The Power of Embracing Labels


I’m sharing my experiences as a gay, Black, female surgeon to advance diversity in surgery.

It was the end of a busy day in Stanford Hospital’s oncology clinic and I was completely spent from the grind of my responsibilities as a surgical intern. I wanted to find a quiet room, finish my paperwork and head home to crash, but my attending surgeon told me I had one more patient to see. In the exam room, an elderly Black woman with a large sarcoma in her abdomen sat waiting with an anxious look on her face. Her shoulders relaxed and her face lit up the moment she saw me, and we talked openly about having the tumor resected and what the procedure would involve. The woman wanted to know that she would be cared for with compassion and cultural awareness, and my presence provided the reassurance she needed.

When the attending surgeon, an older white man, walked into the room, the woman immediately withdrew. She appeared nervous and uncertain as he quickly described the steps of the procedure as if reading them off a checklist. The woman made eye contact with me when he pushed the consent form in her direction.

I nodded. It’s OK. You’re safe here. I’m convinced the woman wouldn’t have felt comfortable moving forward with the life-saving procedure if we hadn’t connected.

I’ve also seen firsthand how the nation’s health disparities negatively impact patient care. When I was in medical school at Dartmouth, my uncle died from colon cancer and my aunt succumbed to breast cancer. They didn’t go the doctor on a regular basis because of the inherent mistrust Black Americans have for the U.S. healthcare system and were unaware of the need to undergo the cancer screenings that could have saved their lives.

My father battles chronic hypertension and was prescribed ACE inhibitors as a first-line treatment when, in fact, high blood pressure should be managed in African Americans with an initial course of a hydrochlorothiazide followed by treatment with a calcium channel blocker. His hypertension went uncontrolled for years until I discussed his condition with a professor in medical school and realized he was on the wrong medication. It’s now properly managed because I was invested in knowing the different treatment algorithms for Black patients.

Watching members of my family die from treatable diseases and the medical mismanagement of my father fuels my passion to improve the care of minority patients. I’ll also never forget my experience in the clinic with the elderly woman. It’s part of the reason I’m committed to being a visible face in the push for more diversity in surgery and dedicated to role modeling for other Black women surgeons. Now more than ever, I’m passionate about increasing representation in health care and advocating for the equitable care of all patients.

DIFFERENCE MAKER During medical school, Dr. August was drawn to the technical aspects of general surgery and the ability to immediately improve the health of her patients.  |  Stanford Health

Surgical facilities need to become more diverse. Representation must increase among nurses and anesthesia providers, instrument techs and sterile processing professionals. The increasing willingness of today’s minority healthcare professionals to mentor and serve as allies for the next generation of providers will make tomorrow’s perioperative departments more inclusive workspaces.

Minority role models in health care were non-existent when I was growing up. In fact, I didn’t  meet a Black surgeon until beginning my residency at Stanford. I’m sharing my story — and those of other minority healthcare professionals — on my Twitter account (@blackgrlsurgeon) to make sure young minorities see someone like them succeed in the field of surgery and know it’s possible for them to do the same.

I’m also happy to be a visible lesbian surgeon in my hospital because it normalizes my sexuality. How can I expect anyone to be comfortable around me if I’m not comfortable with myself? I’m also out and open about being gay because Queer healthcare is important. LGBTQ+ patients who feel safe and comfortable with their providers, and confident to express their true selves, are more willing to share important information that can improve the care they receive.

There are many inspiring aspects of what I’ve experienced since putting myself out there as an openly gay, black, female surgeon. Black patients constantly acknowledge me, thank me for being their doctor or tell me they’re proud that I’ve been successful. There’s truly a sense among the Black community that a success for one of us is a success for all of us.

I’m passionate about my mission, but being an active participant in healthcare’s diversity movement can also be mentally, emotionally and physically exhausting. Many extraordinary people are volunteering their time and energy to generate productive conversations and create meaningful change, but we need more than words to support our efforts.

ROLE MODEL Dr. August is always willing to mentor students and is active on social media so young minorities see someone like them succeeding in surgery.  |  Stanford Health

Talking about needed change is necessary and important, but making change happen requires commitments from healthcare leaders and an allocation of resources. Health systems can’t claim to care about equity and inclusion and not pay the people who are striving to make change happen or fail to invest money and capital into recruiting minority healthcare professionals. Increasing the pipeline of minority medical students is also important. Efforts to make it happen have been ongoing for more than a decade, but significant progress is lacking.

Surgical training is expensive and cost-prohibitive for students with socioeconomic factors that make pursuing careers in surgery financially impossible. The University of Michigan matched three Black physicians into its general surgery residency program in which there are only seven spots. That wasn’t by accident. The program invested in recruiting minority students and the institution provided financial support.

If we’re honest about wanting to make an impact, more programs across the country must follow Michigan’s lead. Minority students who see people of color leading medical and nursing schools will know that the programs value diversity and will likely be more interested in applying. Health systems should also strive to place qualified people of color in leadership positions. These leaders will recruit providers who look like them, and the providers will in turn attract more diverse patient populations.

It will take time to realize the results of actions taken now, but it is worth the investment. My contemporaries and members of younger generations are having constructive conversations and making calls for change that are becoming louder and more prevalent, but I think the diversification of surgery will happen on a medicine timeline. We need to remain patient, but passionate about continuing to push the movement forward.

This feels like a turning point in our nation’s history. The country hit a breaking point last year, and it’s been inspiring and encouraging to see different communities joining together to call for social justice. Members of Generation Z are helping to lead the cause. They’re politically active and socially conscious, and not afraid to be outspoken. Their voices and influence will only become more powerful as they grow older.

Through social media, greater numbers of diverse individuals with varying viewpoints and cultural backgrounds are sharing and spreading information. They’re able to voice their opinions to a vast audience in a matter of seconds, and the national discourse that’s occurring as a result is identifying social inequities and leading to discussions about how to take them on in productive and progressive ways.

The murder of George Floyd was a catalyzing moment that sparked needed conversations about police brutality and diversity in the nation, but there’s been a lack of innovative and tangible action items that will effectively diversify surgery. Social progress occurred in communities throughout the country over the past year at an incredible rate, but implementing new ideas in health care has always been difficult.

We need more drivers of change and allies who amplify the voices of those on the front lines of the diversity movement. More of us should be open to learning about the life experiences of others through productive conversations held in safe spaces. If we aren’t willing to talk and listen to people unlike ourselves, we’ll continue to hold onto questions, assumptions and biases. We’ll never learn from each other and move forward together.

The systems in place that perpetuate social and ethnic inequalities weren’t established overnight, and it will take decades to gradually undo the practices and institutions. Until they’re taken down, which might never fully happen, we need to keep talking about systemic racism and cultural injustices in health care. The conversations must happen, despite pockets of people who question the importance or need of promoting diversity in surgical spaces.

I’m faced with this issue every day as I try to understand how others perceive me while I’m moving through the world. It will always be relevant in my life and in the lives of people who look like me. Being open and honest with how I feel and what I experience as a minority surgeon invites conversation. I’m prepared to keep talking, listening and striving for change, regardless of how long it takes. OSM

Dr. August ([email protected]) is a general surgery resident at Stanford (Calif.) Hospital and co-founder of The Aquarius Lab, a medical device incubator.

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