CME OnDemand - On The Same Page: Black Fatigue: How Racism Erodes the Mind, Body, and Spirit-AOFAS on the Same Page - Black Fatigue: How Racism Erodes the Mind, Body, and Spirit by Mary-Frances Winters

AOFAS on the Same Page - Black Fatigue: How Racism Erodes the Mind, Body, and Spirit by Mary-Frances Winters

Video Transcription

On behalf of AOFAS, I want to welcome you to tonight's program, AOFAS on the same page. It will be moderated by Dr. Jacqueline Noyan from AOFAS and Dr. Heidi Brown from Black  Women Orthopedic Surgeons. You can find their full biographies and disclosures in the AOFAS On Demand Education Center.  I'd like to run through a few housekeeping items before we kick off the presentations. For technical difficulties, please try closing your browser and logging back in the same  way you did the first time. Registered attendees may earn one hour of AMA PRA Category 1 CME credit by completing the evaluation and CME claim form at the end of the webinar.  You can find the link to claim CME in the chat tab, and we will follow up with an email following the conclusion of this broadcast.  This webinar is being recorded and will be available for on-demand viewing on the On Demand Education Center content library in approximately 24 hours.  We encourage you to ask questions during the presentations. To send your question to the faculty, click on the chat tab on your navigation bar.  If you cannot get to your question during the live broadcast, the faculty will reach out following the broadcast to respond.  The 2023 AOFAS Diversity, Equity, and Inclusion Initiative is funded by the Orthopedic Foot and Ankle Foundation, supported by a grant from Stryker.  AOFAS is committed to diversity, equity, and inclusion, and will be hosting several events  this year, including hands-on bioskills workshops for medical students, and a DEI symposium at next week's AOFAS annual meeting in Louisville. We hope to see you there.  I'll now turn the program over to Dr. Nguyen. Thank you. Okay. Hello, everyone.  Welcome to our book club that we are co-hosting with the Black Women's Orthopedic Society. So just like our last book clubs, we want to keep this casual so that everyone feels  comfortable to contribute, even if you haven't read the book, it's okay. So I'll just start by saying that I really enjoyed this book, again, Black Fatigue by Mary Frances Winters.  She's written a few other books, and I thought she did a really good job of kind of giving a, I guess, a more holistic view and explaining really the experience of what it's like to  be Black in America. One of our previous book clubs, we focused more on the healthcare inequalities that Blacks experience.  And so I thought this book was good because, again, it just kind of gave a broader view on all aspects of life and how the disparities and discrimination are really everywhere.  And so I personally, when I was reading this book, I felt the fatigue. I could really feel it in my body.  I felt that's how good of a job she did at kind of explaining what it's like. So I'll just start with how she defines Black fatigue.  And she says, I define Black fatigue as repeated variations of stress that result in extreme exhaustion and cause mental, physical, and spiritual maladies that are passed down from  generation to generation. It is a deeply embedded fatigue that takes inordinate amounts of energy to overcome and  enormous amounts of faith to continue to believe we shall overcome someday. And she kind of breaks it down a little bit further by saying that, or listing four main  causes, the experience of systemic racism that's deeply entrenched, which leads to intergenerational  trauma and stresses, which then leads to health disparities that are inherited as well. And then unequal and impressive life experiences.  So I guess just from this point, another point that she brings up is she kind of went through some history and really explained that while we've made some progress, we haven't  made a lot of progress. And if you look at statistics from, again, whether it's healthcare disparities or housing  inequalities, all sorts of things, there's not been as much progress as there should be and as we would hope to see. So I guess I'll stop there for now.  Just want to see if anyone has any initial thoughts on that. Well, I think the author did a great job of kind of laying out the argument of why racism  makes Black communities sick and really tying in, looking at it from a socioeconomic standpoint,  seeing how, for example, someone's housing really determines your level of education, whether you're exposed to certain environmental factors, what healthcare you have access to.  And as you mentioned, really provides more of a holistic approach or really seeing how systemic racism impacts the health of communities of color.  And I think she laid it out in a very clear, succinct way.  I thought the book was very well done. I thought it was nice and quick.  You know, reading books like this are always so hard to do because, you know, I live them every day. And many of us that are African-American or Black live them every day.  And just to read about it sometimes just become frustrating, especially if you already knew a lot of the facts, it could be kind of redundant.  It also made me sad, not because I didn't know those facts or know about the fatigue or feel it, but because of when this was written.  When this was written in 2020, you know, it seemed like people really gave a damn, you know, like a book like this was like, I remember people clamoring to ask, you know, what  should I be reading? Oh, my goodness. I didn't know this, you know, and this book would be perfect.  But then, you know, you fast forward three years or so and, you know, there's a huge backlash against anything like this.  I mean, there's people who don't believe systemic racism even exists.  There's a guess it's going around in terms of this. I saw a stat that 60 percent of white people or something feel like that the United States is more racist towards them.  And just my overall conversations with people that used to seem like they wanted to know, it now seems like a trap.  I feel like I've been trapped, like I've written all these things. I've taken part in the diversity stuff. I really kind of broke my soul on some of the stuff.  Then it's just a backlash. So, oh, now I know it's like, I told you, I just wanted to know, you know, what you  thought. And I'm just going to swat you down a little bit harder than all these anti-woke things.  Even the tyranny of woke is bad.  So, you know, that's what was mostly about this book was that I feel like 2020 was a bait and switch, that everyone wanted somebody to do something.  And, you know, the black people and other allies around had all these things. But then I even saw a presidential candidate say that Ibrahim X.  Kennedy is a K to the K to the K, obviously that person is in a position to be first lame in the United States of America, and Ibrahim X. Kennedy was really close to that.  So, that's where this book to me was like, oh, like if you had a Good Evening's book in 2020, I would have bought copies for friends and passed it out.  But now it just reminds me of how much hasn't been accomplished and how much we look like, look like a corner was going to be turned.  But now I see why all the people that were a little bit older than me were like, yeah, OK, they weren't quite as quite as enthusiastic about what was going to happen in  2020. And it reminds me of something that is just funny in that year, 2020, I had become the, I think friend is too strong, but I would say an acquaintance of Bernice  King and I live in her dad's neighborhood and down the street from her dad's house. And the one thing that she would always tell us, because, you know, a lot of us were  running around like our hair was on fire trying to do things.  And what she would say is, you know, during the civil rights movement, you know, there's no dates, right? Like you look back like in 1968, this happened, 1958, this happened.  But it didn't just happen.  Those people were working on it for a very long time and sometimes they got tired and sometimes they got stressed out and sometimes it looked like it was going in the wrong  direction, but they just kept going forward. And so when people would come by her house, meet with her father and she was seeing  some of that and her siblings were seeing that, you know, the things that may happen in  2028, hopefully something positive will happen in this arena are not going to happen if we quit or get frustrated or find out that 2020 was really a bait and switch and that  2023, 2024 are just like these seems like this crazy time and the world's on fire. But they just kept pushing forward and we need to continue to do things like this.  So I'll pause for a minute.  I agree that, I guess, I don't know, I'm younger. So I was really hopeful around the time of 2020.  I was super excited that everyone was reading the books and wanting to just educate themselves more. And I kind of the same, you know, similar around the Me Too movement,  just for women. And yeah, I it's interesting, Gary, what you say about the older generation. So I don't really hear people talking with that interest as much as I mean,  not at all compared to 2020.  But I agree with what you're saying. I think back to the civil rights movement. I'm like, gosh, just the perseverance. I mean, it's incredible.  But I like what you what you said about how, you know, it's not one person, it's everyone. And because it is frustrating and tiring and then sometimes you just need a break and then  some other people can take over.  But that's something else I wanted to bring up, too, is what the author states, which is that we have to change our perspective in not labeling this or viewing this as Black  people's issues.  This relates to all of us and it's systemic and it's a societal issue.  And it's pretty amazing to me that there's a lot of people who who don't think that racism is a real problem.  So, I mean, it's starting there sometimes, which can be hard.  But I think, you know, it's it's really the only way I was I was really glad when I joined the committee or our committee and saw that it wasn't just minorities, that there were,  you know, white men wanting to learn and wanting to join. And that was so great. And that's really what we need is just all of us.  You know, I think that the author, as well as Gary, highlights a good point, forgetting who to attribute this quote to.  But the quote is that when you're accustomed to privilege, equality feels like oppression. And I think that's exactly where we stand, where we we as a country in  2020 really had a reckoning on racism. And I think the fact that everyone sat home and watched George Floyd get murdered was pretty jarring for most.  And actually, the Black women orthopedic surgeons was born out of watching that trauma in that there was this rebirth of interest in what is it to be an ally and what is it to  be kind of pro-Black or I want to be anti-racist. And there was a lot of kind of genuine interest in, oh, hello, can you teach me about  your history? And that was something that was pretty exhausting to at least to the women in BWOS.  And that was one of the reasons why we actually started the group, because we needed a space where we could just put all of that aside, put our Blackness aside, even put our  gender aside and just be and vent and empower one another.  And we spoke about this a little bit earlier the other day that, yes, the experience that they highlight and that Mary Frances Winters highlights in this book, of course,  it's we know that Black women die at higher rates when giving birth. We know that this lifespan of African-Americans is shorter than that of white  Americans. And when you actually control for socioeconomic class and education, really the only thing it can be attributed to is racism, not race, but racism.  And I really like how she introduced the term weathering, which has been one of my favorite terms since 2020.  I'm not sure if any of you all caught that in the book, but weathering is a term  described by Arlene DeRonomis, and the weathering hypothesis is that the cumulative stress of being exposed to racism, it does actually impact the telomeric  length and that they consider this a unit called allostatic load. So, for example, if you are constantly in a very racist environment, your cortisol levels are going to be higher.  That is an increased stressor on you. And that ages you faster than if you were a non-Black person in this environment.  And that term weathering, we had an entire workshop on that in BWOS because that is our experience in many ways, but we never had a term for it.  And I think one of the things that was very interesting is that, you know, that's not the be all and end all, meaning that, yes, this is the system that exists in our  country. Yes, this is the experience of she's describing the experience of systemic racism, but there are tools that our allies or I like to call them co-conspirators  have. And really, it is the white male and the white female that are that will help.  Kind of tear the system down to make a more equitable environment, and we know, I think it's McKinsey and Co.  that when companies and environments are more diverse, they're actually more profitable. So it's beneficial to us from a financial standpoint as well.  So that was a point I really wanted to highlight from the book weathering.  Yeah, I think I think that's so great. And yeah, I'm just going to just on exactly that topic, I'm just going to take a quote  from the book and yeah, she just says encountering racism led to higher levels of stress, which in turn caused cells to age more rapidly.  And this was seen on the on the telomeres.  And I think and then and then just that stress, yeah, accelerates aging and puts African-Americans at a greater risk for chronic diseases.  And it's just that this domino effect.  And I think that this is really important information for everyone to know, because it's, you know, perhaps for perhaps the the person who thinks racism may not exist or  that it's maybe not that big of a deal. This is not subjective. This is objective data that you really can't argue with. And it's it's down to the cellular level.  So I just really want everyone to know that it's not made up or exaggerated. It's it's so real. And it's really that's such a such a big impact.  And I also think what's interesting in this book and what she does is is kind of talk about things that many of us that are been doing this reading know, like redlining.  And I still find people that don't know what redlining is and still don't seem to understand that, you know, ghettos are created, that the problem of housing is created.  It was thought out and made and still happens today, which leads to, you know, the food deserts, which leads to more people being sick, not having the right foods.  And then the one thing I also that she puts in here about fatigue is, you know, the laziness, you know, that whole thing about black people being lazy.  And it always struck me when I was growing up, I was like, how is this a thing? Because everybody I know had at least two jobs. I'm not even a West Indian.  I'm you know, I'm I'm an African-American. I mean, you know, descendants of American slaves here.  So everybody I knew had multiple jobs and was working. But then somehow there is this laziness that was being discussed.  And I just, you know, that is something that is fatiguing as well. And you're you find yourself constantly trying to work hard to erase that when it can't  be erased. And it's just these things that happen.  And, you know, if you look at the end, she does like this almost like Nas and Nasir Jones and Lauryn Hill, if I ruled the world type, you know, list of things that, you know, if  the world were this way, this is this is how it would look. And it just seems like such fantasy, you know, at the point of where we are now and  maybe just where my my mood is in terms of where we are as a country and dealing with this stuff after kind of feeling like, you know, the rug was pulled out from under under  some of us is just it just seems like we have to keep moving forward. We have to keep working. But it seems like the proverbial two steps forward, three steps back.  But I do think it's important for us to continue to talk about this and how she talks about how it affluences children.  And I definitely remember being that kid in class that was bored, getting in trouble. And, you know, I was actually it was weird.  I was when probably my only kids that went from special ed to the gifted and talented program in six months, only because I went from a school that they thought was an  intercity school was actually kind of a quasi Catholic school.  And then I went out to a predominantly white school and they just put me in special ed for whatever reason, didn't look any test scores or anything like that.  I have a strong mother. And so, of course, my parents went like when the teacher said, oh, he's out of special ed, she almost like lost their mind.  But that's the type of thing when you tell a child that they are intelligent, they believe it. And I just was just I was like, man, this work is really simple.  So let's go bother some other people in class. Like, I mean, that's just the way it goes.  So but yeah, I think it is so important, you know, to me, this would almost be like a mandatory reading if you're going to do your residency program.  A lot of the residency programs are in cities, in inner cities where they're taking a predominant care of African-American, Hispanic and poor patients.  And to not know this and to think you're going to take care of that population.  Then they really will end up distrusting you and getting sicker.  Yeah. Yeah, Gary, there are a lot of great points there. I it's it's.  I was wondering if, you know, if anyone here had had an experience as a child with what you described with the teacher, just, you know, stereotyping, not believing or just  having lower expectations and just not believing in the potential.  And I mean, gosh, how that's damaging at any level, but especially as a child, because yeah, you're going to believe what especially you're the adults in your life are  telling you. There was one example in the book that made me really sad.  About, you know, they asked black and white kids, I think they showed them a white doll and a black doll and they just asked them, OK, who's the who's smarter?  And everyone chose the white with a white doll. And when they asked why, they just said, because she has blonde hair, because because she has blue eyes. And I mean, it's just so.  It's just so ingrained.  And so but, you know, I'm I'm glad that we're we're starting here and and starting to have these conversations. I feel like for orthopedics, it's it's a big deal.  We're starting. We got to start somewhere. So I'm wondering if if anyone else here on the call has any thoughts about what's been said or or really, you know, anything.  Well, experience wise, I recall and I was at a gifted high school here in New York where my chemistry teacher told me that my people were not made for the sciences and that we  could only be in the arts. And I mean, to her, no, not to her defense, I was a dancer at the time, but I was also a scientist. And I did not notice her say that to other people.  And, you know, I don't know where she is now, but I would love to show her that I'm an orthopedic surgeon, right? And I think that it really, what she said, kind of fueled my fire.  There's a great video of, I think it's an interview with Venus and Serena Williams and their father is in the background. And a reporter's asking like,  why do you think you could be such a great tennis player? And the father actually stops the interview and says, who are you to tell my daughters who they can and can't be?  I don't want you to even place this into their mind.  And I think it's just important to kind of keep that in perspective, that particularly African-American, black and brown communities are really bombarded  with a lot of negative imagery about ourselves, whether you're choosing a certain doll or not,  and what's beautiful and what isn't beautiful, or whether, you know, even my hair like this, I wouldn't wear my hair like this 15 years ago.  I always thought it needed to be pressed straight for me to be acceptable to the larger society, and particularly at academy meetings and things like that.  And now, you know, we have the Crown Act. So it's something that may still be frowned upon, but it's less important to me, right?  Yeah, just thought those were some important points to bring up.  Yeah, I see where, you know, I actually listened to Dr. Gorman's podcast  this weekend, it was excellent, where he has a CEO, a black CEO. And I actually didn't know that until I Googled halfway through, Rob. So he had a black CEO of a health system  in Grand Rapids, I believe. And I just, he echoed that, that professional echoed some of the things in this book about being, you know, the only black person in the room,  as well as being one of the only, you know, they were talking about their hiring practices, and I don't wanna talk too much about the podcast, it was very good.  But just that, you know, when black people saw that one black person there, it was like, well, there's pressure on the CEO to just kind of field, you know, the requests.  He was just, you know, kind of bombarded. And I think a lot, excuse me, a lot of us feel that way  when you're the only person in the room, and it really is tough.  I'm always amazed that it's kind of, I'm always happy when people go to the GLAD meeting, and go to the luncheon at the academy, and they have like the one time in orthopedics  where they may not be in the majority. And even the most comfortable people,  white people, you can see a little bit uncomfortable, and you're just like, these are your colleagues, these are orthopedic surgeons, what's making you uncomfortable here?  You could talk about anything in the world because you all have more in common than you don't. But it's just interesting, it is a very tough thing.  It's one of those things that is a weathering, aging type of thing. And that's why BWS was founded, I remember Ade saying that.  But I would encourage you as well, it's a little bit of a plug for Dr. Gorman's three-part podcast, because he really delves into some things that are laid out in this book,  and to have an actual executive, a CEO, a black CEO,  kind of breaking down these things was great.  Yeah, if you turn in, don't tune in for me, tune in for Bill Manns for sure.  I was gonna say, Rob, can you tell us where can we find that podcast? Which, where is it on?  Well, so it's on the, that's an excellent question, but I believe it is accessible through the Learning Center on the AOFAS website.  I haven't listened to it post-production,  we did it a few weeks ago and there's, and Dr. Petowitz is in the process of organizing the other two parts, basically. So, yeah, I mean, he has some very,  in the interview, again,  Bill Mann, he's been in several different health systems at various levels, and he's now the CEO of our,  the healthcare organization here in Kalamazoo. And, you know, he's had a pretty interesting journey, but all the things that Gary just touched on, the, you know, we still,  we're having some increasing representation of underrepresented people in the organization, but still the C-suite is primarily white for sure.  And probably a decent, I would, you know,  maybe higher than average percentage of women in C-suite at this point, but mostly still white.  And he had interesting perspectives on, you know, the importance of promoting diversity, why it matters. He tells, and I've heard him tell this story before,  when he first came here with his wife, and she said, all right, I need, we're going here, I need to find a new doctor and, or a new intern. And so here are my mandate is, you know,  she has to be a woman, she has to have, and she has to be black. And, you know, and how are you going to help me with that, Mr. CEO? And the reality is in our medical group,  we're very underrepresented in terms of people of color in positions of, you know, as physicians. And so, you know, he's talked about trying to make that better.  And then, and I think the author in the book has touched on a couple of times is sort of the,  the catch 22 of a underrepresented minority  who is a CEO or a leader in an organization, if you will, pursuing diversity, equity, inclusion, and if you will, having that validated, or, oh, well, there goes the black CEO  talking about diversity and nothing, you know,  how do you balance being taken, if you will, seriously and still promoting DEI issues without being looked upon as, well, the only reason we're talking about DEIs  is because the leader is an underrepresented minority. I kind of found that interesting as she touched on that in different ways. And, you know, the frustrations of hiring,  if you will, DEI officers, and giving those people an office and saying to the shareholders that this is important to us. And look, we've put someone in this position  and we care about it, and not giving them the authority and power to move through programs. I found those portions of the book fairly compelling.  I'm going to jump in and say, well, hello, everyone. Good evening. I'm Dr. Vietta Johnson. I am an orthopedic surgeon and I'm one of the early orthopedic surgeons.  I was, well, I was a member of the AOFAS, but there were too many organizations for me to join to spread out my little change to everyone.  So, but I am foot and ankle trained as well.  Did it at University of Maryland. And what I want to bring out about what you just said is that we have to be careful, and I say this because I am a black woman.  Every black, Latino, or someone who is usually put place into the diversity bucket is not, and I want to be real clear on this, they are not culturally diverse.  It should not be based on the color of your skin. It should be based on what you have shown before.  So I want to be real clear on that because that's why you have issues. It's like, oh, this black person doesn't like that person. Well, I don't like them as a person.  Okay, I don't care what color they are, okay? And in my famous statement is an ass is an ass. So if you have shown in your history that you have been in diverse situations,  led appropriately in your, whatever your role was, led equitably, then that's the person you want for DEI. Not just because they check the box. And then I always remind people  when we're talking about diversity, especially in medicine, there are groups that we consider part of diversity, but they are not underrepresented in medicine, period.  So be very careful how you label these items and issues. So I just thought that that's very important. And I understand being the one black person, everybody gravitates towards you  or they think you have an understanding, but I've also met a lot of black people usually in leadership positions who really, they don't understand. They don't understand  and they surely don't understand the underserved population. So I just wanted to bring that up and whoever wants to fire at me, feel free to do so.  Well, first of all, Ida just shared that you're one of the first 10, was it black or black women? Black women. Black women, okay. So that's amazing. And that's really incredible.  I just, I'm wondering actually,  if you've seen changes within orthopedics,  over the past few decades or not that much.  There've been a lot of changes,  but again, I have to caution.  We want changes to move the needle across the board. Don't just check the box.  I think the biggest change I've seen is absolutely in the number of women. I absolutely agree that women are better surgeons. I believe that women are better doctors. Why?  Because we sit there and take the time, even when it is in our detriment. We know we're not getting paid to sit there and do this and that and XYZ is explaining,  but it's critical to us. It is very critical to us to know that person because that's what makes the difference in caring for someone. As far as the number, the diversity,  of course, I'm thrilled with the diversity  in the black population. I haven't seen as much in the Latinx and I'm gonna stick with the four federally designated.  Especially, I have not seen the growth in indigenous people.  I will say that a lot of people who are of color, who come in under the diversity umbrella,  culturally, they wouldn't be considered a minority.  But overall, and I'm really thrilled to see how orthopedics has caught on, in whichever which way we have, to the fact that people are different. We're by far more common amongst,  more commonality amongst people than there are differences, but there are differences that should be recognized and used as a plus in knowing that instead of a minus.  And way too much of American medicine has used the differences as a minus. I mean, I work in an underserved area, probably 80, 75% of my patients, Medicaid,  20% Medicare, and then as I say,  some care and wish I had some Cade.  But I listened to my patients and what they have to offer as people and their common sense and being able to live is incredible.  So if you don't take that opportunity to talk to the gunshot victim, to ask them, hmm, okay, well, did you know the person?  It's huge when they know them versus don't know them. Everybody is not an innocent bystander. So let me tell everybody because everybody seems to be going to church at 10 p.m.  on a Saturday night, but it really does make the difference. And then you see them when you connect more as a person, because trust me, you get shot in your leg, it hurts. It hurts.  So, but I need to know, I need to know, make sure nobody's coming behind me and you're in a gang and they come to shoot me too. So that's really important.  But try and recognize I have a patient now  and I've had patients I used to know more Spanish, but does it take me more time? And it should be recognized on our schedules that it takes more time. I don't care if it's Polish.  I don't care if it's Hindi. I don't care what the other language is, but you can better believe it's two times, if not three, more time consuming.  But is it worth it to treat that patient? Yes, if we want to give them appropriate care. But your question was how medicine has changed.  So yes, interpreters are more readily available,  more women, more diversity, but I don't know if people, if they have bought into diversity, bought into diversity, because yeah, there are a lot of people  who look differently than you versus understanding that there are pearls in those people and that we would be a better America if we all tried to understand that.  A little long-winded, sorry. But that's a great point, Dr. Johnson. And I think it's one of the important things that you've said is that just because someone is Black  does not mean that they're an advocate for diversity. And you can kind of, I know, I think throughout my career and one of my biggest sponsors is a white woman.  So it's, I think it's important to understand it's, and I'm saying that to say that you do not have to be a Black person, of course, to be an advocate for Black people,  really to be anti-racist, to practice. And she really kind of talks about this a bit in the back of the book towards the end, but the steps to take are really thinking about  when I'm in this room, what voices are not here and how do I bring those voices into the table? How do we reconcile? They talk about how do you reconcile the original sin of slavery  and how, and thinking about how that manifests in our patients and how that manifests in their health.  And it can be just so complex, but even thinking about it in our stage, particularly in orthopedics is a step ahead of where we were before 2020.  It is a bit scary to think of certain states that are banning even the discussion of race and the discussion of slavery, because it really is an erasure of my people,  our people, our nation. It's part of our history and it's something that we've overcome and something that we defeated and something that we have to continue to combat.  So thank you for all those points, Dr. Johnson.  Yeah, those are definitely great points. And this book has just been so eye-opening.  Sometimes I feel like I need to have some of my certain residents read it because they can be so sheltered.  I was talking with one of my chiefs and he's like,  we're talking just about vacation, just like, where do you go on vacation? He's like, I don't go anywhere, I just stay home. I'm like, what? There's so much of the world to see.  There's so much out there to experience and get exposed to. And he's like, why would I wanna do that? And that was just like utterly terrifying that he doesn't wanna go out  and explore the rest of the world to see the cultures, to see what's different out there because it's not all about America. Yes, it's great and I love our country,  but there's just so much more that will open our eyes and see differences and just make us a better human being understanding these differences. I just think it's just so beautiful  and who wouldn't wanna experience that? And I was just like, just so mind blown. So if anybody has any ideas of how to enlighten this individual,  please let me know so I can share it with them  because I was just really sad that he doesn't wanna do that. And that he has his kids and his wife and they don't wanna expose their children to these changes of life.  What is happening that they don't wanna experience that? That's just one of my things that, like Dr. Johnson was saying, is listening to people and getting an understanding  and talking to that person. You just learn so much and really understand what that individual is going through, what is affecting their care.  You just have a whole different appreciation and understanding when you just sit down and talk to a patient for five minutes.  You might encourage that resident that first you're a scientist, okay? And scientists go into the unknown. We go into the unknown girded, but you wouldn't be a resident  and trying to figure out people's disease states if you didn't have a curiosity for things unknown. So maybe that will help them step out of their comfort zone. I like that.  Thank you.  You're welcome.  Yeah, just on that note,  I really liked the point where she said, I think this was something that the American Academy of Pediatrics has kind of recently changed, but she talked about how they're trying  to use trauma-informed care. So rather than thinking what is wrong with this person, it's reframing the question as what has happened to this person. And I think that's so important  because that really can be applied to anyone, whether it's a homeless patient or any minority or anyone who is just acting difficult.  Because I think that really is the case is that there's a lot behind that behavior.  And I mean, it's important when we think about that. I'll let Dr. Brown speak. Go ahead, Leigh Ann. Oh, no, I apologize. I'm late.  I was looking forward to this meeting and I apologize.  But what I was very curious about is because we have these conversations and it's almost polarized in how diversity is becoming now,  people are trying to block even having the conversations of diversity and to make it a metrics-driven thing, which is ultimately one of the things  we can continue to encourage with our colleagues, especially our colleagues that are trying to figure out how to be an advocate because I think the important part  is trying to figure out how, and I haven't read, but I want to. I've already ordered it. So trying to figure out how to have the uncomfortable conversations  because as the people that seem to feel persecuted in the conversations about diversity, which are not the people who are suffering the effects of the lack of diversity,  but how do we engage them actively while dealing with our own fatigue  and putting it in a way that makes them want to actively engage, make it metrics-driven, make this about humanities and patient outcomes. Like, why is it that studies are showing  that diverse physicians take care of diverse patients better? Is it because they're better? Is it just because there's a cultural understanding that is not known on the other side?  Like, it's still academic. And how do we phrase the conversation in that way to make it palatable  for the people that have to sit and listen and have to do the hard work of being the majority or being the, quote, seemingly bad person  that has been the face of all of these kind of bad things. So, you know, that's kind of the hard part because oftentimes that falls on us as minority physicians  who are already exhausted, but at the same time, you don't want to lose the people that are willing to listen and participate as well because we're all exhausted.  Yeah, she, towards the end of the book, there's a, and when you get it, you'll see, this do's and don'ts of allyship  and two or three of the things that pop out to me are do amplify online and when physically present the voices of those without your privilege, right?  So that's leveraging your access, leveraging your power, leveraging your privilege to amplify the voices of others and learning how to listen and accept criticism with grace  even if it's uncomfortable.  Even if we start at that space where we can have these uncomfortable conversations, that's where we can really start to break down some of these systems.  And of course, it's beneficial to our patients for us to be able to speak to them, to relate to them, to understand their experience.  But of course, if we had the true resolution to systemic racism, then it wouldn't exist.  I placed in the chat a book, it's a workbook  called the White Ally Toolkit.  I am not pubbing for my current husband, be very careful on my pointed words, current husband. But this is what he does.  He goes into places with different races  and helps them to understand and figure it out. It's way above my pay grade, except for how I do it on a daily basis with my patients.  But the White Ally Toolkit, and so for Dr. Brown, it would be good for you to have that because it has the steps. Because this is not for, like you said, we're tired.  First of all, we're tired of reading everything.  And we don't have time to read everything and get some sleep. But this at least has an already proven record  of how to go about that. Because banging your head on the desk, trying to say, how is it that you cannot understand? Does it work? So I suggest the White Ally Toolkit.  His name is David Campt. I put the information in the chat.  Thank you for that. Because again, the goal is progress and improvement. And we can all have our opinions about it, but the goal is to recruit more  to do the thing that we need everyone to do, which is take better care of all patients and be better allies and advocates for colleagues. And yeah, so thank you for that.  It is needed. You're welcome.  Yeah, and also, Thea, thank you for sharing that. I just, it's something that the author recommends also, what should Black people do, is reject the expectation of being a teacher.  And I hadn't thought of that actually, but when she said it and explained it, I was like, gosh, that's so true. It's not their job to teach all the White people about this.  And that's really tiring over and over again. But I think being able to point to good resources is great.  I have actually a different question for the Black women here. And I'm wondering if when you experience discrimination, can you tell if it's because you're Black  or if it's because you're a woman, or does it just seem to blend together?  Can I just jump in on this? Just a simple answer.  Years ago in the Ruth Jackson Society, someone asked me a similar question. Do you consider yourself Black first or female first?  And my real simple answer is, what do you see first?  When I walk into a room of all White women, the first thing you see is a Black woman. Black, then woman, for me. Because now that doesn't mean that I can't converse  and do everything else with White, Asian, blah, blah, blah. But what is it that you and the world see? What is your perception?  Everything is about perception, not necessarily reality. And that's why I said everybody who is diverse does not promote diversity, okay?  So that's my very simple, straightforward answer.  I mean, I think it's really that it's intersectionality. It's hard to tease one out from the other because we experience this as Black women, right?  I mean, even if we're in the Gladden Society meeting, it almost feels like a big fraternity meeting. So there are several Black women there, but it's overwhelmingly Black men.  If you go to the Ruth Jackson Society, I mean, some of our BWS members have commented that people still thought they were residents.  Someone asked two Black women that were sitting together to sit at different tables so that they could disperse. And it's just, so we, the reason, one of the reasons that BWS exists  is because there was not a space for us, narrated by us, and to empower us.  I think that, yeah, I mean, Dr. Johnson really makes a good point that it really depends on what room you walk into. But recall that even if you're a White woman,  you are carrying more privilege with you than, say, if you're a Black woman.  Yeah, that makes sense. I'm so glad that BWS exists now.  We are too. Thank you, Dr. Brown. Well, we have two Dr. Browns, but this time, thank you, Ida Brown, for coming up, letting COVID have some good outcome  in her brilliance and bringing people together. As she mentioned, I'm one of the first 10, so I didn't, you know, my whole perspective is very different. And like she said, I mean,  I was the first Black person in the day scene, period, in a residency, so good googa mooga, I was surely trained by White people. That's it, and that's okay with me  because obviously somebody advocated for me  to be able to finish. Did I have to work three times as hard? Without a doubt, without a doubt. I will never forget. They were beating me down so badly.  One other resident just stood up and sighed out. He said, just stop. You just gotta stop him. You know, there's no justifiable reason for you to keep doing this,  and he was talking about me. He was White.  So we have allies, and a lot of it might just be we need to be viewed as humans. Okay, let's be real clear. Our Constitution still says  that we are three fifths of a people, of a person.  There are some people who are hanging on to that, okay? We all know that. Let's call the politics of today the politics of today.  So depending on what you've been taught, what you have been seen, it makes everybody's reality. My reality is different than a lot of people's reality,  and their reality is different than mine. So just remember those things about Black women.  And Dr. Brown said it. So the intersectionality, we can't cut one piece off and be something else. There is no, there's no choice. But then when it's convenient,  let's be real clear, when it's convenient, and somebody can check both boxes, a woman and a minority,  but usually it's a double negative. I hate to say it, but it's a double negative.  Right, I almost think that that kind of, that twofer, I never really, I almost would think that that is some type of rumor. Like I haven't really been in rooms  where people are like, you know what, we're gonna hire, put this Black woman here because we can just check the box of woman and Black person. I just, it doesn't, I don't see the,  I see the double negative more so when I'm in a room,  especially of men, than I would hear it being like, oh, this is just, this is just so great. We just can't wait. I almost, very rarely do I hear that. So I think Dr. Johnson,  your point is well taken.  It's more of a, more of a negative, two negatives in a sense, I guess a double negative is a positive somehow, but two negatives in itself.  So I think that you're making a great point. I mean, you're just kind of schooling us here. It's great. It kind of- I think there's something else. Oops, sorry.  It kind of gives people two targets. Your color, your race, and you being a female. So that's why it can be a double negative. And yes,  I've been called up to ask to join staff somewhere. And the person told me straight out, it's because you're Black and you're female. And like, I don't want to be there.  And I didn't go.  Go ahead, Dr. Brown. I think there's something else to also take into consideration. So, you know, there is, you know, as we've said, there's no hiding.  You can't hide that you're a woman.  You can't hide that you're a minority and what you look like. There's also the human side of  always being the person that looks different in the room. Always. And it's a burden that, that's hard to describe. And that can also come off like, can you, you know,  you can be in a room with the best and the most well-intentioned people, but you're already on heightened alert because you feel different. You look different. You're ready.  You're ready to, you're ready to shine. You're ready to fight. You're hypersensitive. You've got to be hyper aware of all of your environment. And that does take a toll on a person  and sometimes can result in a negative effect  unintentionally that can be self-inflicted. So someone can come, you know, it's, you know, not to say that the criticism isn't deserved, but because it's such a sensitive area  and some places may not feel as welcomed as they may pretend that, or project that they are, it's hard to evaluate that. So is it sincere criticism? Is it real criticism?  Is it, you know, I don't like it here. I'm not really friends here. So is this really about performance? Is this about me belonging? And so that becomes the human side  of having to cope and deal with this. So even bringing up our trainees and bringing up people through a system, you can't treat them the same. You know,  it would be nice to be able to do so, but the whole social and emotional dynamic is just different because you don't know if someone's really being sincere  or if someone's going after you. And, you know, as much as we can try to pretend that, you know, oh, everybody's coming well-intentioned initially, that's not always the case.  And so, you know, if you have to evaluate every interaction you have, it is exhausting. And so, you know, in that space and that emotional energy is being used up  where it can be used in some other positive productive matter, studying, retaining information, you know, emotional development, social, you know, rest, you know, it just,  again, it's another thing that elevates your cortisol and just creates an environment that makes it a bigger challenge to succeed. So, you know, it's, you know,  not just to put it on everyone else out there, even though the responsibility is bigger, I think, for the bigger institutions, organizations, and people with power,  but also to remember that these are human beings and they're not gonna be perfect. And, you know, in those imperfections, there's sensitivities to it. Like, am I being treated fair?  Because at this point, I don't even know.  You know, Dr. Brown, there's a part in the book, I'll just read a quote from it, where it says, well, according to one study done at Ohio State University,  the self-reported status for higher socioeconomic class black people that showed that as black people climbed the socioeconomic ladder, as opposed to whites,  they reported lower kind of health quality scores. And the thought being again, with weathering that, as you ascend this ladder, as you become the one black person in the room,  that that stress, again, that weathering really does impact your health. So I think what you were describing again was weathering.  And my summary on this,  and it's very sobering. So everyone on the call, I don't want you to think I'm being out of pocket. It is stressful being black. Period. It is stressful. Whether you live or work  in an underserved area, trust me, I'll tell you how I go to my car at night. When I'm, it's gated, but I make sure that I'm closer to my car than any other human walking around  because if they can jump that fence before I get to my car, then that's a problem. That's stress being black. It's stressful being black, having to always go on and prove  and reprove and unprove and blah, blah, blah yourself because people just,  really? It's stressful being black. Like you said, because everybody needs you to do something besides your own family, et cetera. It's stressful being black.  Maybe I have to put in quote, in America. It is stressful. And so what Leah Brown said, Dr. Leah Brown said,  my fatigue level is great.  The both Dr. Browns, they always say, Dr. Johnson always talking about she's tired. I'm tired. And as she mentioned, I'm the 10th black female. So imagine how tired  I kind of am for multiplicity of reasons.  And it's not that I don't own, I don't want people to say, oh, well, she shut down. We can't use her as a resource. No, I want to be used as a resource because I have information  that no one else can give you. I have information that can help all of us be allies for each other. Okay. White women need allies. White men need allies. It doesn't matter.  We all need somebody to believe in us at some point.  Okay. And we all have bad days. And that's when really it comes to fore that hopefully someone will help gird you up. But I will tell you in no uncertain terms, some of it,  as Dr. Leah Brown said, unintentional, but we have to go in without armor intact because we don't know what's going to come at us. And so we have to be prepared,  which is a whole nother level of cortisol rising and stress. And as I used to tell all my friends, everybody else was not in medicine. And when my back hurt,  my this, I said, it's stress.  And then I used to end by saying, you know, stress can kill you.  Ta-da.  You know, there's this book called, Rest is Resistance. And I've been pushing it forever in our BWS group,  but it's a good counter to, yes, there's stress, but I don't want people to leave this conversation thinking this like fatalistic outcome, that there are things and evidence  that shows how do we counter that? So it's by creating less stressful environments. I know that sounds really simple, but for some of our colleagues,  it means, you know, sitting down and talking to that patient and maybe viewing their complaint with a more culturally sensitive lens.  As a woman of color, as Afro-Latina, particularly this book, Rest is Resistance, was pretty revolutionary because she talks about how the author, Tricia Hersey, who's a bishop,  she talks about how naps are revolutionary. And Jacqueline and I spoke about this the other day, that naps are necessary because they're restorative. And that so much of,  and I think we see this throughout our field. You don't have to be a black woman. We, as orthopedic surgeons, are very, very hardworking people. We have a higher suicide rate  that we have to all be okay with just sometimes taking a rest. And that rest allows us to kind of open up. And of course, you know, she's a more creative person,  but she calls it the dream space. That with rest and with decreasing that stress that we begin to unleash an inordinate amount of creativity and freedom and can start to restore  and decrease that cortisol level that we're always struggling with. And of course, mindfulness and yoga and meditation and whatever it is that you do to bring joy  and to relieve stress is something that has to always be incorporated into your weekly practices.  And it's hard to do when you're trying, when you have to work three times harder to get to the same point. So that's why I say, I mean,  I am still learning how to focus on giving myself something.  Ta-da! I finished residency in 1993. It's 2023, I think. That house dress, I don't even know what year it is. But it really, and to be a good orthopod,  black, white, pink, green, et cetera, it doesn't matter.  Being able to focus and be creative, because I stopped myself the other day, I said, oh, I really like to do X, Y, Z, and I'm actually good at that.  You know, time, 24 hours in a day, and now I tend to try and get some more rest. So I suggest that everybody earlier than later,  don't wait till you're 30 years into after residency, okay? To start putting yourself on the top of the heap of the things that you have to do.  You just have to step back and say that I'm worth it, so you can be here for the long run.  So does anybody, you know, anybody have any advice to forward?  In educating those, not the 10% that you're never gonna change, but those that kind of read or hear the,  you know, the world is so racist against white people stuff, but kind of know that's not true, but want to be an ally, but are kind of on a,  kind of on, I guess, a fence of sorts. There's so many messages. 2020, when this book came out, was just, you know, like a high watermark for people wanting to learn.  But now there's so many different types of information, and people seem to conflate information.  Anything can be gleaned from any of y'all personal experiences.  Hey, Gary, I'll comment. It's Dave Thorson. I'll speak as,  and next week I'll become the president-elect of the Foot and Ankle Society, and this is a topic, and Mike Aaron will be president starting next week,  and it's a very important topic, and it's always, honestly, it's uncomfortable for me to listen to these conversations, because I hear about the stress and the fatigue,  and I have never experienced that a day in my life. I mean, I'm a male white orthopedic surgeon. You know, I don't get that, and it's just so hard for me.  It's almost embarrassing for me, because whereas I absolutely don't ever overtly do anything, and I do my best to be aware of all this, it's hard.  My daughter, probably five years ago or whenever it was, gave me the book, White Fragility, and I read that and said, holy cow. I mean, yeah, I am privileged. I didn't think I was,  I thought I was privileged because I had a good job and all that, but you know, my whole life, I've never had to deal with the issues that keep coming up in these conversations,  and so I have a very open mind. I'm on the DEI committee for my department. I've got two underrepresented, you know, mentees that I, you know, in my department,  but the problem is, it is, I mean, I hate to be pessimistic, but when you have whole states like Florida and Texas, and I don't want to get into this big political conversation,  but when there's a lot of people that believe there's a problem that doesn't exist, it was alluded to earlier, or that we shouldn't even mention this stuff,  what do we do? We write off those states, and there are, honestly, I'd say the majority of white people would say, well, they're not racist. They're not privileged.  You know, nobody ever gave them anything. They worked for everything, but they don't realize the fact that we haven't had to work with this underlying,  you know, problem that underrepresented minorities do have to do, and other than, you know, educating people, but I think, and you're right,  in 2020, when Black Lives Matter really took off,  when Floyd was killed, and all these heinous things that happened, it was put in people's minds, but I don't, it's hard for me. I guess what I'm, my whole preamble there is to say,  what can we do? And granted, we're only a small microcosm of the world, you know, AOFAS, but what can we do, other than being supportive of the DEI committee, et cetera,  to try to help? I mean, I'd love to do whatever I can to help. I try to do what I can, you know, locally at my own hospital and all that,  but what, are there things that we aren't doing as a society, you know, that where we can, you know, the foot and ankle society, forget American society. I don't even go there,  but what we can do that might be helpful, because here in Utah, what can we do? What can we do? Because I, Mike, in particular, as president starting next week,  and me the following year, you know, we're in a position where we can influence things, so what can we do?  To me, you started it. The fact that you're on this call,  you're open, you read White Fragility.  It's hard when somebody is literally, it's like,  one of the greatest songs ever is Michael Jackson's Man in the Mirror, when you listen to the lyrics.  Since you're starting with the Man in the Mirror,  you, hopefully you will continue to turn the mirror on other people. As far as from my point of view, especially since I was AOFAS, and like I said, my money ran out.  You have to be in the black society, you have to be in the AMA, you have to be in the local society, you have to be in the women's society.  I'm like, look, my little coins have run out, okay? So my subspecialty that I trained for, I was like, well, it will have to go to the wayside  as far as my continued membership, but I will always proudly say that I'm foot and ankle train.  But from my point of view, having like real conversations like this, especially when we get in the space of being around people, that three dimensionality of being around people  makes a difference. Having events where people can actually feel comfortable, not easy.  Having one-on-one, I spoke to a rep today, which was really weird. I've seen her for years  and just today I had time to talk to her and it was mind-blowing what I learned about her and  what she learned about me in just that half an hour. So it takes time. It takes time and people have to be willing to give the time. And congratulations on being the next president.  That's Mike, I'm president-elect.  Yeah, I think it's great that you're having the conversation. The fact that you even read white fragility is a victory. And I think as much as we would all like a perfect solution,  because we're scientists and we're surgeons and we're OCD and type A and we want results and  we're metrics driven, but this is the humanities part of what we do and it's going to take time.  And I think just encouraging other people to listen and open their minds is a big step.  Encouraging people to have the conversation is a big step. And I think the biggest way to try to  continue our progress is to figure out a way in which people are willing to listen  without feeling demonized and be open to hearing a different perspective and considering the  different perspective. I mean, we're not talking about immediately going and making half of the  staff or half of executive leadership look a certain way, but even just introducing to people,  hey, let's just have the uncomfortable conversation and open your mind to hear and listen and to be uncomfortable. I think one of the things that as an underrepresented minority  or essentially any minority, but especially an underrepresented minority, is that we have  had to get comfortable being uncomfortable. And I think that for a population that is not used to  having to consider their discomfort is encouraging them to be uncomfortable for just a little bit to do some self-reflection.  I'll do my best.  Yeah, I think that's great, Dr. Brown. I think what you said is we are comfortable being uncomfortable and people putting themselves out there to be  uncomfortable to kind of get an idea of what it's like to be in our shoes definitely makes a difference. My chairman, he is a huge advocate for everything, trying to diversify  orthopedics. And he's like, oh, you know what? I'm going to be a white male and go to the  Ruth Jackson Society meeting. And he was like, the first time I went into there, he was like, oh my  gosh, I felt so uncomfortable. He's like, this is what it's like for them to be in their shoes as women. And he was like, he actually said to our department, he's like, I encourage  everybody to go experience being uncomfortable so that you have a better understanding of what  it's like for your co-residents, your faculty members, your patients, because it is enlightening  and something he had never experienced. So it definitely was eye-opening for me for him to recognize and appreciate the uncomfortableness that he experienced during just attending a  meeting of women orthopedic surgeons. I truly believe it's that first step is just recognizing that you have privilege. And then it's incredibly brave to be vulnerable and say,  I'm uncomfortable. That allows us to have an honest discussion. That allows us to start to  examine and dissect what makes this uncomfortable for you. Let's flip this and feel how is that for  me. And also, once you're seeing that level of privilege that you hold, you've already talked  about being an advocate for others. You have two underrepresented minority mentees. It's the  awareness of being different and privileged and then leveraging that power is very important. Even if 20% of orthopedic surgeons did that, I think it would be very significant,  especially in the experience of our residents who we know have a dismissal rate, Black residents, and also in decreasing the stress level of the rest of us.  All great suggestions. I'll just add one other thing. We've talked about this in our committee,  and Gary was the one who originally brought this up, so maybe he can really talk more about this.  But just making it more known to, I guess, the AOFAS members who may be interested in leadership positions, what is the pathway and what does it take or what are the steps to become  president-elect or to be anywhere on that leadership position?  Because maybe reaching out to some of our societies like GLAAD and RBWS, because maybe somebody in those societies wants to be ultimately in that role but just doesn't really  know how to get there. Because when we spoke about this in our committee, it made me realize, oh yeah, how do you get to that point? I'm actually not sure.  It's interesting you should ask that. One of the things we're trying to do on the board right now  is actually create a framework, almost like a point scoring system for considering people.  For instance, this year is the secretary spot that becomes open. But anyhow, to get in the  presidential line, to become a member at large, to become a member of the foundation board,  those are kind of the board positions that you can have. We're actually trying to create a  framework in DEI, both being an underrepresented minority and very importantly, having participated  in DEI activities. For instance, being on the committee are things that those are positive for  the whole process. It won't end up being a rigid thing because we want some flexibility  to not make it mandatory. But back in the olden days, it used to just be a smoke-filled room, literally. The past president led the nominating committee, and he had a slate of  characters. Almost invariably, it was the nominating committee's rubber stamp who it was.  Now, you submit your CV, you write a statement. There's now actually mandatory interviews for the  applicants for the positions. Then we'll try to score it. Then when the nominating committee actually votes, it's chaired by the past president. There are four other members of the  nominating committee. The votes are anonymous. One heavy hitter can't control the process  because if somebody's not agreeing or two people aren't agreeing with what he or she might be saying, they won't know who are the other four committee members it is that's saying,  well, I don't want your person. We're trying to make it more that way. I don't know if Elaine  wants to comment. I know Elaine's going to call it. I think we'll probably try to make it  publicly available. It should be out there. We need transparency for the selection process.  But we're very interested in getting more women and underrepresented minorities in the leadership  position because it ain't going to change until that happens, until somebody of a given  color or creed or sex see somebody like them in that position. They probably want to entertain  the thought of everyone aspiring to do that because if it's just the old white boys club,  then I understand not even bothering trying. We're going to try to make that a lot more transparent. Actually, there will be essentially a scoring system for it.  I just wanted to add a few things to that, like Dave said. Now 60% of the committee is elected by the membership. So the membership controls who's going to be selected. I think  the last couple of years we've been getting more diversity at the member at large position  because that's kind of one of the prerequisites for being on the presidential line is you need to be on the board first or the foundation board. I think we're getting that pull.  As Dave said, adding interviews so people get to know you. If there's no interviews, you're  biased on what you've heard of people. Interviews give people the chance to show who they are and  why they're qualified. Probably the most important thing is just for applicants not to be discouraged  or afraid to apply. You don't try, you don't succeed. The plan is not to pick the top seven  people next year. The goal is to have the best leadership for the next 50 years. So we need  people all the way. I would just encourage anybody on this call who's interested to apply.  And if you don't get picked the first time, find out what you need to work on and keep working on  it and you'll get there. So just to make a quick comment on that, having served on the board,  the foundation board and the nominating committee, there's still a mantra of what has this person  done before? We don't know that much about them. They haven't, where have they served? And I think  that when you're somebody who feels uncomfortable in the room, everything that's just been talked  about for the last 45 minutes, to put yourself out there to be in a committee, when you're not  picked to be on the podium, there's no, it's just this never ending cycle of not getting picked.  And so the criteria for getting picked by nominated or picked for a board position or  even a committee position needs to be really well thought out and rethought. It can't be based on  all this past performance, right? If you've never had the opportunity to serve, how do you serve?  If somebody says, well, I've never seen that person before. Well, maybe you've never asked them. And so giving, asking people, reaching out, I think is a better way of bringing more  people in than just saying, well, you know, apply to the position you try. I think it's, I think that's important to encourage people to try it, but also reaching out to people and  giving them the opportunity, putting the opportunity in their hands to show what they can do.  Yeah, no, I agree that you want to encourage people. The only problem with like reaching out  to people is sometimes there's an expectation that if you reach out to somebody, they'll be chosen.  And if they're not chosen, instead of, you know, keeping and trying, sometimes they get discouraged,  which has been part of the, you know, the, you know, the complaints that have been heard in this process. So, you know, I think, you know, the past accomplishments and what you've  done is probably more important for the presidential line of people, the members of large positions, particularly the two positions that will now be for people under 45 or under  eight years in practice, you know, that's more based upon interest and potential and stuff like  that. But I think what she just said is a great point, because if you're not on the podium  and when everyone, if 50% of the membership, I mean, if 50% of the leadership positions are voted on by the membership, if you're not the one presenting at the meetings,  if you're just there, you could have attended all of the meetings, but no one really knows you.  So I think that, and I don't have an answer at the moment on how to broaden that, but  that is, that's huge, because people, what have you done? You've done a lot in your world, but maybe not that everyone considered to be podium worthy or publication worthy,  because that's the other one for us. So that's something to give thought to in the future.  That's 100% exactly my point. If you're working in a private practice in a community where you  don't have residents and you still do a ton of surgery, and you're an innovator in your own  world, you know, your own community, which is probably a larger community, and you've done a  lot of things, you may be completely missed or passed over, despite the fact that you've had  incredible leadership at different levels, just not on the podium or, you know, at the AOFAS.  So I agree with you, and there's got to be a better way about identifying those people. And  again, to me, it's just giving people the opportunity. Yeah, I would say that, particularly  like last year, Casey Humbert and Dan Guss made a big effort to try to get new people on the podium. And I think that has continued on this year and will continue on next year,  because giving people the opportunity to speak, and also for the audience, it's kind of good not  to hear the same speakers every year. So I think we're making an effort to try to do that. I also  think that, you know, the board is, we're trying to be, you know, complete in expertise in all  areas. So we're not just looking for the, you know, the seven people with the most publications,  we're looking at people who have strength in communication and humanitarianism, you know,  in finance and advocacy. And so, you know, if you're somebody who hasn't written a single paper,  and, but has done a lot of good work in the community and that kind of stuff, you're still  going to be considered strongly, because we're looking for, you know, our mission is not just  research, it's education, it's, you know, working with other people, other parts of the world,  patients and physicians. So I think we're looking for kind of a diverse board, you know, I'm not just in, you know, race, sex, sexual orientation, but also in skill set,  experiences, you know, and goals.  I thank you for that, because that's interesting. So I will, I will kind of secretly divulge,  I'm not a foot and ankle surgeon, but, or part of the society, but I'm, I'm a sports surgeon,  and I have been privileged, and, you know, great, like, like, and I've had great mentors,  and they're, you know, I've been lucky enough to have been given opportunities, just as you said,  is it do you go by Michael, Michael, I'm not sure, but by, but that Micah said, that,  you know, I didn't have a ton of publications for a lot of the reasons that we discussed,  but started getting invited to the podium and, and, and able to fully participate in the society.  And it has completely changed my whole perspective on the society. And I'm just giving my personal  story. It's been across the board, I think, and, and I, and I'm sure that the sports society is  not the only one, but it was, it was kind of the same thing. It was at first an initial invitation  to, to kind of speak, knowing that they just were looking for some different panels, and then it was  advisory. And so I put out the question that, you know, do all the society leaderships  meet or discuss and talk about things that have been successful for each society versus not  successful, because that may be a benefit. There are a lot of reasons that people may not have  publications, or people may not have those things, because these same people that you may want to  try to push up in the forefront are bogged down by being mentors. Like, and, and that was one of  the stresses that I had, or, and that a lot of us have as underrepresented minorities, is that  we feel it is our job to uplift the students and, and represent the students. So we do a lot of work  that may not be recognized on a CV by mentoring students and doing all these advocacy talks and,  you know, kind of doing this work that may not be easy, but is not, you know, on the CV may not  have as much weight as me doing, you know, a research project that, like, really, I didn't  have much involvement in. But literally, I am pulling people up with me as I climb. And, and,  and that's hard work. And, you know, kind of acknowledging that, and using that as something  that is meaningful, important, and then seeing it, you know, portrayed in a meeting, you know,  that that's what underrepresented populations have had to do is that, you know, you know, not to say  that people aren't looking, you know, people who are not underrepresented are not mentoring us,  because I absolutely wouldn't be where I am if I didn't have those. But, you know, we're carrying a  lot of different weight. And, you know, sometimes, you know, I, you know, I was a private practice,  because I had to be private practice, I didn't have an academic machine, I couldn't put out papers.  But, you know, mentoring 15 and 20 students, like literally, you know, you're the, you're the black  woman, you're the, you know, underrepresented minority in an area, and literally trying to mentor 20 students. And that was finally recognized. And, you know, got an invitation  to have that discussion. So that long winded response to is, are those things considered when you're talking about leadership skills, and, you know, putting people in the forefront,  and putting them in, you know, lecture and presentations, or even having that discussion  as maybe even a separate ICL to, to start inviting people to meetings to have these discussions?  Yeah, I think that's the, that's the goal. I've been on the nominating committee for the AFIS,  and also for the, for the BOS. And I was on the BOS nominating committee, the person who was  probably last on our list based on CVs was the person we chose after interviews,  because the interviews, you know, gave that person a chance to, you know, basically, you know, state  their vision, you know, their experiences and see what they're like. And so, like David said, you  know, this year, we're starting interviews as part of the process. And we're going to kind of,  and we're looking at a whole bunch of factors. And again, it's a work in progress. But our goal  is to try to have the best, you know, board we can, not just presidential line, but members at  large. And the way you do that is you increase your, your applicant pool to the, you know,  to all society, and you give the, you know, the people who have unrecognized skills that are  useful, you know, the opportunity to demonstrate them and to succeed, hopefully. So that's our  goal, where, you know, we're not 100% there yet. And we'll see how things go the next few years.  But that's what we're trying to do. You know, looking for educational leaders and everything else. So I appreciate your bringing your perspective from sports to this.  I have to say, I hope and I heard it mentioned that you were looking for people for 45 and under, I would hope that you are not just looking for people 45 and under.  No, no, the the members at large, there's now going to be five of the five positions  to are going to be reserved for people who are 45 years and under or eight, or under eight years in  practice. And that's to give, you know, opportunity to people, but also, you know, we want, you know,  the perspective of our of our younger members and the issues they're dealing with, you know,  as part of our board discussions. So, you know, age is another, you know, type of diversity. And so that still leaves, you know, three mal spots for, for people older than that.  And all the presidential line spots. So good to know.  Well, this has been such a great discussion. I know it's getting late, especially everyone on  the East Coast. So I think we'll probably end it here. But I just really want to thank everyone for coming tonight. And for everyone's contributions. It's really been wonderful.  And Dr. Brown, did you want to add anything?  Just the same. Thank you. This was a very robust discussion. Thank you to the BWS members who popped  in to this wonderful book club, and look forward to more collaboration in the future.

Video Summary

Summary 1: The video features a discussion among medical professionals about the importance of diversity, equity, and inclusion in healthcare. They discuss the impact of systemic racism on various aspects of life and emphasize the need for change and understanding. The conversation highlights the importance of recognizing and addressing racism as a societal issue and touches on topics such as housing inequalities, educational disparities, and the fatigue experienced by black individuals due to racism. Participants share personal experiences and emphasize the positive effects of diversity in medicine. The discussion concludes with a call for continued efforts to promote diversity, equity, and inclusion in healthcare and society.<br /><br />Summary 2: The video transcript showcases a discussion about being a white ally and supporting underrepresented minorities in orthopedic surgery. The participants discuss the stress and fatigue experienced by black women in the field and the importance of allies stepping up to support them. They recommend resources like the White Ally Toolkit and emphasize the need for understanding the intersectionality of race and gender. The discussion addresses challenges faced by black women, the need for self-care and rest, and the importance of diverse leadership. They discuss ways to improve diversity within leadership positions and stress the importance of uncomfortable conversations and open-mindedness. The participants promote awareness, understanding, and action to create a more diverse and inclusive environment in orthopedic surgery.

Asset Subtitle

AOFAS On The Same Page: Black Fatigue
Presented in collaboration with Black Women Orthopaedic Surgeons
Moderators: Jacqueline Nguyen, MD, and Haydee Brown, MD

Join AOFAS for a discussion of Mary Frances-Winters’ book Black Fatigue: How Racism Erodes the Mind, Body, and Spirit (2020). This is the first book to define and explore Black fatigue, and the intergenerational impact of systemic racism on the physical and psychological health of Black people. Mary-Frances Winters describes how in every aspect of life—from economics to education, work, criminal justice, and, very importantly, health outcomes—for the most part, the trajectory for Black people is not improving. This is a vital resource for Black and non-Black people who are looking for ways to heal, learn, and have productive and supportive conversations about racial injustice and trauma. Attendees discuss how systemic racism affects our Black patients and ways to provide compassionate care. While the book will be the starting point for the discussion, you do not need to read the book to enjoy the conversation.

At the conclusion of this webinar, you will be able to:

Discuss the intergenerational impact of systemic racism on the physical and psychological health of the Black community.
Identify some of our own biases when treating these patients.
Identify common barriers to equitable access to healthcare.
Consider the changes we can make as healthcare providers to provide more inclusive and compassionate care.

Meta Tag

Content Type Webinar Recording

Year Published 2023

Keywords

diversity

equity

inclusion

healthcare

systemic racism

change

understanding

housing inequalities

educational disparities

fatigue

black individuals

medicine

efforts