If you’ve been given the opportunity to argue a side in a pro/con that you don’t agree with, you know how much you learned (and that you possibly changed your mind afterwards!)

Fostering dialogue within a group, however, improves inclusion.  It helps us make better collective decisions. In the most dramatic situations, it helps foster peace.

Clearly this is the extreme, idealized version of deep listening.

However, if I think about the times when I have sincerely tried to listen like Thay describes, I have learned so much about myself, about others, about the world.

From a more business-based perspective, it is possible to foster deep dialogue among team members using a collection of tools.

And if you’re wondering, yes, one of my 2017 goals is to work on my deep listening.  I would challenge you to join me. I would also challenge you to help keep me accountable on the days when I’m struggling.




Not the usual suspects

As I mentioned in this week’s reading round-up, I am completely enamored right now with the book Appreciative Leadership. I recognize that some view my tendency to skew positive as a leader as a shortcoming, and what I most value about this book is that it takes that it’s giving me great ideas to take that positive skew and convert it into positive power.

Last week I was reading the chapter entitled “The Genius of Inclusion,” which has sections on improbable pairs and and a section encouraging us to reach out to the “Other” as an act of inclusion. The take-home message from these sections centers around the importance of truly listening to someone who is different from us; it helps us learn what we have in common with people (which may not be at all obvious on first pass) and it also helps us to build trust and foster respect. The authors encourage the fostering of improbable pairs within our teams, in which team members choose a partner whom they believe to be greatly different from them and then do a 20-30 minute appreciative interview.

Let’s extend that idea of the improbable pair further out of our comfort zone since used within a team there’s at least one thing we have in common with the other person.  What about the Other, as the authors refer to it? We all have an Other- a person or group of people whom we like or don’t trust.  American politics this year has proven just how relevant this idea of Other has become, particularly in the face of a lack of willingness to listen to ANY opposing viewpoints (which, for the record, is behavior I’ve seen at both ends of the political spectrum).

So, an exercise for you this week, friends, that I’ll admit I straight up stole about half of from the book.

  • Who are your Others? How did you learn to see them this way?  We all have them, and if you say you don’t, you’re not being honest with yourself or others.
  • What might you be missing out on by excluding them?
  • How can you reach out to an Other to learn about them? I bet you know at least one whom you can have a conversation with, and whom you might even be able to build a bridge with.  Go do that.

I know this isn’t an easy exercise, and that in some ways it’s downright scary because it challenges a core belief about your Other. But what do you have to lose? And think of what all you have to gain if you discover that while your Other is quite different from you and you have common ground with them.  You might just change your life and theirs.

Unconscious Bias #AWSChat- May 24, 2016

May 2016 Association of Women Surgeons Tweetchat


An accidental feminist

I have to start with a brief explanation of the framework I approach the world from.  I’m an only child.  I was raised by parents who never divided my world into girl things and not-girl things. I loved dresses, hated ballet, loved my motorcycle (yes, I had one), hated being told I couldn’t do anything. I took piano lessons for 10 years and was in choir from 1st grade on. I wore pink because I liked it, and I wore blue because I liked it too.  I did have a tutu and a tiara because in my mind those were power objects (fairy princess, FTW!). My career aspirations were to be a cowgirl princess surgeon President- at least I got three of the four right (with two only being part-time gigs, of course)!

The first time I encountered actual gender bias was at age 16.  I was in our family doctor’s office getting my requisite pre-College paperwork filled out, and when he asked I responded that I was headed to A&M with plans to go on to medical school. His response? “Well, I guess it’s okay for girls to be doctors these days.”

I walked out of his office, never to return.  Note: this was 1984.  It simply had never occurred to me that people might question my ambitions because of my gender.  Never.

The next episode of gender bias was during my career “detour” between college and medical school. What I didn’t realize when I started graduate studies in Political Science, and in International Relations in particular, was how much of a male-dominated world that was.  Women were definitely exceptional, though it truly wasn’t an issue in my day-to-day existence with my advisor and the rest of our group who worked for him.  Where it became an issue was when one of my classmates commented, “Well, you get all of the good assignments because you’re a girl.”

My response? “No, I get all of the good assignments because I’m good at what I do.” Please note that this classmate no longer was considered a friend after this episode and that I kept getting the good assignments until I left grad school.

And then I landed in academic surgery. I’m one of the 16% (women who are associate professors in surgery) and aspiring to move in the near future to the 9% (women who are professors in surgery). I finished my surgical residency with a class that was 60% women and in which everyone else took parental leave. I want to clearly state that my career has been fostered by many of those individuals whom Pat Numann calls “enlightened  men,” starting with my mentor in medical school and continuing into my decision to become a burn surgeon and my subsequent clinical career in burn surgery.  When I started as burn faculty in 2005, we had fewer than 10 women practicing in burns in the US.  Here’s the thing, though- when I decided to go into surgery, and when I decided to go into burns, I knew there weren’t many “like” me, but I also didn’t have anyone look at me and tell me it wasn’t a career for a woman.  I was fortunate to have been promoted and mentored and sponsored by people who simply wanted the best person for the job, and who (fortunately) thought I was that person.

My experiences have definitely colored who I am and how I perceive gender relations in our profession today. I believe that times are changing and that those who don’t believe that women can do the job, or who believe that women get special treatment, are fading quickly from our profession. I’m not delusional enough to say that it’s all sunshine, rainbows, and bunnies because I know the reality is different.  It’s not perfect everywhere…yet.

What do I want for all of us at this point? A level playing field, and one in which we don’t have to think about a woman surgeon or a surgeon’s race. I want us all to be surgeons, and to be great ones who reflect who our patients are.


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.