Association for Academic Surgery (AAS)

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How do you change someone’s mind when their worldview has never been challenged by their life experience?

Recently, a disturbing tweet was circulated on Twitter. A Harvard Professor of Physiology and Medicine and former Dean tweeted the following statement: “When I last lectured in @BrighamWomens Bornstein auditorium, walls were adorned with portraits of prior luminaries of medicine & surgery. Connecting to a glorious past. Now all gone. Hope everyone is happy. I’m not (Neither were those I asked – afraid to say openly). Sad.” This blog is not going to unpack that tweet or debate whether or not we should venerate white guys on walls. Instead, I want to address this man’s sentiment because this undercurrent feeling of disconnection with a “glorious past” lurking just below the surface in many of our newly evolved departments will poison our path forward if we are not careful.

A few weeks ago, I had a conversation in a friend’s kitchen that is playing out in kitchens and living rooms across post-MAGA America. This man is 76 years old and is both a kind friend and a loyal father figure. He was raised in a large East coast city in the 1960s, went to a local college, got married, had two kids, moved to the suburbs, worked many years, and retired with a pension. With the exception of a brief period of military service, he has lived and worked in the same 30 mile radius his whole life. His friends’ lives all share a similar trajectory.  Perhaps because of this, many of his opinions go unchallenged day in and day out. Thus, it should have come as no surprise to me when he put down his beer and made an overtly racist remark at the dinner table. Like a good self-proclaimed “woke” democrat, I quickly responded to his macroaggression with my pat response: “It’s not okay to say that just because you’re old”. I could see he was taken aback, and for a moment even my self-righteous indignation couldn’t save me from the twinge of guilt I felt for insulting him in his own home. I saw a flash of anger in his eyes that assured me he had the same thought. We both regained control, I apologized for being harsh and he explained that in his day, things were different and this is just how he was raised. I replied to him (with some admittedly false equivalency) that when he was young, he could have found old people who said the same thing about slavery.  That’s when I saw his jaw set and I knew we would make no headway that night with the winds of change. However, that interaction and countless others beg the question: How do you change someone’s mind when their worldview has never been challenged by their life experience?

This question is particularly relevant as we navigate this sea change of attitudes in academic medicine. Everywhere I look, long-accepted paradigms of previously permissible surgeon behaviors are shifting. Many of these shifts are good: we are trading suits for sandals at conferences (on committee days only of course… we’re not animals), trading merciless intra-operative pimping for modular learning strategies with defined metrics and standards, and trading disdain for women with the audacity to operate and procreate for support and encouragement. We are making it unacceptable for people with egregious behavior patterns of bullying and assault to remain employed just because they are amazing in the operating room. Perhaps most importantly, we are beginning to understand and acknowledge that our monochromatic, predominantly male past looks nothing like our diverse future. And these are all good things, right?? I’m pretty sure there is objective data to support all the trades mentioned above except the sandals.

But there’s a problem: not everybody is embracing the change. There are a lot of surgeons whose opinions about gender equality, and whose biases toward people of color are only recently silenced by the new and improved, post-#metoo, inclusive culture in academic surgery.  These harmful biases and opinions still lurk just under the surface and are easily unveiled with a little bit of alcohol and the right (or wrong) company. Just one or two defamatory statements that both deride this new and improved ethos and smack of nostalgia for the good old days can bring monsters out of the mouths of our otherwise evolved colleagues. And this is where the rapidity of our movement toward a better, brighter, kinder academic surgery scares me a little. If all we do is make it socially unacceptable for our unevolved brothers and sisters to voice their dissent for this more tolerant surgical arena, then we will only situationally change behavior. Once the unevolved reach a safe space or leave “mixed company” (in any sense of the phrase), what is to keep them from falling back on the comfort of an unchallenged worldview? Failure to truly change hearts and minds will only result in a clandestine society of like-minded people who yield to inclusivity and support on the outside but internally ascribe to a more caustic ethos of yore. As soon as somebody comes along who validates their old feelings, confirmation bias is activated and the cause of inclusivity is again injured. In other words, while forcing somebody to go through the motions of tolerance certainly has its merits, it is far better to actually change somebody’s mind. So, how do we do that?

Patricia Devine is a psychologist at the University of Wisconsin. She says that in order to break a prejudice habit there must be 1. Awareness, 2. Desire or motivation to break the prejudice habit, and 3. Training in ways to overcome bias. While formal training to work through these steps is great, it will be a long time before awareness that we have a problem percolates through every academic surgical department.

In the meantime, we must acknowledge that although some of us gravitated toward surgery despite the absence of our own likenesses on the walls, others pursued surgery specifically because they did see themselves reflected in leadership and hallowed halls. I am not saying we need to extend their privilege one step further by slowing our progress, I’m simply saying we must bring them forward with us without alienating them. In order to really move the needle toward true inclusivity, we need open dialogue. This cannot happen if we fight our battles with the same shame and disdain that the establishment has long aimed at outsiders.  So, how can we invite open dialogue? In addition to formal training on implicit bias, I think the best way to change somebody’s mind is to change their life experience. And how do you do that? Live your life openly and invite them to be part of it so that you are no longer “other”. Allow me to suggest a few action items:

  1. Pick somebody in your department who has a different life experience than you, and invite them into your life. Examples include eating lunch with them instead of at your desk. Invite them to a dinner party or schedule a happy hour. If social interaction isn’t your thing, find a way to collaborate professionally with them. Working closely with people is a great way to break down barriers.
  2. Demand diversity at all levels of management in every organization. Promote people at work and in professional societies who look different than the majority. Amplify people with different perspectives by speaking immediately after them during a meeting and acknowledging whatever great point they just made. For example “I agree with Dr. X. I think his/her/their idea is great, let’s move forward with it.”
  3. Challenge micro- and macro-aggressions, but do it gently. If you hear somebody make a statement to a woman like “you don’t want to pursue an MBA, it will take time away from your children”, engendering empathy is your best weapon. If the person transgressing has daughters, simply ask them how they would feel if somebody limited their daughter’s professional aspirations for similar reasons. If that example is unavailable, you can name a male of similar age in the department and gently ask if they would give that same advice to him.

In conclusion, for all you folks out there who are only sort of on board with this culture shift, we see you and we know that you don’t see or feel the cause of inclusivity all the time. We also know that you are trying to understand more about the experiences of a young female surgeon or a surgeon of color, and how they differ wildly from what you “grew up” knowing. We know it is unlikely that you have ever been mistaken for a nurse or a janitor, and that we need to show you that this happens regularly. But please know that until you understand what it feels like to spend your day swatting away microaggressions, or to walk into a room full of people who look like each other and nothing like you, you will not understand why walking past rows upon rows of old white men doesn’t make everybody feel good. Nevertheless, let’s talk about why those rows do make you feel good and then let’s make room for everybody to walk forward together because there is no way forward if we are not considering all perspectives. As they say, if you want to go fast go alone, but if you want to go far go together.

Susanne Warner

Susanne Warner

Susanne Warner, MD, FACS is an Associate Professor of Surgery in the Division of Hepatobiliary and Pancreas Surgery at the Mayo Clinic in Rochester Minnesota. twitter handle @drsuswarner