The Power of Embracing Labels

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.

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.