Diversity education and awareness have long been recognized by many organizations outside and inside the house of medicine as being important for achieving resilient organizations. With regard to medical education, the Association of American Medical Colleges famously announced an ambitious goal of seeing 3,000 people of color in medical schools by the year 2000 (the 3,000 by 2000 initiative) in order to intentionally meet the needs of the greater public, as physicians of color are more likely to care for patients of color (asamonitor.pub/3Q59aM8; The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions: Summary of the Symposium on Diversity in Health Professions. 2001; N Engl J Med 1994;331:472-6). While founded on noble principles, this program did not achieve its stated goal, though it did raise the issue of diversity in medicine.
Recently, diversity has been distorted into something that it never was, nor intended to be: a political bargaining chip and hot potato, relegated to specific localities, ideologies, or agendas. In our more divided and polarized body politic, it’s important for us to recognize, as physicians, what the role of diversity is and how it can facilitate success in our ORs, clinics, intensive care units, and applicable medical spaces.
In short, mindfulness about diversity is a tool that functions as a means to an end, much like what we all see in quality improvement or basic science research. For example, in the sphere of quality improvement, improved patient satisfaction scores have been assumed to be analogous with improved care. Patient satisfaction as a payment metric has been implemented by the Centers for Medicare & Medicaid Services (CMS), even in the setting of lackluster or conflicting data. A major study looking at outpatient clinic visits demonstrated that improved patient satisfaction was associated with increased utilization of inpatient care and even increased mortality (Arch Intern Med 2012;172:405-11). Another study analyzing 171 hospitals did not find a consistent correlation between patient satisfaction and favorable surgical outcomes (Ann Surg 2014;260:592-8:598-600). Regardless, there has been no change in the use of patient satisfaction as a quality metric in spite of conflicting data, because an administrative agenda has already been put in place that attempts to equate medical care with retail venues, effectively equating physicians to car dealers and electronics salespersons.
In similar fashion, the perception of basic science research, which has served as the backbone of medical discovery for the past several decades (and arguably centuries), can itself become distorted into a deviant of its original identity. A case in point is the 1975 “Golden Fleece Award” (designed to highlight government waste) issued by the late Senator William Proxmire, a Democrat from Wisconsin. This award, announced on the Senate floor, derided federally funded research by psychologist Ronald Hutchinson. Dr. Hutchinson’s research analyzed why rats, monkeys, and humans clench their jaws – research that eventually helped NASA and the U.S. Navy design systems to allow astronauts and soldiers to tolerate confined spaces. Even more glaring examples of such behavior can likely be recalled by most readers in the post-COVID world. Such cases indicate not something wrong with the science, but the agenda of individuals distorting the science itself.
Diversity education at its foundation is no different. In many ways, it is being distorted by both those who support such efforts and those who oppose them. At its core, awareness of diversity is simply an application of the concept that intentionally diverse organizations are likely to problem-solve more effectively. We need go no further into history than World War II, where the language of the Native American Navajo tribe was essential to the creation of encryption codes for use in the Pacific theater (asamonitor.pub/3ZJPhNR). Without a diverse population and Navajo volunteers willing to give of their expertise to serve as “code talkers,” many more lives could have been lost. This was not the first time our country’s Native American community helped at a critical juncture. The Choctaw language was similarly applied during World War I. Our differences as a country have literally and figuratively made us strong! Intentional diversity fundamentally means that differences among a team are not discouraged but embraced; the various perspectives offered by members of a team are all taken into account and equally respected in order to rise to the challenge presented. Differences are not seen as a threat but as a tactical advantage, and an intentional effort is made to cultivate collective appreciation and respect for those differences.
When we look at our ASA Board of Directors, we see a diverse organization with a variety of ideas and backgrounds. Three of the past six ASA presidents have been female, and the Board of Directors includes every conceivable demographic, background, and perspective. Recently, in the Texas Society of Anesthesiologists (TSA), we undertook the difficult decision to change the benefits package of our staff. This is not a new challenge for us; in fact, until recent years we did not provide health insurance for our TSA employees. This evolution is part of the natural growing process of a society that has been blessed to thrive in a challenging environment. In order to provide family leave for our organization, we deliberately brought a team together that had a diversity of viewpoints, ranging from minimal expectation of structured leave to highly generous expectations of automatic leave. We were able to respectfully discuss the ramifications of all possible approaches and collectively came to a decision that worked well for our society. This process was effective because we had an intentionally diverse array of opinions from our diverse leadership. Men and women, junior to senior in stage of practice, private and academic physicians, economists, and political experts all coming together for one purpose: to make the TSA successful.
Some of you may be in a state or jurisdiction that statutorily forbids diversity as a thought process or structured initiative, and some of you similarly may be in a state that strongly encourages diversity awareness. In either scenario, we must all recognize that diversity of ideas, even on the political front, should be respected. Even in our effort to promote diversity, even when it’s greatly desired, it is possible to inadvertently stand against diversity. The proof will be in the pudding. If the historical thinking in the business world is correct, organizations that forbid diverse thinking will not be as successful as those that do. In the meantime, as leaders in our various departments, we all can and should do our part to ensure everyone feels welcome, included, and respected. It comes down to each one of us ensuring our practice partners have the same opportunities that we would want for our loved ones. Our expectations should not replicate our individual privileges or hardships. Rather, we should choose a course of action that universally maximizes opportunity for everyone coming after us. This goal is not easy or free of effort, but it is the best thing and the right thing to do. We shouldn’t wait for our leaders to instruct us on how to respect and not fear each other; this is something that falls to each of us without outsourcing. Let us all remember what diversity awareness truly is, and therefore our diversity on an individual level, just as we proactively display professionalism and excellent patient care in our individual daily interactions. Our diversity of places, perspectives, and ideas makes us strong!