Three Things I Learned Serving on ACEP’s Diversity and Inclusion Committee

How to take responsibility for diversity in our organizations, and what we as individuals can do to stand up to injustice in the workplace.

Following the protests, the Pride parades, and the Juneteenth celebrations, individuals everywhere are being called to introspection, self-examination, and speculation on what can be done to improve the situations of those most vulnerable to racism and discrimination. 

Even with the best intentions, standing up and speaking out in this political—and professional–climate can feel like traversing a minefield. What to say, how to say it, and who it should come from poses challenges for individual providers and organizations alike. 

While there’s no simple formula for how to take responsibility for social injustice, I’d like to share three lessons I learned from my time on the American College of Emergency Physicians (ACEP) Diversity and Inclusion Committee that can offer principles we can adhere to—and steps we can take—as we work to speak up for others that can be adapted to local, organizational, and individual circumstances. 

Lesson one: It starts with you

My father is Syrian, but I was born in Kentucky and raised in an affluent, predominantly-white and conservative town in Florida. As a result, although I was the son of a biracial marriage, I managed to grow up in a life of white, male privilege. 

When I was invited to participate in the Diversity and Inclusion Committee, I felt for the first time what it was like to go from the sheltered life of the majority to the minority among minorities. 

Stepping into the shoes of a minority can feel intimidating. While racial and gender minorities have spent a lifetime being confronted with what makes them different, it can be difficult as a majority to understand the factors that make us the majority—and privileged. Savala Trepczynski, J.D. and Executive Director of the Center for Social Justice at UC Berkley School of Law, explains:

“[The majority] can see that a black person, for example, is deeply embedded in what we call ‘race,’ and lives a life impacted at nearly all levels by race... But they often can’t draw the same conclusion about themselves.”

Serving on the committee opened my eyes to the privilege I had grown up with—and my responsibility to act as an advocate. People of color, the LGBTQ+ community, and other minorities have been protesting and advocating for years. As Trepczynski continues “If that were enough, it would have worked already… It is [white people] who are responsible for what happens now.”  

In healthcare, a 2019 study shows that 56.2 percent of all active physicians identify as white, 17.1 percent identify as Asian, 5.8 percent as Hispanic, and 5 percent identify as Black or African American. This highlights the fact that—although racial and ethnic diversity in the US is rising—we are slow to follow that trend in healthcare. And the gap is significant, especially for the Hispanic and Black communities. 

One study suggests that there is a 30.5 percent gap between people belonging to an under-represented in medicine (URM) minority and the percentage of URM physicians. Recognizing this, we aren’t going to get anywhere as a country if we put the sole burden of equality on that collective 10.8 percent of URM providers. 

Which means that we need you. Yes, you. Whatever your name, race, ethnicity, specialty, or political affiliation is, the diversity and inclusion initiative happening today needs you to step into the shoes of the minority, examine your privilege, listen, learn, and join the movement. 

Lesson two: Inclusion shouldn’t be isolated 

As a committee, we developed a system of “best practices” for promoting equality, diversity, and inclusion that covered everything from equality of pay to representation of minorities in leadership positions. We participated in a number of PR initiatives, educational events, and lively discussions, anxious to help increase the diversity within ACEP—which currently has less than 1 percent of its leadership identifying as a minority. 

As noble as our intentions were, we soon realized that for diversity and inclusion to really improve, it couldn’t be the “job” of a small committee of individuals. It had to be an organization-wide undertaking. 

When we relegate topics like diversity and inclusion to committees or departments, we isolate the change that happens. Equality becomes perceived as the charge of a select handful of individuals, rather than the responsibility of all team members. As a result, if something is amiss in the company culture, fingers are pointed outward saying “the committee needs to…” instead of individuals looking inward to reflect “I need to,” and we end up walking right into the “lip service” trap we want to avoid. 

Since my time on the committee, ACEP has worked to increase its efforts to expand its diversity and inclusion initiatives beyond conference room discussions to organization-wide policy, statements, and change—such as the Statement on Structural Racism and Public Health released a few weeks ago. These steps, while small, can be expanded organizationally to strengthen cultural diversity from the top-down and work individually on the hearts of members to facilitate change. 

Lesson three: Seek discussion, not defense

Once organization-wide policy has been put in place, getting that policy into practice is the next step. And as Michelle Mello, JD and PhD and Reshma Jagsi, M.D. D.Phil share in The New England Journal of Medicine article, “Standing Up Against Gender Bias and Harassment”: 

“Though robust organizational processes are necessary, they are insufficient to transform culture. The profession must also articulate the ethical obligations of individuals who witness harassment and inequitable treatment... We focus here on women as targets, but much of our argument applies more broadly to mistreatment based on gender, race, or other characteristics.”

When it comes to determining our ethical obligation to stand up for diversity and speak out against discrimination, fears about what to say, when to say it, and how to say it can paralyze providers that disagree with the situation into staying silent or ignoring the behavior. Developing an individual or organizational playbook for addressing discrimination—beyond the important-but-proverbial report it to your HR department—can empower employees to respond to injustice in a way that’s professional and productive. Some examples of this playbook could include:

  • Documenting racist behaviors or comments for future reference
  • Removing the person being discriminated against from the situation—for example, moving a minority patient to another room away from the harasser, or calling a physician away from the racist patient for help with something elsewhere
  • Engage the individual in an honest, question-based discussion—using a lead-in such as “That’s interesting that you feel that way. Can you tell me more about that?” 
  • Address the person privately, letting the individual know you felt uncomfortable with what was said/done and that it wasn’t acceptable

The options shared represent less aggressive approaches to addressing discrimination, which may help the diversity ally feel more comfortable speaking up for others. Ultimately, the goal is to address behavior in such a way that it facilitates discussion—not defense. For me, I have found that using humor to deflect inappropriate behavior can halt the discriminatory remarks in the moment, and allow for a more in-depth conversation later without the individual getting defensive. 

This is our problem

As healthcare providers, ours is the sacred mission to care for life, making everything that is happening in the world today very relevant to us, and very much “our problem.” 

We cannot in good conscious stand for health when we turn a blind eye to those being physically assaulted on the streets, or quietly succumbing to undiagnosed illness behind closed doors, and we turn away. We cannot stand for wellness when our treatment and prejudice of others leads to the depression, anxiety, PTSD, and other mental illnesses going untreated—exacerbating pain and leading to unfair arrests and criminalization.  

While we can't stand in everyone's shoes—and in some cases, may even disagree with some things—respect and equality are an absolute requirement. These don't require anything, but having a willing heart and approach to our diverse world is what makes us stronger. 

We can trust that our voice is needed, we can advocate for better policies protecting our underserved patients and underrepresented care team members, and we can participate in honest discussions about uncomfortable topics with a genuine interest. Respect, equality, empathy, and love cost nothing, and that is ultimately what is asked of each of us.

Related Reading: Mental Illness: A Condition, Not a Crime

Hamad Husainy DO, FACEP, is a staff physician with Helen Keller Hospital in Florence, Ala., the founder and chief medical officer of Sycamore and a member of Collective Medical’s Clinical Advisory Board.

This article is provided through a collaborative effort with Collective Medical

 

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