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The Handshake or the Fist

      Good morning. My name is Richard Ryu, and I have the honor of presenting the Inaugural Diversity and Inclusion lecture for this year’s combined AOSSM AANA meeting. I want to thank Drs. Ciccotti, Cole, and Getelman, the Diversity Task Force led by Drs. Julie Dodds and Don Buford, as well as the leadership of both organizations for this opportunity and for their confidence.
      I have been on the podium a few times, and I will tell you that the task of putting something together on this potentially incendiary topic has been challenging but ultimately enlightening. You might be asking why I was selected to give this talk when there are so many other deserving and powerful speakers. I think of Dr. Hannafin’s implicit bias presentation or Bill Levines’ “He For She” award from the Ruth Jackson Society, and I can only hope to measure up to their standards. Please know that if I don’t include your particular diversity category in every context, it is in the interest of time rather than a lapse of conscience.
      I am not smart enough to lecture you on this complex topic with any real authority. I am not here trying to provide solutions for the deep divisions we face as a nation. I have been part of the problem. I have been guilty of passing judgment on others. I have fallen for the low hanging fruit. There is no moral high ground for me. I only ask that you listen, with an open mind, to my narrative and decide for yourself what your next steps might be.

      Background

      I am a 68-year-old private practice orthopaedic surgeon, the son of Korean immigrants who came to America for an education and after a year of mistreatment and disillusionment, decided to return but after being befriended by a sizeable Korean community in San Francisco, they elected to stay just as the Korean War broke out.
      We were eventually a family of 7, and when I was 8, we lost our home. We ended up living in and running an old motel for the next decade as we worked our way out of poverty. I cleaned bathrooms and made beds so much so that I cannot stomach the thought of doing it as an adult (just ask my family). Although there were times when the walls were closing in, my parents never gave up, always telling us that education was the surest way to defeat poverty and the ignorance that lingers with it.
      I am not sharing this with you for your sympathy or pity or to escalate my small life victories, but to let you know that as an older person of color whose gas tank is closer to empty than full, I have always found strength in facing challenges head-on, and I am asking you to join me in this effort.
      The world is pretty confusing for many of us right now. Equality versus equity, new pronouns, The MeToo movement, “woke” politics, the doubling of information every 2 to 3 years all contribute to an uncomfortable feeling. However, the power of this “internal tension” may very well be the impetus for us to take a closer look at what we want to be as individuals, as a community of like-minded surgeons and as global citizens.

      The Fist

      Is there implicit bias in our specialty? Absolutely. Are we as organizations guilty of failing to be inclusive? Yes. Historically have we neglected the power of diversity? Yes. Guilty as charged. All of us, and I am as guilty as anyone. I have managed to have my way most of the time; the college I wanted, the medical school and residency, the fellowship and the practice, a nice house and car, and successful children. I evolved as an orthopaedic surgeon, learning my craft, working with my patients, and becoming a colleague with many of you. Nearly all of you in this room represent the scenario I just laid out; top students, highly successful in your ventures and practices, and comfortable in your lifestyles; good citizens, generous and kind.
      And because of my “success,” I became “color- and gender-insensitive.” I believed that anyone willing to work hard enough would have the same opportunities and enjoy the same privileges afforded me. If you were a woman, or gay, Asian, Hispanic, Black, or Native American and you were not having the same success, it was your fault, your problem, and you simply needed to put in more effort. Success can erode one’s humanity.
      I think we now realize that the playing field was never level, that women were often relegated to second-class citizenship, that Hispanic and African American surgeons had to deal with speculation that their accomplishments were dependent on affirmative action. Women, people of color, and other underappreciated minorities were not afforded the respect they deserved. It is this pernicious mindset, based on our own personal accomplishments and success, that blinds our outlook. Defining racism through skin color is too narrow. It is not the color of your skin that makes you a racist, just as gender does not make you a misogynist; some of the most critical and cruel comments about women come from other women. What can ultimately doom us all is an unwillingness to open our hearts to a different narrative, to consider an experience that is completely different from the one we are most comfortable with, to walk in someone else’s shoes.
      We have come to understand that you don’t have to be a racist to be part of an unjust system. You only need to be ignorant. As we move to a more diverse and inclusive community, it cannot be that you in this audience will simply tolerate it or not oppose it; you must embrace it; you need to believe that as we put forward a collective effort, the next steps are good not only for the organizations but equally good for you. Can you sit by idly when the nurse calls you doctor but your female colleague by her first name only? Can you silently countenance a patient asking for a Caucasian doctor only? Will you allow a patient to comment to your colleague that his English is pretty good for a Hispanic? Perhaps for a very small percentage of us, the old ways are still tolerable, but for most of us in this room, when we look into our heart of hearts, when we think about our children and their children, we all know that we can and must do better.

      The Handshake

      I must turn my attention to those who have suffered because diversity and inclusion have yet to be fully celebrated. Do you have the right to be angry after being marginalized? Yes. Should you be discouraged by the lack of support when you needed it? Yes. Should you be vocal about the shortcomings in our profession and otherwise? Yes. My daughter is an orthopaedic surgeon, sports trained, and well educated. I am proud of her. I can guarantee you that she is not one to be overly sensitive about perceived slights, but make no mistake about it, she and others like her have been underserved by our profession, and we must do better.
      That said, I implore those of you who have been victimized by the system and did not get the residency, fellowship, or job of your choice or were treated with a lack of respect in the operating room to not use this oppression as a way forward. A New York Times editorial described the “Oppression Olympics” where those who had been failed by the system chose only to emphasize the systemic bias but not to be an integral part of the solution. If your attending surgeon criticizes you for a sloppy knot, you cannot fall back on the lazy trope of sexism, racism, or homophobia. If I dismiss a person of color from my office staff, am I a racist? A woman, am I a sexist? A gay person, am I a homophobe? Perhaps, but more likely the person was let go because of a substandard performance. Are there teachers, faculty members, colleagues, and hospital administrators and employees who are biased? Yes, they exist but the vast majority of people in this room want to do the right thing. They want you to succeed. They want to see you help others in a lifetime of doing good things. Having your teacher or colleague pull back for fear of a miscommunication or perceived unpleasant demeanor or sarcastic tone of voice is to lose that which you need the most; a guiding hand, a mentor, a difference maker, a friend. Before you decide to attribute a tough day in the operating room to racism or misogyny, please take the time to dispassionately assess the situation. Were you prepared? Did you make a mistake? Could you have been a better leader in your operating room? If the oppression is real, you have a duty to call it out, but you will only impose limits on your potential if it isn’t, and we cannot afford to lose a single member of the next generation of leaders, regardless of gender, color, or orientation and you all must represent the very best that we can aspire to.

      The Value of Diversity Versus the Value of Merit

      I am not going to inundate you with slides that validate the value of diversity in corporations, sports, classrooms, and politics. We understand that everyone has something to offer, and that we need to be welcoming yet diligent. A recent editorial in the Wall Street Journal described the collision between the value of diversity and the value of merit. In the short term there may be some element of truth to this “collision,” but as the playing field is leveled and our diversity expands, and with it, opportunities to participate, the leaders of our organizations, whether it be from the podium or the boardroom, will demonstrate that the value of merit and diversity are one and the same.

      We Will Do Better

      Darren Walker, an African American, and president of the Ford Foundation, has talked about the tough journey from generosity to justice; if you are generous in giving, it will make you feel better; however, advocating for justice is hard work. Justice and fairness are things that everyone is this room yearns for, and it is within our grasp to make it so. This room is filled with some of the smartest, kindest people I know, and I am confident that you will heed my message of self-discovery, of opening up your hearts and minds to the power of diversity in our ranks and the universal fairness inherent in including everyone who wants to be part of this incredible community. I hope that you are ready to take the next active steps on this journey, and I am excited to be taking them with you. AOSSM and AANA are leadership organizations; vanguards that will put into action the lofty goal of diversifying our membership, our leadership and cementing our strength through purposeful inclusion.
      I am honored to have been able to share this talk with you. Thank you.

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