Just Read: #WhatADoctorLooksLike – Implicit Bias in Academic Medicine – via JAMA

Where I went to medical school (University of Arizona College of Medicine), we had the typical “wall of fame” of all the previous graduating classes prominently mounted, covering the history of the school’s first class from 1967 to the present.

It was amusing to note that as you walked along the wall that the number of women in each class steadily increased, to the year after mine, when for the first time there were more women than men in incoming class.

Except that in retrospect, it wasn’t really funny.

The other thing I noticed was that the Nursing School building, erected a few years after the medical school building next to it, didn’t seem to have very many men’s rooms…

The wall showed another thing, that there were no LGBTQ human beings enrolled in this school. Except that there were. However, all the signs and signals in our curriculum and the behavior of our faculty conspired to keep this just an “allegation.”

And so…we can now measure the impact.

This issue of JAMA Internal Medicine includes three studies looking at sex and racial bias in academic medicine, and as it has been shown in many (many) other studies, the profession tends to mirror the society around it. No more, no less. This is a link to the editorial accompanying the studies, written by Molly Cooke, MD (@mollymcooke) at the University of California, San Francisco.

Cooke M, AJM A, RA G, E M, M N-S. Implicit Bias in Academic Medicine. JAMA Intern Med [Internet]. 2017 Mar 6 [cited 2017 Mar 15]; Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.9643

This wouldn’t be a problem (actually, it would always be a problem, but maybe not as high-stakes) if our society’s health didn’t depend on physicians who understand the life experience of the communities they serve (It does).

Another bank of studies show clearly that people learn better from people who resemble their life experience more closely. It’s just science, not an opinion. And so, when people are selected to present at grand rounds:

To the extent that those role models do not mirror the sex and racial composition of the trainee pool, we are delivering the implicit but powerful message that these leadership roles and examples of excellence are for someone else. Women, blacks, Asians, and Latinos need not apply.

I have previously posted on the environment around LGBTQ trainees, also studied, and also with outcomes that parallel these.

Just Read: Sexual and Gender Minority Identity Disclosure: “In the Closet” in Medical School

This gendered quote from a general practitioner in 1966 (the ancestors of my medical specialty, family medicine) is relevant here:

S/He does more than treat them when they are ill; he is the objective witness of their lives. They seldom refer to him as a witness…that is why I chose the rather humble word clerk: the clerk of their records.

If this is what doctors do (it is), then we have an interest in examining our biases and modulating them. And there’s science to show that can be done, too. Isn’t this century grand 🙂 .

One more from Shania Twain, because it’s my RSS feed.

She’s a geologist, a romance novelist
She is a mother of three
She is a soldier, she is a wife
She is a surgeon, she’ll save your life
She’s, not, just a pretty face
She’s, got, everything it takes

I’ll post again on the actual studies referenced.

And I was the man (barely): XX in Health 2015

And I'm the man (barely) this is fantastic XXinHealth #ally

And I’m the man (barely) this is fantastic XXinHealth #ally (View on Flickr.com)

Wow.

I woke up the day after the 6th XX in Health Retreat (@XXinHealth #XXRetreat) thinking, “what just happened?”

I showed up at the Harvard Club of New York, one of those old world boys club types of places, with lots of paintings of men covering the wood paneled walls (with the exception of one woman) for a day of discussions and workshops with 200 women about innovation, leadership, courage. I left having participated in all those things, and then…

Ted Eytan Implicit Association Test Result 52735Only moderately male (View on Flickr.com)

The title of this post comes from the fact that when I was recently asked how much I identify with being “male” I didn’t select the the strongest category.

It’s because I don’t identify with the male privilege I see all the time in my cis-gender, heterosexual male colleagues (and throw in that I’m Generation X who are less about “winning” and more about “wanting to make it happen”). And yet I know I benefit from it, no matter how much I protest.

This is probably why I spend my innovation energy in the places that few men dare to go.

….and so I listened to the stories and scanned the room of so many faces of people who are doing incredible things with visible and invisible hurdles systematically planted in their way by society:

  • What does a person get to be in society?
  • Are they known by the quality of their clothes/appearance or the quality of their ideas?
  • Do they get to ask for things or are they supposed to wait to be asked?
  • Are they allowed to reflect on these differences in the workplace to make them stronger, or is that a sign of weakness?
  • Do they have nearly 100% prevalence of being harassed on the street or online in their lifetime?
  • Is this fair?

This is the part where an attendee might tell me I’m being naive (go for it) for not already knowing this. I know it, but I don’t deal with it, which means I don’t “know” it.

As my trans mentor, Garrett reminds me, I will never ever know what it’s like to be a trans person. Same goes for being a woman. Allies have to understand and be aware of this, recording it here is a way to remind myself.

If you could choose to be brilliant OR happy

We had the most awesome lunch table conversation about The Role of Courage in Leadership, led by Mary Zappone, where this question was posed to us.

Seems like a false dichotomy at first, but think about it, and think about the (voluntary) choice that innovators make.

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? – Marianne Williamson

The post-gender world

The science is clear in 2015 that being a woman happens in the human brain, not in chromosomes, which Dr. Vivienne Ming (@NeuralTheory) and I quipped about on stage.

It turns out that Vivienne and I have similar interests in terms of human potential. The difference is that she has something(s) I don’t have – data + the ability to simulate the human brain to understand how it works. I believe from reading her work that she’s discovering answers to questions about how we build human potential rather than searching for it.

Our uber-hosts, Robin Strongin (@DisruptiveWomen) and Halle Tecco (@HalleTecco) are the ones who invited this dialogue in the first place. I give them tremendous credit for their intellectual flexibility and modernity. They’re already “there.”

I was excited to be introduced by them to Vivienne and I still am.

In addition, when they invited me to be present, it would have been completely appropriate (and my suggestion) for me to be told, “Ted, show up 15 minutes before the session you’re in and then you can leave right after.” And yet, they said to be present and participate as any member of the community.

Who isn’t drawn to this kind of leadership.

Getting educated

It was received significantly on me that it’s the men that should be educated. And as with every issue of power balance, it’s not the responsibility of women to educate us.

I’m not sure that the answer is to open up this event to men more broadly. That’s up to the XX in Health community. I definitely saw the value of women getting together as a group of leaders on their own. Perhaps there might be a companion event that men sign up (and pay for, the whole responsibility thing) to learn about the impact of gender from our colleagues, in a safe, educational atmosphere.

We need to own this conversation in partnership, not hear about it when we discover we did everything wrong. And the everything wrong is, as Vivienne pointed out, when we wake up to a workforce that looks exactly like we do, because we used a referral based recruitment system, and therefore produces monosolutions to things, which ultimately fail.

In recovery

I have found myself in the day(s) after telling people, “Yes, you should ask for what you want,” and focusing my listening a little bit more.

I knew when I was asked to do this that it was a unique x 10 opportunity and I wanted to do my best to be an ally to the community. That, and making sure Vivienne’s talents were recognized by the audience 🙂 .

She reported to me the next day that she was engaged in dialogue with the group until late in the evening (11:20pm). So clearly that happened. I felt brilliant AND happy when I heard that. In all seriousness, from knowing her work, I predicted that would be the outcome. She said a few times during the day that she wasn’t in the health field. Human potential, neuroscience, child development…. it seems a lot of people (me included) think she is in health…

“Fitting in”

This is one of my favorite quotes about that:

“if there is a _________ person in your unit, their fitting in is dependent on how open your unit is to diversity. It is NOT based on how hard they try to fit in. – UK Army LGBT Forum, 2013”

It is not the job of anyone to try hard to fit in. It’s up to our workplaces and health system to be open to their diversity.

Trans Women are Real Women 53173Trans women know what it’s like to be a woman, because they are women (View on Flickr.com)

As I’ve mentioned on this blog a lot of times, I am learning more about gender than I ever have through the lens of people who transgender. There’s a lot of insight in the experiences of people who have lived experiences as both men and women in their lifetimes. Here’s an especially enlightening account: “I never stand too close.” And, transgender women, who are women, face all of the same challenges.

I work for leaders who are men and women whose mantra is “I’m a work in progress” which is an awesome asset. And, I live in the future, where gender will be acknowledged, respected, and celebrated.

There’s a really good reason for diversity – without it, the human species wouldn’t survive.

It is not necessary to change. Survival is not mandatory – Edward Deming

We have to change to survive, and our generation is going to change everything (of course). Thank you for the warm welcome, XX in Health, and for aiming me.

Oh! And thank you Erica Chain (@EricaChain) for bringing yourself as a leader AND a patient as well as the entire XXinHealth team who brought meaning to those old boy walls on Tuesday.

Here are my photos and I put select tweets in a storify below. Sorry, long post, a lot to figure out! Feel free to help me in your comments….

I AM excited to be part of XXinHealth’s sixth annual women’s retreat

And I'm the man (barely) 😀 this is fantastic XXinHealth #ally
And I’m the man (barely) 😀 this is fantastic @XXinHealth #ally (View on Flickr.com)

The title of the post says it all. I will be present this year, where I have the honor of facilitating a discussion with Vivienne Ming, Entrepreneur and Scientist (@neuraltheory).

We’ll be addressing the concept of a “Post-Gender Business World” which is totally cool, because of my passion around the subject (which is slightly palpable), mostly and significantly because of Vivienne and the other people in the room. As a famous pop star once said, our generation has the power to change everything.

They are taking over the boys club, The Harvard Club of New York, and I am delighted excited to be there with this group, not just as an honorary woman, as an ally and with allies.

Thank you Halle Tecco (@HalleTecco) Robin Strongin (@DisruptiveWomen) and the XX in Health (@XXinHealth) team for creating the vision. A lot of us came to health to ensure that all people have equal access to it. And why shouldn’t they. The human species depends on it. Our communities and society is more enjoyable because of it. And…. love always wins 🙂 .

See you on March 31, feel free to nominate yourself or a colleague to attend.

Women’s Wednesday: Capital Area Gay and Lesbian Chamber of Commerce, Washington, DC

A pleasure to host a healthy and productive women’s community at the Center for Total Health (@KPTotalHealth) in conjunction with The Chamber (@DCLGBTBIZ). The courage of Rosie the Riveter and her colleagues continue to inspire (see: Photo Friday: Yes they could shatter glass ceilings. Meeting the women of the Kaiser shipyards | Ted Eytan, MD to read about their amazing visit to us this year)

Washington, DC 2013 Sheroes of the Movement, Leadership

The Office of GLBT Affairs 2013 Sheroes of the Movement Award Winners – Lately I have been meeting people who have what I call I high “humility/experience” ratio. This is a compliment, it means someone who is approachable, and human, and has at the same time accomplished so much that it’s expected that they wouldn’t be.

Diana Bruce, Julie Ost, Reverend Dyan Abena McCray, Ruby Corado, and Ellen Kahn – View 2013 Sheroes of the Movement Award Recipients for Washington, DC on Flickr

Last evening I got to attend the Washington, DC government Office of GLBT Affairs (@GLBTAffairsDC) second annual Sheroes of the Movement Awards, which honor “five lesbian, bisexual and transgender women who have made a significant contribution to the GLBT movement and community in the District.”

A few things I learned just during this time together:

  • The average age when a child comes out as LGBT is now 12 years old. They need more support than ever in our schools and in their communities.
  • Transgender health support is inappropriately inadequate, I am not alone in feeling this, and specifically behind that for lesbian, gay, bisexual persons (and they’re behind the rest of society).

These women are years if not decades ahead of their time in changing society. And with all that comes with being a change agent, they are still open to all. As it says on the Casa Ruby web site:

Today, after 20+ years of precious life experiences with my LGBT family, Latinos and otherwise, I have the opportunity to continue to be the voice of those who can’t speak for themselves, I have the honor to continue to be in their life and tirelessly work to make their lives better.

Casa Ruby, is a Multicultural Latino LGBT Community Center, A Resource Center A Recreation Center, A Place You Can Call Home.

EVERYONE IS WELCOME

No matter where you are in your life, if you have nothing or maybe have all the material things but something is lacking, We Want You Here.

Leadership versus Followship

It’s wonderful in 2013 that so many other public officials are saying that they’ve changed their mind about equality – this bodes well for our society (and proves that love always wins). The reason they’ve changed their minds, though, is because of the work of the 2013 Sheroes of the Movement, who are the ones receiving awards. This is the difference between leadership and what I call “followship” – leaders are the people who say “this is the right thing to do, so we just did it.” Who would you rather follow….

Thank you Washington, DC Office of GLBT Affairs for introducing me to these women and for the powerful leadership lesson during 2013’s National LGBT Health Awareness Week.

Oh, and also, thanks Fathom Creative (@fathomcreative) and all of the other local businesses who supported the event. I’m used to coming to this space for monthly WordPress meetups, nice to know that community is created around many topics here :).

Photo Friday: You could be a stewardess if….

Could you be a stewardess? Display at National Air and Space Museum. View on Flickr.com

I can’t help that I am always drawn to the people side of technology. I took this week’s photograph at the National Air and Space Museum ( @airandspace ), when I bypassed all of the fancy flight machinery to focus on this exhibit, attached to an American Airlines DC-7. It’s called “Could you be a stewardess in the 1950’s?” I called it “You could be a stewardess, if…” in my head.

The blog on the Smithsonian web site refers to this as a “fun online checklist.” When I think about the fact that this is a list of attributes used to keep people from reaching their potential, based solely on who they were instead of what they could do, I have a feeling a lot of Americans didn’t see the fun of a list like this.

I also noted that the decade is not just the 1950’s – it was the 1960s, 1970s, and 1980s – in our lifetimes, we have lived (and flown) in workplaces where discrimination was the norm.

I tend to be drawn to these things because they remind me that norms change, and what seems impossible, like a married woman working as a flight attendant (or a nurse), any woman working as a physician, or a patient without a college education accessing and understanding their medical record can go from a “why would we” to an “of course we should,” sometimes overnight. We just have to believe in the new norm.

Ironically, the flight attendant situation is actually a regression from the equality that existed previously, and portrayed so beautifully by another government agency, The Library of Congress, in this photograph from 1942:

I wrote about the Flight Attendant profession previously, among the first posts on this blog (“Working the Skies,” and “Femininity in Flight“) – if you want to understand diversity better, the story is definitely worth learning. Today we’re seeing changes like this, “the end of if…” in our nation’s military.

The rest of the display, along with images of the work environment are below. With gratitude for @airandspace in bringing the history of people to life alongside the history of the technology.