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?