To Be or Not To Be Silent

In the strongly political environment that persists these days, people at work have been discouraged from talking about a lot of issues including politics, religion, race, sexual orientation, and salaries. As a youngster, I was always puzzled by the phrase, “an elephant in the room.”  I didn’t understand how a big elephant could be in a room and nobody see it.  Well, race relations have been a mammoth elephant in most of our meeting rooms and even in the rooms of our patients.  Being silent about an issue as important as life and death is not an option for those of us in the medical profession. Approval of the status quo shouldn’t be an option either. 

We stand at the threshold of improving patient care exponentially by expanding diversity among our health care providers. Those of us who have been in medicine for a long time have come to know that patients whose medical team includes workers who “look like” them often feel more confident that they will get the best care.  As physicians, nurses and other healthcare professionals, it is incumbent upon us to do everything possible to have and keep satisfied patients. None of us would hesitate to sound the alarm and take immediate action if we saw our (or someone else’s) giggling toddler so engrossed in play that he/she is unaware of an approaching speeding car.

Lack of diversity is the speeding car in our medical world. Let’s face it: We are not as diverse as we should be in selecting our healthcare providers. Survey findings are numerous about how diversity impacts people. Take skiing for example. Diversifying a male ski group with women has been known to help some males summon the courage to avoid skiing on a risky black diamond with the potential for causing an avalanche in Big Sky, Montana. The findings from examining the behavior of all-male ski groups conclude that men tend to suffer in silence to avoid being called a coward. On the other hand, a ski group that includes women is likely to have outspoken women who do not hesitate to raise questions about the dangers ahead and demand a return to safety, if that is the most practical option.

Speaking up in the face of danger may sound easy. The big question is, who gets to determine the extent of danger and how to handle it? Unforeseen dangers like a COVID-19 viral super spreader event during this pandemic is a case in point. “I don’t want to be the one to tell them to put on a mask or get the vaccine,” might seem to be a reasonable response for some. But weighing in on the potential calamities that follow inaction or ineffective response could literally be a matter of life and death. Physicians are faced with unrecognized dangers daily, including the hurting dyspneic sickle cell patient thought to be in a routine crisis but discovered to have a submassive pulmonary embolism. The 85 year-old grandmother moaning on an ED stretcher for hours might have a large ST segment elevation myocardial infarction requiring prompt percutaneous coronary intervention (PCI).  People are in eminent danger every day, making it necessary – even crucial — that we heighten our clinical awareness to be the best doctors, nurses and other team members caring for patients.

The survival of the fittest during COVID-19 has proven to be true.  The disparity in morbidity and mortality rates of minority populations is stark and unquestionable.  Albeit, as physicians trained to take care of everyone, we must ensure a systemwide approach to providing excellent healthcare to the weakest and least resourceful among Mississippians.  It feels great to know that the University of Mississippi Medical Center has led the state in patient care, education, and research.  The political climate, unseen viral attack, persistent racism, and recent extremes in weather are just a few human tests/trials we still must overcome to deliver the best care for every person.

Soon, the next pool of candidates to become the best internists, emergency medicine physicians, surgeons, etc. will stand before us. We must have our minds open to the fact that while interviews are important, the applicant’s potential must be weighed seriously as well. “I just didn’t get the right vibe from this candidate” is a cop-out that we cannot afford. Taking the time to check into and inquire about the under-represented minority applicant might reveal a person of strong character and commitment with the potential to become a shining star in our efforts to serve patients effectively.

The Department of Medicine is participating in a pilot study with the AAMC to increase underrepresented minority faculty physicians and house officers.  The holistic review concept takes into consideration the applicant’s experiences, attributes, and academic metrics in deciding whether he or she has the potential to help provide excellent care to a diverse population.

As we walk into the room to begin our discussions about house officers or faculty applicants, let’s resolve to concentrate on the gravity of our selections.   Identify the elephant in the room and SPEAK UP.

One comment

  1. Thank you Dr. Myrna Alexander Nickens for truly addressing the “elephant in the room.” As a general internist, I concur with the acknowledgement and recommendations to “Speak up” and not to be silent regarding our interaction with patients of different ethnicities. Physicians are looked upon as leaders in the community whether we desire to or not. If we don’t address the problem, who will?
    How attending physician interacts with patients and colleagues has a profound effects on how medical students or residents speaks or addresses the patients. Being silent or saying that is not my problem contributes to the disparity. Listen and visualize yourself in their lives. How can I improve the situation?


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