The stereotypical orthopedic residency class looks like a construction scene from the Flintstones, a few burly white men playing with tools. I can spend time here listing off different statistics and percentages showcasing why orthopedic surgery is the least diverse specialty in medicine, but just the fact that the stereotype is what it is should be enough. With this history in mind, it was almost a shock to see AAOS president Dr. Joseph Bosco release a very eloquent statement on the murder of George Floyd at the hands of police and the ensuing protests and riots across the country (the statement can be found on the AAOS Twitter page in its entirety). The AAOS should be commended, not just for this statement, but for the efforts placed into diversifying. Multiple initiatives have been embraced to generate more minority involvement in leadership, and this was exemplified by Dr. Kristy Weber serving as the society’s first female president in 2019. Historically, medicine, including its most homogenous subspecialty, is not keen to involve itself in societal issues. Medical professionals, despite not being largely representative of the lower socioeconomic classes, generally do not discriminate between social classes, ethnicities, or sexual orientations. This does not preclude us from subconscious racial bias, though. “I don’t discriminate in my practice. I am obviously not racist. I am not a part of the problem.” This mentality is personally safe but societally useless. We treat disease, but do nothing to treat the source of the societal disparities that worsen disease. Nobody expects the medical profession to fix society’s biggest social injustices, but we can be a part of the solution through our own care for its constituents. It is clear, now more than ever, that this silence in the face of injustice is not only purposeless, but detrimental towards this goal. The statement given by the AAOS is a huge step towards ending this culture of silence and should be viewed as an example of what our profession can do to help curb systemic racism in our small niche of society. Systemic racism is a blight on our society, and our profession is not immune. While racism in medicine is not usually as overt as what was seen in Minneapolis, subconscious biases do still exist and affect our colleagues daily. We must use the momentum currently being generated in our country to address the inadequecies in our own profession. The first step is admitting that there is a problem. We need to look within our programs and practices and see that we all, regardless of skin color, have biases. This not a white male phenomenon. This is pervasive. And, while minorities are disproportionately affected by these biases, if we truly want to obtain the utopia that we seek, we all must face our own subtle biases. Once we realize that we hold biases in our subconscious, then what? How do we change ourselves to ensure that our colleagues and patients do not feel untoward discrimination by our words and actions? What is our finish line, and how do we get from start to finish? When will we be satisfied? There is no objective measure of systemic racism. There is no quota or percentage that will allow us to say, “mission accomplished!” Instead, we are left with nebulous and often intangible aspirations. A medical student, resident, fellow, or attending of any skin color, sexual orientation, or gender should never have to feel like these characteristics have caused them undue hardships. Frankly, this goal is very likely only attainable in our wildest, most socially idealized dreams. It won’t happen. As long as there are differences between us, there will be people that focus on these differences. So if our ultimate goal of ending subconscious discrimination against our patients and peers isn’t attainable, then what do we do? The answer is that there is no good answer. Nobody knows for sure how to get there or what a realistic goal should be. Encouraging minority participation in leadership is a good step but is only a part of the solution. It is clear, though, that whatever those answers are, they require us to address our own biases. We may never fully eliminate personal biases, but we can call out others’ when we see them. The culture of silence extends to our own interactions with patients and peers. People that speak up against perceived subconscious racism are often seen as being race-baiters and disruptive. Imagine being a medical student in that position. Speaking out against what you see risks your position in the match. This cannot be allowed to continue. We should be championing and encouraging people to speak up when they see discrimination or when they themselves feel it. We must hold each other accountable in order to break this cycle. The culture of silence has to end. And if you truly aren’t comfortable breaking your own silence, allow your colleagues to break theirs. Be an ear for the oppressed and allow their experiences to enrich yours. I am truly proud of our society for taking the first step towards breaking the quiet, but now is the time to continue pushing for more. If the least diverse specialty in medicine can do it, anyone can. M. Asad Khalid is an orthopedic surgeon. Source
