(SOUNDBITE OF MUSIC)
ANNOUNCER:
This is Residents in a Room, an official podcast of the American Society of Anesthesiologists, where we go behind the scenes to explore the world from the point of view of anesthesiology Residents. Those are the things that are going to improve the studies and the policy and the, the bedside care that impacts our patients every day. If we have that attitude of trying to discover the experiences of other people who are different from us then we can help promote them, and, and lift everyone up. The antidote to judgment is inquiry.
DR. KANDICE OLSON, HOST:
Well, hello everyone and welcome to Residents in a Room podcast, a podcast by residents for residents. My name is Kandice Olson. I'm a current CA3 resident at Baylor Scott & White in Temple, Texas and I will be the host for this session. We are going to discuss women in residency and the ways that gender shapes our experiences, education and our opportunities. But first, let’s introduce the outstanding female residents who are joining me today.
DR. COURTNI SALINAS:
I'm Dr. Courtni Salinas. I am currently a CA3 at University of Washington in Seattle.
DR. SHARRA AZAD:
I'm Sharra Azad. I'm currently a CA3 at Tufts Medical Center in Boston.
DR. KELSEY MCGINNIS:
Um, I’m Kelsey McGinnis. I’m currently a CA2 at Baylor Scott & White, um, in Temple, Texas.
DR. OLSON:
Excellent. Thank you all again for, for joining us. Um, to start off, you know, I did a little research and I learned that roughly one quarter of anesthesiologists are women. And although, you know, that seems to be increasing with a rising percentage of young female anesthesiologists and those in residency, in some ways women are advancing in the field, but I still feel that are some attitudes and, and assumptions that are hard to disrupt. So, let's start off today by sharing some of our experiences as female physicians, and females in anesthesiology. And I'll start trying to, sharing a brief experience that I’ve had. I had one morning, I entered a patient's room for preoperative evaluation prior to an elective surgery. After a quite lengthy discussion surrounding the patient's health history, um, and her consent to the anesthetic plan, you know, I talked to her about me being the physician in training who was going to help take care of her. Um, so after this long discussion, the patient's phone rang. Um, they apologize for the interruption, but then answered the phone and said, oh hello son, give me a few moments and I'll call you back. The nurse is just about finished. So I, deep breath there, you know, I, I felt defeated. I’d worked so hard to try and build credibility and trust as a physician, but was still misidentified. And I know, you know, it wasn't the first time that happened, nor the last, but just something that we experience as females. So, is there anyone here that has an experience you'd like to share? Moments you’ve been misidentified or singled out because of your gender? Or, you know, in our cases, we’re young, young females, also perhaps age, and even discuss like what you did in that moment, or even what you think we should do in moments like that?
DR. SALINAS:
I can start by sharing a, a time when I was assessing a patient postoperatively, um, making sure that his peripheral nerve block was functioning appropriately and my female attending and I decided that he was doing well. She left the room and the patient turned to me and said, someone should tell your boss to smile more. She comes across as way too serious. I didn't know exactly how to respond to that, how, whether or not, it was pretty early on in my training and I was, I was shocked quite honestly. Um, so I just make sure that his block with working and left the room, but it, that experience never left me and I think because this attending had such an Ivy League pedigree, she was the head of her subspecialty, she's an excellent physician. But for some reason this patient cared to focus on the fact that she didn't smile throughout her interaction with him and I, I really had to ask myself would he have commented on the lack of smile in their interaction if the attending was male? I really don't think so, and it was a reminder of how we as females Filling this role as, you know, a type of caregiver, how sometimes we are sort of boxed into this idea of what that means to certain patients. Not all patients, but some patients. And I think it's important for us, at least in the moment, especially when we're caught off guard like that, to remain professional and sort of give yourself a moment to process because the last thing I want, even though personally, it really affected me, is if, it is for that to affect my care, my patient care. Do you know what I mean?
DR. OLSON:
Wow, you said that so eloquently. I, I'll just kind of piggy back on that, you know, I think that one action, you said you wondered if on the flip side of that was a male provider how that would be interpreted, or even commented on, you know, one action from a male may, may be seen one way, but a female viewed a different, different way. Just the expectations that are, you know, implicitly or explicitly there, and that's, I, I love your response, too, to try and remain professional and, and not let it affect your patient care as much as you can but to be aware of those times and, and your reactions to it.
DR. MCGINNIS:
Um, one situation, I had, um, my first year residency, um, along these same lines where, um, it was actually me and a male colleague, uh, another resident discussing how we do patient interviews and he had seen me perform an interview just moments before and had said that he, you know, prefers not to say I am doctor so-and-so, he likes to use his first name. He was implying that using his first name gives him a better connection with the patients, that brings them, you know, more ease and things like that and kind of thought about it for a second and kind of realized why I never did that, and, um, while what he was saying really made sense and sounded great, I have such a hard time, even when I say I'm a doctor multiple times in the room, getting the patient to believe that and really hear it, that I, I've never felt comfortable doing something like that, that even saying Dr. McGinnis, they sometimes just don't even hear that. That so I thought that was interesting how he didn't really understand that and really didn’t even think about that as a possible reason why to say Dr. McGinnis or Dr. Whoever, um, and it was interesting to me to kind of think about how I have thought about that so much, even in my first year, um, as a resident, so I'm not really sure kind of how to convey that to our male colleagues that, um, this is something that we go through literally every day, um, having patients, fighting to have patients respect us. Um, so that was, um, something that I, that has stuck with me throughout the years.
DR. SALINAS:
I think it's hard for them to know unless they've actually seen it happen.
DR. OLSON:
Yeah, I, I agree and I think it's a huge step to even just have those discussions with them, you know talking about experiences you’ve had because honestly, often times we as women will act differently to try and compensate for, for some of those things. You know, I've heard women saying that they always try to wear their white coat, or in the operating room they'll change their voice, um, to be like a deeper voice to sound like they’re more competent, or have authority, or even you know, just the feeling if you need to prove yourself, it's, it's something that without, you know, expressing those or discussing those with other people, it’s hard for, for people to be aware. You know, even, you may not be aware you're doing them. It's just something that you, yeah, that you need to try and compensate for.
DR. SALINAS:
I completely agree and if I may just step in and say that I, I'm sure we've all faced that type of situation. One way that I like to, um, inform my male colleagues or attendings is by letting them know before we enter a patient's room for any type of discussion, hey, can you do me a favor and address me as Dr. Salinas with the patient? It’s just an, and important thing for me to maintain credibility. And most of the time they just say yes and, and do so. Other times they say yes, and then introduce me as Courtni, and then I have to remind them. And I will say that no one's really ever asked me why, which is interesting.
DR. OLSON:
Yeah, are there any things that we would ask of our male colleagues on a routine basis? You know, watching the American Society of Anesthesiology Conference, there was a video of kids, there were males and females, and they each got a disproportionate amount of prize in their cup, you know, males and females, and, and how the, the boys in the video where like, this is not right, you know, they were, um, even, even as children they understood like this is, this is not okay, and were like speaking up for them. But at the same time I think it's important to, to highlight that just because, you know, a female, um, gets a promotion or has, has something that's also not at the expense of males, and for them to realize that or, or understand it and still, you know, use their positions or what ever it is to try and, and support females.
DR. MCGINNIS:
Yeah, I think it's important for them to just understand that promotion of women in medicine and anesthesiology in particular, just benefits everyone, and, um, benefits our colleagues, our patients and that it's not something like us versus them that this is something that is definitely needed in our specialty and I think we’ll do great things in the future.
DR. OLSON:
To kind of follow up, you know any kind of situation that we have, uncomfortable times or you know, us in training, I feel like our sense perhaps, of a lack of power, um, have there been any situations where you been so uncomfortable that you felt like it was essential to talk to someone else or someone who had more authority to, um, to speak about any situation or having fear, you know, of, of retribution, um with us in training? Any comments on that?
DR. SALINAS:
We must not forget that as women, we are sometimes subjected to uncomfortable situations that involve unwelcome advances or even perhaps touches that are meant to be harmless, harmless, but probably shouldn't happen when, you know, when working with someone of the opposite or even same gendered sex, and so I just wanted to speak to that, and encourage other women out there to feel empowered to speak up if they're, if they find themselves in a situation like that. And I will share that at one point in my training, I did have to bring up the ladder, um, a concern about inappropriate conduct, and I felt that it was handled to my satisfaction. I was assured that it there would not be any sort of retribution from, for the fact that I brought this to the attention of the administration, and I felt good about it because I, I learned in speaking with one or two of my colleagues at this person's actions had been perceived by other women as perhaps inappropriate or a little too much, if that makes sense. And so I felt good about the fact that this person, that it was brought to this person's attention and that it stopped. And while there may not have been any harm intended, I think that we should all feel empowered to have these, um, to, to bring these issues to the, to light. Because we're probably not experiencing it alone.
DR. OLSON:
Yes. I feel like that, that topic’s extremely important to talk about and, and also crucial to have an org, you know, organization in your department, in the, in the work force to be able to have outlets for, for people to speak up when there are uncomfortable situations, or times when they may fear retribution, to have a place that they can turn and raise those concerns is extremely important. So, thank you.
DR. SALINAS:
Thank you.
DR. MCGINNIS:
Um, something along those same lines, um, is that, that I really still struggle with kind of almost on a daily basis is sometimes getting inappropriate comments and things in, of that nature directed towards me from patients. And, um, you know, it’s something that I don't think my male colleagues struggle with as much and, uh, in the moment, a lot of times, I feel just uncomfortable and kind of brush over it and I, I think maybe, um need to stick up for myself a little more but I'm very uncomfortable doing that in that setting especially with a patient not wanting to offend them and, you know, make sure that they're still comfortable with me as their physician which is, um, something I think is a lot of women struggle with in medicine. You know, like, I'm uncomfortable but I am much more worried about if the patient’s comfortable. Um, and so that's something that I think, um, is important to talk about and how we deal with those kind of situations cuz, it’s something I, I still to this day am having problems with and don't necessarily do much about.
DR. OLSON: Yes, I, I’ve personally had countless encounters where you know, whether it's advances from a patient waking up or inappropriate comments, you know, offhanded thinking they're funny, but largely inappropriate and have fortunately have had people who have spoken up for me in those situations or, or taken over to remove me from, from the situation or address the issue. It's difficult, and again going back to just trying to create a safe environment for everyone to work in, is, is something that we can all make an effort daily to, to try and create.
DR. AZAD:
Um, I will say that at my residency program, we have had some issue with the (sic) nurses on the OB floor, which is kind of interesting to think about because actually the nurses on OB are predominantly female, um, whereas some of like our OR nurses and pre-op nurses, etc, are male, but it’s a very women-driven atmosphere and, um, as an anesthesia resident, or an anesthesiologist, we’re sort of like interlopers in this like, group of people that are there all the time. Like we, as residents, we do like a one month rotation there, and then we sort of like take senior call downstairs like in our second and third years, but at least in like the first month that's not enough time for really like the nurse, all of the nurses, to get to know you immediately. So we have has some issues, uh, with like that group in particular getting very frustrated, um, with the anesthesiology residents that are down there, um, and it seems to be actually more geared towards the female residents than male residents. Um, they sort of seem to welcome this rare male presence sometimes. Which is, I think somewhat different from what the patients sort of want, because sometimes they request no males in the room, but the nurses like really seem to like our male anesthesiology residents and there's definitely been some swearing and sort of like an us versus them like atmosphere that was created, to the point where we have to have, um, like our Program Director get involved and talk to the charge nurses about sort of, like the anesthesiology residents coming down there for the first time and sort of what the expectations were from the nurses from us and also just being uh, slightly more welcoming to our presence.
DR. OLSON:
You know, I would, I would say you're not alone in that experience. It's, it's kind of funny being in at completely separate places and having similar encounters and, and circumstances. Um, we actually, you know OB is, is one area, but more recently in the, or in the past few years as I've been training, um, there's been issues with nurses in the ICU um, where, you know, notably all, the female residents may have a, a different experience and like nurses will question orders from, from the females and, and not really push back on, on the male colleagues in it. We have, um, an attending, uh, surgeon in the ICU who is, who tried to give advice regarding this, and, um, frame it in a way that, that the female nurses may see us as, oh, they want to talk through things, and they may feel more comfortable to do that with, with a female physician and it may, may seem as pushy or, or that they don't respect us, but on the flipside it might be that they’re more comfortable because they see us as female, but they're also could be tension just viewing us, you know, as, as like a, um, hierarchy. When in reality, we're all there to to take care of the patients, and, you know, I feel like once we start getting the discussion out there with some of the, the nurses, and we didn't do it personally cuz it, it felt too uncomfortable but some of the, the attendings and even this, uh, female attending surgeon kind of started having discussions with them and it seemed to improve. To try to just, um, get everyone's perspective and, and understanding that way rather than just reacting to what was happening. Any advice any of you received regarding situations like this?
DR. SALINAS:
Well, I’d say in general I find it more effective sometimes to address these types of inter professional issues directly with the person involved and it doesn't have to be in a confrontational way. One, um, tactic that works well for me is to in, simply inquire or call attention to the dynamic that's playing out in the room. Hey, I'm sensing some, a bit of, well, I don't want to use the word hostility, but I'm sensing a bit of hesitation on your part. What can I do to address that so that we can both take care of this patient together? We're a team. So let's, let's do this, you know, when I sort of have to call it out and reframe it and sometimes it takes people, it really catches people off-guard. But I think in the end they end up liking it because I'm asking you know, what, what's, what's happening from your perspective? And then, what can I do to sort of alleviate this tension so that we can get things accomplished? Um, that, that tends to work well for me.
DR. OLSON:
I love that. I think it’s important to try and gain perspective understanding and, and you know, having a tool set like that to, you know, reframe things and address the issues without it being like a hostile environment is, cuz, I guess this kind of leads into the next, uh, part that I wanted to dis, discuss, cuz there’s multiple issues that may be bigger for men or women than just, you know, likeability, feeling like we’re apologizing too much or even just how we, how we come across. You know, fear of speaking up, or role of imposter syndrome, you know, there's, there's many things that we kind of deal with but I think, you know, being aware and trying to, um, gain perspective and understanding regarding all those and just how, that those are present. My next question, talking about other issues that we might have, I'm going into private practice anesthesiology and, um, not going to be working in academic center, but there's a couple of you here that at least trained at large academic centers. And are you wanting to do research or, you know, any academic pursuits and do you feel, you know, as, as females, any disadvantage there? You know, there's plenty of research out there showing even nowadays, you know, discrepancies in, in leadership, in academic, um, advancement and even pay gaps. What are your thoughts or experiences there? And where do you see any difficulties or opportunities to, to improve upon?
DR. SALINAS:
I think you just named the most pressing issues for female anesthesiologists either who are in practice or in training quite well. I think the biggest issues are closing the pay gap, increasing female anesthesiologists who do hold leadership positions, those who win grants, those who publish as first authors or senior authors, and those who affect policy within our field. And I don't think it, that we all have to be actively working towards improving these issues, you know, all the time, because we all have lives, we're all human and our job doesn't have to be, you know, number one, such that we must actively improve these issues. But we must have at least all be aware of the issues. So for me, as someone who is interested in an academic career or working in a big academic institution, um, as hopefully a clinician educator in pediatric anesthesiology, I’ve found that it's very helpful for me to talk with people who are practicing in the type of profession that I see myself in one day and I try to take advantage of every encounter with an awesome female anesthesiologist and really pick their brain. Even if I'm just doing one case with them, and I'm rotating at, and you know, some hospital, un, that’s not my, my home base, get to know them, ask questions. The other day, I was at a, a private hospital doing OB anesthesia, and it took me a while to figure out that I was working with the Chief of the department who was a female. And that was surprising to me. And it shouldn't have been. Why should it surprise me that there is a female who's the Chief of this department? Um, and so for me, it was just a little shock, like, oh yeah, we're still living in this world where we're females in medicine, don't have, not just anesthesiology, in medicine, where we don't always hold positions of leadership. So I took it upon myself to figure out, you know, I asked her what are the issues that you encountered in this position? Did you even want this position? And you'll be surprised how many people get to their current position in roundabout ways and I don't know, I just feel like making the most out of your encounters with people who have been through it before, uh, that's a really, that's a really big one. Um, and finding great mentors, um, so seeking people out, um, and I think part of that is also deciding whether or not you want to be a mentor for your junior residents. Or, you know, medical students who you meet in the OR who are rotating through, I think creating a network, uh, as leaders and mentors is a big way that we can contribute to the issues that you've raised.
DR. OLSON:
Thank you. So I, I think it's very timely, uh, for, for us recording this podcast right now. There's a few things that have happened just in the last couple weeks that I, I wanted to discuss with you all. One, um you know we’re recording this just after the completion of the first ever virtual Annual Meeting of the American Society Anesthesiologists and the esteemed, uh, Rovenstine Lecture this year was a given by female anesthesiologist Joanne Conroy and actually part of her lecture, she addressed gender equality. You know, something that she highlighted was that uh, companies with a higher percentage of women in leadership have a greater financial performance, but women are 25% less likely be promoted to leadership positions. And so, she really, you know, encouraged anesthesiologists to disrupt this current setting and encourage for a diverse group of leaders to make better decisions so that, you know, we can thrive socially and economically. I thought that was very timely to hear from an esteemed anesthesiologist, and, and urge others to be more aware and do something about it. So we've been talking about women and anesthesiology today and some of the experiences that have shaped our experiences. But let's just pause for a second and um, talk about why this even matters. Like, why is it important to have gender equality in professionals, and why does gender matter? Is there a value in highlighting gender at all?
DR. AZAD:
Well, I think obviously, um, you know, ster, stereotypically, the field of medicine was not very welcoming towards women or minorities. Uh, so sort of historically, um, there just weren't women. And now that we are starting to have, um, more female anesthesiologists, some of these issues that are coming up are somewhat unprecedented. Um, so we sort of touched upon mentorship. I know for me personally, um, I'm going into cardiac anesthesiology. Um, we actually only have one female cardiac anesthesiologist on staff uh, from our, like, group of ten cardiac anesthesiologists, and um, like, she's really great and she's an awesome mentor but she's actually not my main mentor, just because, um, they're such a paucity of women in the field. Um, but then she is like very valuable to me because has really explained a lot about like work-life balance, um, since she’s fairly young, and has, um, two kids under the age of ten. Um, and that's also like sort of an issue that didn't really come up in the anesthesiology workplace beforehand, um, because having predominantly male attendings meant that like, someone else is at home taking care of the kids and we didn't really think about, um, sort of how to make workplaces more family-friendly in a way that actually would benefit both genders. So I think, um, like it’s sort of more of a modern topic by virtue of the fact that we’ve let more women in, um, but sort of now, it’s opened up like many more things that we have to talk about, which is really probably for sort of the progress of society as a whole though.
DR. OLSON:
That, yeah, that’s a very important thing I definitely wanted to highlight, you know, what you just hit, um, that us all being females, you know, we have, may have other responsibilities, um, at home. You know, I, I'm the mother of three children. I just had my, um, youngest, um, five months ago and, um, as a woman physician in training and having many of my male colleagues having children, I, I felt, you know, I, that my experience was a little different, um, but also, just, um, being a woman in medicine, you know, it’s evolving but starting out when I entered medical school, I remember countless occasions when people told me, oh you, you want to do medicine, well, you must not want to be a mom. Or, oh, you're a mother now, so you probably won't be a very good physician, um, or, you know, tell me that I, I can't be a great physician and a great mother and that home responsibilities would detract from, from work and vice-versa. You know, I think that women with children, um, may be viewed as like less competent or less committed, um, or even other, you know women who have other responsibilities, even if it's not as a mother. Um, I know some women who are careful how much they actually speak about their families and their roles outside of work because of those, those biases. Um, and it's incredible to see, you know like that a ment, that physician that you have who’s the cardiac anesthesiologist, um, to see people there who are working to, to show that, that you can be great and both and, you know, you have support systems otherwise and can build a work-life balance and um, really encourage and empower other women who are trying to chase their dreams as well, both at home and, and at work. So I love just finding those people that you can like look up to and strive, or even being the one to, to pave the way. You know, it's an exciting time to, to be like that but a little scary in, in some instances as well.
DR. SALINAS:
I completely agree with both of you. And I think another part, another reason that gender equity amongst healthcare providers matters is because we're taking care of all types of patients. Um, and so I personally believe that providers should reflect, we should mirror, you know, that diverse pool of patients because it does matter to patients that we can connect and empathize with them or at least try to understand from their perspective. And having a diverse perspective, that includes men, women, but not, not just gender but race, orientation like SES, all the things that, that we all identify with, or as, and that shape, that shape our perspective. Those are the things that are going to improve the studies, and the policies, and the, the bedside care that impacts our patients everyday. So I think it, it matters to our patients as well.
DR. OLSON:
I love that. Well said. So we’ve talked about how our gender identities and being female has shaped our experience in the field. But how does it affect our patients? You know, you, you started discussing this. Um, do you think that there are gendered healthcare disparities that anesthesiologists specifically should be focused on? Or have there been situations where you saw biases or micro aggressions that negatively impacted patient care?
DR. SALINAS:
I wish I had numbers, statistics to that, that could, at this moment, they could highlight maybe in an, an imbalance between you know, the treatment of pain in male vs. female patients, but I, I will say as an anesthesiologist in training, I, I've seen this imbalance present itself mainly in the treatment of pain, or in how some people identify patients as crazy or as unreasonable. So, if, I, I’ll give an example of hearing a colleague present a patient to an attending as, you know, that Miss X is a very reasonable patient who, you know, XYZ. But my question is, why are we are identifying this female patient as reasonable? Does, does that mean that, it, how does that shape our care of the patient? Um, and, and, and sometimes when patients are presented as unreasonable, I like to model to my colleagues who are less tuned-in, and I'm not going to say that it's male colleagues, I think women do this as well. I like to model to them how I might conceptualize a patient situation, um, by re-presenting it to the attending or to the group as this is someone who maybe has poor coping skills or needs more, does not have a lot of support on board to help them with their, you know, current medical situation. And so I think reframing it, and turning um, patient scenarios into more, um, giving it a more compassionate lens is really helpful and I've had multiple colleagues comment that, wow, that is a really kind way to put it. And I think that we owe our patients, including our female patients, that type of kindness to not make assumptions about their mental state or stability based on their gender, and I think we do it more than we would like to admit.
DR. MCGINNIS:
Um, yeah, I, I, uh, was going to speak on that kind of as well, that, that the amount of times I’ve heard of patients described as, like you said “crazy”, uh, has been something that I've been thinking about lately, has been kind of upsetting to me, and how I, I tend to find that the majority of those patients that, um, my colleagues find like you said, unreasonable or crazy, uh, not to be taken seriously, are female patients. And I think it's important to kind of highlight that, and I, I love the way that you kind of address that and how you handled those situations, definitely something that I'll keep in mind going forward.
DR. OLSON:
Yes, thank you. So let's talk a little bit about solutions. I know we've, we've mentioned great, you know, solutions to things that we’ve talked about. But, um, on a larger scale, what is the role of organizations like the ASA or even organizations that we work for, to address these issues surrounding equality? Any thoughts?
DR. MCGINNIS:
I think we kind of, uh, touched on this a little bit already, um, but I think, um, the importance of, uh, female mentors cannot be understated. I think having those role models and people that we can turn to and get advice from and kind of go through this experience together is, is really important, um, and something that I found really helpful throughout my residency and medical school experience.
DR. SALINAS:
I completely agree. I think creating mentorship programs and workshops, resources, that empower women to achieve that promotion, that leadership, and that eq, equity within the field is key.
DR. OLSON:
Absolutely. Yeah, so we have talked a lot about the role that mentors play, um, in our experiences and, and us, um, thriving as female anesthesiologists. Has there been any advice that mentors have given you, or things that you would love to pass along to, to other individuals, individuals? I guess I can start. Um, one of my role models and I, I don't know that I'd call her a, a mentor because she's never met me. But she's a, a female cardiac anesthesiologist, and ya’ll probably know her, um, Sasha Shillcutt. She’s an incredible advocate for women and she recently wrote a book entitled ‘Between Grit and Grace’. I feel like she poignantly address is a lot of these issues that, uh, women face. And there are many like her, both male and female, who do incredible work in awareness of these issues. Um, but I loved reading her book and hearing about her experiences, how she just talks about being your true self and un, unapologetically being you, really going after your dreams. It's, it's so empowering to, to see women put themselves out there and encourage other women and, you know, males alike, to do the same. I love following people like that who help me to, to achieve.
DR. MCGINNIS:
Um, this isn’t quite advice, but I did think it was very helpful. I actually come from, uh, a long line of doctors in my family, but I'm actually the first female physician to come out of my extended family and so seeing kind of my dad and how his practice has gone and how people treated him at work growing up and things like that, I kind of had always as, you know, just naively assumed my experiences would be the same and so when I was in medical school, I had a really great, uh, pediatric anesthesiologist as one of my mentors when I decided to choose anesthesiology, and um, really just talking with her and her kind of setting my, honestly my expectations, for residency and just, you know, reminding me that it is going to be a different experience because I am a, a female physician, um, and kind of expecting, um, unfortunately, um, some challenges that go with that. I found that really helpful cuz it's something I hadn't yet really thought about, um, and going into residency it was definitely helpful to have already kind of thought about how I felt about how I was going to be treated, and what my expectations were about how I wanted to be perceived in residency. So I thought that was something that was very helpful to me.
DR. SALINAS:
Um, I did have a mentor once tell me, um, it was actually a mentor in medical school. It was the first time I met her and I never forgot when she said to me, the antidote to judgment is inquiry. It's simple but it's something that I keep with me, especially for those times when I find myself becoming frustrated or assuming that someone means to do me wrong because I'm a woman or because I'm Brown or because of this, or that. And so instead of assuming or judging that this person means harm, I ask what did you mean by that? And again, it's really simple, but it's worked for me countless times. And so I, I did want to pass that along as some awesome advice from a mentor.
DR. OLSON:
Yeah, I'm just floored by having you on here. I've learned so much already. One thing I wanted to touch that we talked about the role of organizations like the ASA. I, I feel like strong support by organizations is crucial. You know, the voices of many gathered together to impact policy. Even, you know, in 2019, there was a pilot study of women anesthesiologists, and this goes back to women, mothers, but 50% of women who gave birth during residency or fellowship at that time of that study in 2019 needed to extend their training. And there was actually a policy that was released last year by the ADA that the ASA helped promote, was an extended, or a leave of absence extension, new policy for leave of absence, to allow for extension of training for situations, like maternity leave, but others that males and females may experience that would have previously extended their, their training and I think it's incredible that organizations on a larger scale are, are working to, you know, support women or men or any, you know, minority or to achieve more equity, all across the board. And so I think, you know, for us, you know, just speaking up and, and making things known, I love that you were saying, asking questions to, to learn more like if we have that attitude of trying to discover the experience of, of other people who are different from us, then we can help promote them and, and lift everyone, everyone up. You know, I think that, you know, we can in turn, become our own mentors, or sponsors, friends or advisors of other people and, and help them advance as well. So we started to address this, but are there any other comments? You know, um, us as individuals, what can we do to address inequalities and help lift other women up? Or, you know, as a female, uh, in training, do you feel an extra responsibility to speak up for other women?
DR. SALINAS:
I absolutely do, and I think a big one is making sure that we speak impeccably about our colleagues, especially our female colleagues. And I like to remind my colleagues and my mentees, think before you speak because the ramifications of a biased story can irreparable harm someone's reputation. We might think that we're just venting or letting off steam about an encounter that we had with someone, but that news can get around, that information can get around pretty quickly, and it could impact how others view this person who’s worked so hard and, and, and perhaps overcome things that we’ll never understand, and so I think choosing our words wisely, um, when it comes to our awesome female colleagues is key.
DR. OLSON:
Thank you. Another question, you know, although we are all women our listeners are almost certainly not, so what do you wish, you know, your male colleagues, um, or those listening, um, what do you wish they understood better and how they all can be better allies for us?
DR. AZAD:
Well, I will say that most of my mentors are male, um, with the exception of the lone female cardiac anesthesiologist I mentioned. Um, and I feel very grateful that they took me under their wing, because I definitely don’t look like them. I don’t necessarily have the same career ambitions at them, but they were willing to, um, sort of get me into their subspecialty and sort of put me on the path, um, of research and making connections in the field and being like really stellar mentors, even though, um, they aren't female. And I think that's really the case for a lot of people, um, because if there are only, sort of 25% of practicing anesthesiologists are female, most of us trainees right now are going to have to find non-female mentors. So we really appreciate sort of the men that take us under their wing.
DR. OLSON:
Absolutely. Well said. Are there any resources that you women have that you rely on to either stay educated, motivated or plugged in, like any books, blogs, social media personalities, or other resources that are worth tuning in to? We can give resources to people listening. You know, one resource that I've used quite heavily, um, is social media. I've, I've followed many, um, female physicians on social media and they often have very empowering and educational posts, as well as groups, you know, like on Facebook there's a group for like female physicians, um, and female anesthesiology mom groups, different places like that, um, to kind of band together as women, you know, with certain identities, whatever intersectional identities that may be, to try and support each other and discuss things that are affecting us and have people to connect with. And that's been an incredible resource for me to have.
DR. MCGINNIS:
Um, I think something that was a great resource for me as a medical student in particular were, um, the American Medical Women's Association. I think a lot of medical schools and academic centers across the country have, um, groups through that organization and at, at my medical school, at the University of Oklahoma, um, we had like an underrepresented fields, like, meeting. So women that were underrepresented in certain fields, so like anesthesiology in particular, um, and now, like that I'm in residency, I act as somewhat of a mentor to those medical students. So I think that's a, a great opportunity there. I think they also do, um, great, like, career building, um, opportunities and mentorships and networking through that association of women for women so I thing that’s a great resource as well.
DR. OLSON:
Thank you. I've been blown away spending this time with you. Um, my vision for this podcast as the host was to, you know, candidly share our experiences and information regarding women in anesthesiology in hopes that someone will benefit, and in turn, improve the environment that we're creating for each other and future individuals, both male and female, and any, however we identify. You know, I, I’ve felt extremely empowered by each of you and I really thank you all for, for joining me today. I'm Kandice Olson, and this is the conclusion of the episode of Residents in a Room on women in anesthesiology. Thank you all for listening and we hope that you can tune in for future episodes.
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ANNOUNCER:
From small practices to the world's best teaching hospitals, ASA members have a wealth of experience. Tap into this knowledge through the ASA community, your hub for real conversation, meaningful connection and valuable support. Find your voice at community/asahq.org. Join us for Residents in a Room, where we'll share timely info, advice and resources designed to help residents succeed in residency and beyond. Find us wherever you get your podcasts or visit asahq.org/podcasts for more. (Chatter and laughter)
ANNOUNCER:
Welcome to ASA’s Central Line, the official podcast of the American Society of Anesthesiologists, edited by Dr. Adam Striker.DR. ADAM STRIKER:
Welcome to another episode of Central Line. I'm your host and editor, Dr. Adam Striker. The specialty of anesthesiology is dedicated to advancing diversity, equity and inclusion, so it just makes sense that with this podcast the ASA is shining a light on problems and on possible solutions. To continue this work today we welcome Dr. Karen Williams, retired Associate Professor of Anesthesiology and Critical Care Medicine at George Washington. Currently Consulting Co-Chair of George Washington’s Anti-Racism Coalition, Dr. Williams, thanks for joining us today.
DR. KAREN WILLIAMS:
Thank you Adam.
DR. STRIKER:
You have a powerful and painful story to share that resonates deeply with what's happening in our country today. So before we get into the medicine side of all of this, do you mind sharing your story with us?
DR. WILLIAMS:
Sure and thank you for, for the opportunity to do so. I, um, am a native of Washington DC. I was born in 1954, at what was at that time Freedmen's Hospital is now Howard University. But Freedmen's was named after freed slaves, obviously. And that same year that I was born, just as a backdrop of what was going on in the country, um, the Brown vs., vs. Board of Education was approved to, um, dismantle discrimination, um, in, in the public school system. And, uh, anyway, that was the backdrop with which I was born.
My mother was from Harlem, New York. She was a mathematician, um, and my father was an organic chemist. They met here, from South Carolina, they met here in Washington DC while taking a civil service exam to try to get in the government. They were the only two black people in the room. Uh, she finished her exam first and he ran out after her in order to meet her and that's how they met.
The year after I was born, uh, Emmett Till, uh, in 1955 was beaten for supposedly flirting with a white woman. And so a lot of these things that, that I'm talking about obviously happened a long time ago, but continue to happen today.
Um, my family stayed together, my mom and dad, until I was 10 years old, and in 1964, um, my parents separated and my mother decided to move us out to Montgomery County, Maryland. At that time, Montgomery County was predominantly white, it was still segregated, and the way that she was able to get in the neighborhood, into Kensington, Maryland, um, that we moved to, was that she and her white girlfriend, uh, went to the bank, filled out all the paperwork etcetera, bought the house and it wasn't until they got to the settlement table that the people who were selling her the house realized that she was black. Um, by then, you know, everything was tied up legally in the paperwork so there was nothing they could do, but essentially, my mother moved into a red lined district that we weren't supposed to be in. And I believe she did it because the educational, uh, system was superb in Montgomery County at the time, and, um, coming from New York, she was very used to going to educational programs outside of her neighborhood because many of her family friends were Jewish and she also went to schools outside of her neighborhood and that's how she got her stellar education.
So it's interesting that, at that time, being a woman and not having a man with you the banks were hesitant to lend you loans, you couldn't get credit, so there were a number of things working against her at the time.
But to make a long story short, short, that was my first introduction to racism because I came from a predominantly Black community to now an all-white community where I was the only person of color, my brother and I, he's five years younger than I am. As I was going to 5th grade elementary school, um, riding on the bus, people would want to feel my hair because my hair was so different than theirs. Um, I was treated as a novelty. I was spit on at times, called names, and it was very confusing for me as you can imagine at the age of 10 not understanding why people were treating me so differently. Uh, fast forward to junior high school there, and we were the only Blacks in the elementary school at the time, fast-forward to middle school and there was a cadre of, uh, Black students that lived and grew up in, in a similar community, um, in what was called Ken Gar Maryland, uh, short for Kensington and Garrett Park. They all knew each other, grew up together and at, by this point, I'm very shy, I, you know, I have my white friends. And so because I didn't immediately go up and introduce myself to them, I became an outcast, um, again. I got teased, um, ridiculed and all kinds of things by people who looked just like me.
So in a way, I wasn't accepted by the Blacks or the whites, and then one day one of the girls in this, uh, group approached me. It happened to be in front of the principal's office. I was on my way to cheerleading practice. She approached me and try to challenge me to a fight and somehow, uh, the real me came out. I say the real Karen, but now Karen has become, you know, synonymous with something else, so since my name is Karen, I'm going to say my Karen came out not someone else’s Karen. And, um, the real Karen came out and, you know, she, she wanted to fight with me and I think because I transformed from this very shy, regressive person into this monster it frightened her and is frightened the other girls that were with her and she said to me well, well, let's go outside because we were standing in the hallway in front of the principal's office. I said, and I knew that if we went outside I'd be dead, so I said no, I'm not going anywhere. We're going to do this right here, and somehow I got my voice then. She backed away. I went on to cheerleading practice, sobbed my eyes out.
Uh, another similar occurrence happened in high school, same group of people but different characters and fortunately someone who wasn't from the initial group in middle school stepped in between me and my harasser in high school and said you have to go through me in order to get to Karen, and I didn't even know she was my friend. So my, my primary school days were filled with being not really sure where I belonged and not really sure where I fit in. I didn't want to hang out in the bathroom and smoke cigarettes or skip class. I, I went to class. I was a, a good student.
So by the time we went to college, I went to Ohio State, and the very first black person I saw, I ran up to her and I said do you want to be my roommate because I was determined I was going to have black friends and not make the same mistake. Turned out that she was a wonderful, uh, roommate. She was from New Jersey, she ended up being an oral surgeon, but she jokes about it to this day because she said she could have been the Manson murderer and I didn't know anything about her. I just ran up to her and said please be my roommate. Anyway, that was obviously all about trying to be included and trying to feel like a part of, of something, trying to feel normal.
Um, in 1975, I had a life-altering event where my father was shot. One of six black men shot in Wheaton, Maryland, um, which was a white suburb, again, at the time, um, by a white man. Um, there were six Black people shot at that time coming home from, from a family dinner. Um, my father was shot and killed. I had, uh, the wife of one of my cousins who was shot and is still paraplegic. And four other people were shot, uh, and a bus boy that was coming out of a restaurant trying to get some ice from somewhere else. Another, uh, happened to be a scientist that also worked at the National Bureau of Standards where my father worked that we didn't know that at the time. The gentleman shot six people before the Montgomery County Police, finally, I guess, were called to the scene and ended his life.
There was no such thing as mass shootings at the time. Um, it was obviously a very traumatic event that unbeknownst to me now looking back on my life had an indelible impact on my life for the rest of my life. And it's interesting that we come to this point in 2020. And as I’ve looked back over my life and, and how I was raised and how I succeeded, um, in becoming a physical therapist and becoming a physician, um, and being a woman, and being Chair of, you know, a couple of notables departments, that we are where we are now, um, in the world in racial disharmony. I'm, I'm amazed that we're here and I, I, in reliving the events that are going on today, I am heartbroken because these were painful memories that I didn't want to ever remember.
In order to succeed in my life, I probably put them somewhere in the background of, of my mind. But with all the, um, escalation of shootings, mass shootings, bombings, whatever, has gone on over the last several decades, I have had to comfort myself almost, and sometimes even recuse myself from certain things that went on, uh, at the hospital where I last worked, George Washington University.
Um, in particular, I remember there was a shooting at the Holocaust museum in Washington, DC, and the, uh, perpetrator was brought in. I was running the OR that day meaning coordinating, you know, who goes in what room, etcetera, and I remember them bringing the gentleman in. I assigned him to someone else to take care of. I didn't take care of him in the, in the room that I was covering. And I remember I had to give the phone, the beepers, everything to someone else because I, I, I was shaken, you know, and, and the memories of my father kept recurring. And so every time there would be a mass shooting, it was like ripping off a Band-Aid off of a wound that couldn't heal. So it really wasn't until about 2 years ago, um, that I finally forgave the shooter and you hear people say that all the time, but I finally forgave the shooter. And now I can listen to other people's heartaches and pains and not feel as entrenched in it. And I didn't realize that was a key issue for me.
Um, so anyway, I, I think because of the notoriety of what's going on, because I have, I am now retired and I have time to reflect on my own life, I am a mentor to many younger physicians, um, and friends. I, I feel more comfortable now sharing my story. Many of the people at GW didn't even know my life story. The people that I row with, I row with a rowing group, didn't know my life story and it wasn't until all these things happened in our social world that I began sharing my story. And I think it's important because it, it puts a personal, a personal face on what's happening today, why it's important, how impactful it is. You know, among the, the myriad of other things that we're going to talk about.
DR. STRIKER:
A truly powerful story and instead, I know you're comfortable sharing, it but it's still incredibly brave of you to share that with all of us. I'm certainly deeply sorry for everything that your family has been through and for your loss and what you have been through and I, I certainly want to start tackling some of the medical aspects, as most of our listeners are going to be interested in those. But before we, we get to that, you did touch on something that I'd like to just follow up on. You said you were able to forgive the shooter and you, you know, were able to move forward then. Do you feel like that's something that necessitated the amount of time it took to, to get there, as, as perhaps maybe other individuals are listening that may be in the same situation? Or is it something you wish you had known sooner and could have gotten to sooner?
DR. WILLIAMS:
I actually thought I had done that sooner. My mother took me to counselors, you know, early on. Um, doctors would ask me, um, some of my co-workers would ask me do you hate all white people? Do you hate us white people? I’m like, no, there, there are good white people there are bad white people, there’s good Black people, there’s bad Black people. You know, I, I had honestly thought I had forgiven him. But for some reason all these years that I've been carrying this, I, I, I, something must have changed in me to get me to the point where I am now that, that when I did this particular forgiveness, and it was unemotional, it was very deliberate, um, something was different about it now than it was 40 years ago, and I, I don't, I can't tell you what it was. Maybe it was just timing. Um, and I've heard people talk about that before, about, you know, letting something completely go and I'd, like I said, I thought I had done it before but, uh, apparently I hadn’t.
DR. STRIKER:
Well, let's talk a little bit about your experience in medicine. And, have you had those kinds of experiences, micro aggressions and such, you know, whatever, whatever the term you want to classify it, it as, but uh difficulties with the regard to race and, uh, in going through your medical career?
DR. WILLIAMS:
Oh, absolutely. Um, so I was a physical therapist as I alluded to before I went to medical school. I worked up in Boston at a large hospital, um, as my initial job. I was the only Black person in my department of 60-plus physical therapists at the time. And I had a horrible experience. I, I was not accepted, incorporated. Um, Boston is a difficult city for person of color to live in unless you're in college. If you're in college, or if you know somebody up there, but if you just come up there without any friends, family or whatever, just to work, it, it was a difficult city to integrate at the time.
Um, anyway, when I finally was ready to leave and come back home, the Vice Chair of the Department at that time pulled me into her office and essentially wanted to know what was I going to say when I left the Department? And I knew what she meant. But I was like, well, what do you mean? What am I going to say? And essentially she wanted to know was I going to sue them for how they treated me? And I just said to her if you were concerned about that, you would have treated me properly in the first place. I, I think you can't worry about how, what I'm going to do now that I'm leaving. You know, but it was, it was confirmation for me that I was not treated the same way everybody else was, and it was a very difficult year for me.
Um, I came back home and worked as a physical therapist for another, maybe, year or so, and then, um, started my medical school process and the next big thing I can remember is during one of my medical school interviews. One of the interviewers asked me how I was going to feel being the only Black person in the classroom. And this was back in the 80s, so, you know, this is not 1940 something, this is in the 80s. And I said, well, I don't think it's any different than the way I've been living my life for, you know, decades now, so what's the difference?
Fast-forward a little bit to uh, being a, intern. I had a medical student shadowing me. There was a, uh, young woman, a black woman. She wasn't young, she was an older black woman who was having a heart attack, you know, on a regular floor. She wasn't in the ICU or anything and so it was my job to, you know, package her up, get her up to the ICU, etcetera. And I went in and I was trying to tell the gentleman what to do, you know, do this, do that, do the other, as I was trying to hurry and get her to a higher level of care. And the young man, who happened to be white, said, looked back at me, medical student, he said you can't tell me what to do. I was, what? So, what? You know, how can a medical student say to me you can’t tell me what to do? Are you out of your mind? I got so enraged and, you know, we're standing on opposite sides of the patient's bed. And I looked at him and I think the veins were bulging out of my neck and I just kicked him out of the room because I needed to take care of the patient. I had become so upset that the poor lady, the poor patient was trying to calm me down as she's having a heart attack and I'm trying to get her to the ICU. It’s gonna be ok. Don't worry about it. He was wrong. And so I go out in the hall and I get my resident, I’m like come in here, you have to help me, well, well, you know. So that, that was another example.
Um, a couple of others I can think of are when I became the Chair of Anesthesia at NIH, there were times when a patient would not want a person of color to take care of them and, you know, recoiled for them, from them, didn't want them to touch them, etcetera. And so they would ask to speak to the boss. And so they would call me. I'm the boss. Right? And they were so stunned when I walk in with my brown skin that they didn't say anything and I just said it's your problem.
So, um, and I guess I'm a, a last one that really has to do with being a woman rather than being Black, was when in a private practice situation, uh, one of my bosses, when I had my baby, suggested that maybe I should stay home to take care of my baby, because that's what he and his wife decided that they would do. He was the physician. She was not, and, uh, maybe that's what I should do. And I said well, I don't think that's what I should do. You know, my mother worked my whole life, you know, and I didn't turn out so bad so I don't think that's what I should do. But it's funny how people will put their own implicit biases on you as their opinion as though it's correct. So those are brief examples, I suppose.
DR. STRIKER:
How do you handle it then, when people underestimate you because of your race and/or gender, as you just pointed out? And importantly, how to use those decisions on how to handle it to give advice to younger physicians?
DR. WILLIAMS:
Right? I, I, I would say initially it's going to start with how threatened you feel, and how safe you feel in your environment. I didn't feel very safe as a resident. I don't think I felt very safe until I, I myself learned how the medical community operated, learned also by being the leader of a department how human resources and laws operate. I didn't know at the time what I know now about the legal system, um, and so part of my strength now has to do with maturity, evolution and experience. Part of it has to do with getting the shock value out of your responses so that when people come up with things that you cannot believe they just said, that you're not standing there dumbfounded and you can actually formulate some words, some articulate words, that aren't curse words, that come out of your mouth in order to respond.
Um, some of it has to do with becoming confident in who you are as a physician so that when someone is trying to take you down, whether it be as a woman, as a Black person as a you’re too young person, if you have knowledge of a certain topic and you can speak to that knowledge, that articulation becomes your strength and it becomes your, your, your fight back.
I, I, I think those are the things that I, I have learned over time and it, and, and it took time to get there, but I will also say that the environment that you work in makes a difference. I don't know that the environment up in Boston, well I know, the environment up in Boston’s hospitals are not the same as the environment in Washington DC. Two different places, Washington tends to be a much more, um, international city, so therefor, the patients we serve and the people who work there, on all levels are, are much more ethnically diverse. Um, and so you feel more comfortable in an environment like that. If I worked somewhere else in an environment where it was not as diverse as Washington is, I don't know that I would feel as comfortable or as safe. So I, I think that has a lot to do with it also.
DR. STRIKER:
You mentioned people's implicit biases and you know, we're all socialized in the same milieu, and if we're being honest with ourselves and each other we all have biases. And how do we face them? How do we tackle them, in your opinion?
DR. WILLIAMS:
Um, first being willing to have difficult conversations. Uh, these are uncomfortable conversations to have with one another. Um, particularly, if you don't look like me. There are people, like I indicated previously in my rowing club who were so, they're all white, who were very happy when I shared my life with them because they were afraid to ask me. Um, and I was afraid to say anything.
Um, so once you're open, I, I think it's important to educate yourself. There are so many resources out there now that can educate all of us about our biases. Um, one is called White Fragility that I'm sure a lot of people have heard of, by Robin Diangelo. Another one that is really excellent, that it's difficult for me to get through, but it's an excellent book for physicians in particular, um, is called Just Medicine by Dana Matthew. She is the newest Dean of the GW Law School, who’s married to a cardiothoracic surgeon, and she talks about, so she interposes, legal construct and, and how it started back in the 1600’s in this country and before, up till now. She interposes that with how we got to where we are, socially, economically, educationally, etcetera, and then starts to help you examine your own unconscious biases of what it's like when you walk into the room with somebody who un, a patient, who's looks different than you. And how you unconsciously draw on these, um, suppositions that may or may not be correct, based on how you were socialized, brought up, etcetera.
Most physicians are very generous with their heart. They don't intend to be biased in any, in any capacity, but we have all grown up with a certain set of values and, and pictures in our minds about what particular categories of people look like. And this book is very good at not only giving you the history of how we got here, but helping you examine some things that you may not even be aware of, of how you're treating patient A differently from patient B. Until you walk into the room and patient A is complaining of chest pain and, as you know, there's many studies that have shown that Blacks are treated differently for cardiovascular disease, not ordered as many tests, EKGs, referred to a cardiologist. Um, another example is, uh, the calculation of GFR for kidney function. There were formulas for years that, that universities taught that inaccurately categorized, uh, the kidney failure of Black Americans differently than white Americans so that the Black American essentially wasn't put at the higher end of, like say, the transplant list. So their kidney failure was not categorized as, as serious as a white person’s was because of this mathematical uh, computation that was put in to calculate GFR which is incorrect.
Um, pain management at that, obviously a lot of our anesthesiologists know about. Um, a lot of experiments were done back in the day on OB-GYN patients without anesthesia, um, Blacks whose legs were amputated without anesthesia, to prove that the Black person could tolerate more pain. And all these things obviously are not true, but a lot of them are still taught, what, even if it's subconsciously, we don't realize that a lot of our medical students are coming in in the first two years, they are very aware of the social biases, the racial biases, etcetera. But studies have also shown that by the end of their clinical training, they now have somehow converted because of examples that they're watching their attendings do of how they treat people differently. And we're not calling them on it, our attendings, um, that they, they then start to perpetuate the disparate treatment of different ethnicities.
DR. STRIKER:
In, in terms of medicine, do you think that's probably the, the biggest source of injustice in terms of bias rather than each personal interactions, but the fact that we as scientists, physicians, don't even realize how those biases affect the care we’re giving when we, a lot of us think that, well, it’s science and its objective and, you know, that's, that's what I do and I'm, I’m not, nothing’s gonna affect that. Do you think that's probably the most important aspect of all this that, uh, we need to be addressing?
DR. WILLIAMS:
No, not necessarily. I, I think that there seems to be an entire, as I've learned more, and I, I'm learning more in my old age, that there’s an entire system behind how we got here in the health arena from not paying appropriate wages so that people can't afford proper housing and therefor they’re living in crowded communities where there were communicable diseases, to not being able to afford healthcare, proper healthcare, so that they can get their, their, uh, illnesses taken care of, to not being able to be as well educated as someone who could be well educated and therefore you don't know any better than certain things, um, to lack of generational wealth from one generation to the next in the Black family. I think all of these things have hampered the Black community so that it, it, all of this ends up affecting our health.
The white community, in the meantime has, um, prospered in its generational wealth, doesn't realize the, the, um, history of how all this started to begin with. And it's, it's, it's a lot of history that was not taught in school, that's not taught anywhere. You, you have to look for it. And, and this history that is taught even if it was taught in a non-malicious way, has perpetuated itself through the generations so that it becomes accepted norms now, but we don't realize it. And so, until again, you start at the individual level yourself, and have an honest conversation with yourself, but then start to read, and read things that may not be comfortable, you may not be comfortable reading, having conversations with people that don't look like you. And then, you know, expanding that to where you work, your community, and eventually legislation, you know, which is sort of where we are now. Um, I, I think there's going to be a lot of different facets that need to change in addition to our individual selves and our individual place where we work. I guess that's what I'm trying to say.
DR. STRIKER:
It's been a topic of discussion, I know, in the medical community, but do you think there's a place where we should be carving out time within medical school training to learn about these public health issues, public health biases, or other, uh, systemic problems that lead to individuals succumbing to health problems that they might otherwise not have?
DR. WILLIAMS:
Definitely, definitely. There, there are so many resources out there now. There’s um, the large effort by White Coats for Black Lives, um, which is a racial justice report card that many academic medical institutions are using that has outlined goals. Um, you know, it gives you a preamble but then there's outline goals of what you can do to try to change your organization, which is difficult to do. Uh, the AAMC, even though they have come out previously with statements, they just came out today again with another outline about things that, you know, medical schools can do. I think there’s just three or four specific goals that people can do in their organization to try to change.
Um, there is a wealth of information, um, and it really needs to start from the top down. Um, George Washington University established the Anti-Racism Coalition in order to try to do just that. And we started from the executives, and that was a small group of people, to make sure we had buy-in with, do you think this is a problem? To make sure they understood what the problem was. Do we have financial and other support that we might need in order to support such a large robust multi-dimensional project? And then we developed a steering committee, which is actually the body of people that are actually doing the work, um, that is from people, groups of people from the medical school, to the hospital, to the staff, to the clinical labs, to the medical faculty associates, you know, it, it sort of, encompasses a large group of people. Um, and it's going to take some time with diligent effort in order to not just, you know, do the mouth work like we have done in the past, but to actually put our feet to the fire and actually make actionable changes.
DR. STRIKER:
In anesthesiology specifically, what do you think those of us could be doing differently or better in terms of offering support to colleagues?
DR. WILLIAMS:
Hm. It's interesting that you asked that. I was a previous Chair of the Professional Diversity Committee, many years ago now. And at the time, the ASA Chair, and I, uh, the ASA President, who I can't remember who it was now, said to me Karen, we want more people of color and more women on the dais. Praise God, there's more people, more women, you know nowadays. That's great. You know, what can you do? So I developed a mentoring program to try to take young mentees under our wing to show them how the ASA worked, you know, it’s a political machine, you know, how they had to get involved in committees and reference committees and get involved in their local, um their local community uh, anesthesia society, etcetera, how they had to bring themselves to the table, essentially.
And I put together formal program and I went to the House of Delegates to ask for money to support the program and I, it was a very painful meeting. Um, there were many people who were against the program, didn't want it to happen, didn't see the importance of it, and, um, so it barely squeaked, brought, by with approval, but with no money. So because of the generosity of some of my colleagues on the Foundation for Anesthesia Education and Research, FAER, Board of Directors, they helped me and volunteered their time and leadership into this mentoring program. And because of their time and our efforts over the years, that program has become self-sustaining and as I understand it now has $60,000 in order to support mentoring projects, whether they be leadership projects or projects of, uh, diversity and trying to get people in positions where they can get experience and exposure, etcetera, bringing them to certain tables that they wouldn't ordinarily be exposed to. Um, that is a, a fabulous thing, um, but that, that was painful and, and it, it wasn't because the leadership didn't have the foresight to, to look there, it was because there is inherent biases in our society just like there is in the country.
So I, I think the ASA would be wise to maybe offer at their Annual Meeting training in this. I mean, we educate our physicians in everything else. I mean, I think this might be a, a wise thing to do particularly since our Anesthesia Society is very diverse within and of itself.
One of the reasons I became an anesthesiologist was because there were so many people from so many different countries it, it felt comfortable to be an anesthesiologist. However, realizing that the way Black people in particular got to this country and the way we were, you're, uniquely constrained into a lifetime, lifetime of slavery and all of the side effects of that, as opposed to the other immigrants who may have come here on their own. There's a difference in how Black people are viewed, how Black people are treated, and that's why when people say Black lives matter and other people say all lives matter, you’re correct all lives matter. But all lives are not getting shot. All lives are not being hunted down, put in jail for minor offenses, being suppressed to vote, all of these things and, and you know, just recently I learned that the police force back in the day, the way that the police force got started was in Boston was to guard the harbor there, but in the South it was to protect from runaway slaves. That's how police got started.
So, uh, you know, I'm not surprised now to learn that there's a lot of people who are racist, some not, that go in the police department because they are trying to propagate stuff that started a long time ago.
Anyway to get back to the ASA, I think giving educational venues, um, on the topic would be important, to have open conversations about it at the executive level on down, um, to continue to support the Professional Diversity Society. I, I think those are some of the things that can be done in order to help the people who are willing to listen and are willing to learn something. Not everybody's going to be willing to change and not everybody's going to be willing to listen, you know you can’t do anything with that.
DR. STRIKER:
You know, the, the Welcome Session at the ASA this past weekend, the Surgeon General, in his talk addressed this a little bit, uh, with, within the ASA, about representation of minorities. Forgive me if I don't remember the exact figures, but I, it was something like 13% of the population is African-American and 3% of anesthesiologists are. And you know we’ve touched, we’ve kind of circled around this so far in the conversation, but how important is it to have that representation and, and, and why?
DR. WILLIAMS:
Um, it's very important, uh, and it's important because we need to have more people who look like me so that we can mentor younger people that realize that they can, they can do what I can do. It's important because, at least right now, it's been shown that, that patients who go to doctors who look like them trust that doctor a little bit more and that again has to do with history of Tuskegee, Tuskegee Institute research etcetera, etcetera.
It's important because, you know, our country obviously has become much more diverse than it used to be, back in the day. And so we need to have not only doctors that look like me but also, um, research on various diseases and, and procedures that, that may affect a certain population more than the other. I mean, why are Black people, more Black people, dying of COVID? Blacks and Hispanics? You know, it's not it there's no Black gene that all the sudden is, is making the COVID virus cleave to the Black gene and then all the sudden we get sicker and we die, etcetera. That has nothing to do with it. But if you don't have a vested interest in why are Black people dying, why are Hispanic people dying? If you don't have a vested interest in that, you're not going to take the time money and intellectual aptitude to investigate that.
It's important because there are many Black inventors that have never gotten their, their recognition, and that we are using some of their inventions today that we have no idea they were created by Black people.
And it's also important because if you have a homogeneous population where everybody looks alike, thinks alike, etcetera, you're not going to ever grow. You're not going to ever grow beyond your routines, beyond your common expectations, um, and, and think about things differently than you normally would. And it's important to have people who think differently than you, and have you, en, envision things differently than you in order for you to be a well-balanced, well-oiled machine, whether that be as a person or as an organization.
DR. STRIKER:
What are you hopeful about when it comes to this issue moving forward? Are there bright spots that you can identify, things that we can point to for people listening as it relates specifically to diversity in the specialty?
DR. WILLIAMS:
You know, I, I am not sure. I was so honored when President Obama was elected as President and, and this is not to get political, but I was honored because of the life I had lived previously. Never thought I would see the country evolve to the point where they elected a Black president. And to see all of the divisiveness that is going on now, on top of the shootings that have been going on, you know long before our current Administration, you know, I, I'm not sure. I'm, I, I personally am hurting.
I am proud that the ASA has had, I think, two women Presidents now. I'm very proud of that. I know both of them, and I, I'm, I'm very proud of that. I'm proud that the ASA is trying to move in the right direction. I'm proud that the ASA has always been inclusive of people from all over the world.
But I, I, I am not clear right now on where we stand as far as what's next. Um, I, I was, you know, a few years ago and now I'm not so sure. I feel, hon, honestly, I feel a little discouraged. Um, I, I feel a little bit disappointed. I almost feel a little bit afraid sometimes when I go outside, even though I'm not a black male I get afraid. I don't know who's friendly, who's not friendly and it reminds me of 1964 when I would walk up my neighborhood and somebody would spit in my face and you don't know why they do it. It's, it's for, I feel, for a Black person, it's, it's a frightening time to be an American. As I'm riding my bike on the street, I don't know somebody's going to run me over. And some people may say that that's, uh, paranoid, but I don't know that it's paranoid. You know, people go out to, to jog and they get shot. You know, people go to the gas station, they get in a fight to try to break up another marital dispute or domestic dispute, they get shot. I, I don't know. I, I just don't know. Um, I'm, I'm hopeful.
The reason that I'm involved with the Anti-Racism Coalition is because I'm trying to put action behind my words, like I said, put a personal face to a painful part of our history both in the past and now. One of the reasons it became so prominent in the 60’s was because it was the first time it ever, all that was on TV, the hoses on people, etcetera. Um, and now that we have these little cameras, video cameras, you know, it's in your face all the time so you can't ignore these things anymore.
And so, I, I guess my positive spin is I'm glad that I, I had a successful career. I, I have a new career now. But I will tell you that even as successful as I've been, and as confident as I feel, I will still go to a valet parker to get my car out of the parking lot, I'll stand and wait my turn. The, the parking attendant comes up to the white woman behind me in line who came up after me, and tries to take her ticket instead of mine. The white woman will say to him, well, she was here first. And the guy will look at me, look at the white woman, he will still take her ticket go get her car and leave me standing there.
I'm a great anesthesiologist. I followed the rules. I've gone to school, I’ve, you know educated my children, you know, I've been the great leader at NIH, all of this, that has nothing to do with it on, on an everyday level. So the hopefulness, um, that I have is that we have become so energized recently by what has gone on and it's a, a multicultural, multiracial movement, that I am hopeful that we won't tire of it, forget about it, and just let it fade into the background. I feel, I hope that we will have meaningful change out of all of this and the only way I can, I feel that I can do it as myself, is to put myself there on the front lines hoping I can engage other people to put themselves on the front lines. But it's going to take some work, and it's going to take time, and it's going to take uncomfortable movements and uncomfortable discussions.
DR. STRIKER:
Well, Dr. Williams, thank you so much for sharing your, your experiences, your insights, your expertise and hopefully just having this discussion will cause a, a lot of people reflect and give this topic it's, it's due. And, uh, we can hopefully affect that in some small way here today.
DR. WILLIAMS:
Thank you. And thank you guys for taking the time to have this session. I, I am honored to be asked and like I said, I don't know that I would have had the courage to say anything before now. I mean, I think current events are, are, are sort of making me feel more comfortable about sharing my own life, and I'm, I'm hopeful that we can move forward in a positive way.
DR. STRIKER:
Well stated. Um, well, thank you again. This is Adam Striker saying thank you everyone for joining us on this episode of Central Line, and please tune in again next time. Take care.
DR. WILLIAMS:
Thanks, Adam.
DR. STRIKER:
Oh, absolutely. Thank you.
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