What’s Important: Concrete Actions to Combat Racism—Our Role as Orthopaedic Surgeons

Field: Health Professions (Health Sciences)

Dear Colleagues in Orthopaedics, I do not usually address you in terms as personal as these, but as one of the tiny handful of black men among you, I think the time has come for me to say something about what is happening in the U.S. right now. The demonstrations by our hospitals and supportive letters to our community have been remarkable. At my own institution, I serve as the residency program director and I have been even prouder of the initiatives of my trainees, who have organized special journal clubs and lectures as a show of support. Their effort has been inspiring. But I would like to take this a little further. As a program director, it is my job to help guide the education of young surgeons, and I have always believed that this guidance should be broader than just the (literal) nuts and bolts of our craft. To be complete, their education should address the influential and privileged role they are assuming in our society. This notion of a complete education is no less true for those whose careers are already well underway. So I have decided to take this moment to ask you to deeply ponder your own role in America’s racist culture, and how your influence can help to change it. Marches and protests and kneel-ins are meaningful, but for anything to actually change over the long term, I ask you explicitly to contemplate your own biases and to consider some concrete actions that you can take. As a physician, you are viewed as a leader in your community. People listen to your words. They also respond to your biases and attitudes—and the actions that reflect them—whether you are aware of them or not. At work, those attitudes have daily consequences. For instance, you may spend much of your time in the emergency department, one of the places where minority communities have maximum contact with our health-care system. There, we as surgeons are conditioned to make snap decisions to save lives. But consider the other quick decisions and judgments we make: How does the race or native language of the patient shape your response to their pain or distress? What preconceptions do you bring with you? Please consider this each and every time you interact with a patient. Orthopaedic surgeons are also among the power elite in the U.S., and even residents are fledgling members of that class. As a resident, you may sometimes feel powerless or that your voice is ignored, but you wield more influence than you realize, both within and outside of the hospital hierarchy. For instance, yours is the most influential voice when medical students are recruited. Is every applicant, student, or rotator welcomed equally? Remember that visitors may come to an orthopaedic rotation expecting snobbery, so you have the extra job of overcoming those expectations. To this end, 1 concrete action you can take this year is to genuinely engage with a minority student. Leaving aside matters of fairness or affirmative action, I believe that a diverse residency functions better, trains better, and better serves its community of patients, and there is a lot of objective evidence to support this belief. But in 8 years overseeing the selection process at my university, it has been dismayingly hard to coax our program to even maintain its diversity. Every year as we discuss applicants, I have watched women and minorities pushed down our rank list with vague, biased criticisms like “not a good fit for our program.” Culture and camaraderie in the residency are important, but too often we gravitate toward people we already know or toward people who look, speak, and act like those already in the club. So here is another concrete action you can take: in ranking applicants this year, ask yourself “why not?” before you say “she wouldn’t fit in here.” That bias toward the familiar extends beyond the club of doctors. I believe that how surgeons interact in their environment plays a role in reinforcing all sorts of power structures. Although it is unintentional, our hospitals can be functionally very segregated places. For example, in the operating room, how many nurses are non-white? Some, of course. How about the operating room assistants or the people who clean the floors—how many of them are white? Often, few are. And how many people among each group do you know by name? This matters. It matters because casual, personal contact with wealthy and influential people—like you—is one of the keys to social mobility. Leaving aside actual hate-based racism, one of the reasons household income varies so much by race in the U.S. is the opportunity gap. People who are already privileged, as well as their children, have access to many more opportunities. Entire sectors, such as private clubs, are predicated on this fact, and if you think about it, I am sure some of you have benefited. This is not to say that those places are bad, but it is certainly unfair. So although you cannot singlehandedly integrate your golf club, another concrete action you can take is to spend the time between cases making friends with an operating room assistant. These are just a few examples. There are many other opportunities for your advocacy, both explicit and implicit, to help make the U.S. fairer and more prosperous for all of us. I hope you will take them seriously.