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12. Diversity, Equity, and Inclusion: Why It Matters with Dr. Laverne Thompson
62 Plays1 year ago
How do racial and gender bias, discrimination, and microaggressions affect health outcomes? Why does it matter? Can we really make a difference?
This week, I have the pleasure of being joined by Dr. Laverne Thompson to discuss how we can all make the workplace a more inclusive space for everyone involved.
Dr. Thompson was born in Rochester, NY. She attended Allegheny College in Meadville, PA before attending medical school at Jacobs School of Medicine and Biomedical Sciences in Buffalo, NY. She went on to complete her surgical residency at the Case Western Reserve University Hospitals Program in Cleveland, OH. During residency, Dr. Thompson was able to actualize her vision of supporting diversity in medicine while creating professional cultures of understanding and support. She created the Cultural Humility Series in the Department of Surgery to teach faculty about systemic bias, healthcare disparities, and microaggressions. The series continues to review patient outcomes affected by bias and find strategies to improve the health system. Additionally, she was able to explore her passion for education and resident advocacy through multiple avenues. She has demonstrated her commitment to these endeavors through research, several leadership positions in her local GME office, and appointment as Administrative Chief Resident for her program.
Featured in this episode:
- How microaggression can build up over time for medical personnel
- How internalizing issues lead to burnout and increased employee turnover
- It’s not just about people’s “feelings”
- How to incorporate DEI principles into Morbidity and Mortality conferences
- Building systems and curriculums to educate staff on bias and microaggressions
Submit your questions on anything and everything women's health-related and we will answer them in one of our episodes.
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Transcript
Introduction and Welcome
00:00:00
Speaker
Hello and welcome back to Arvo Manadi. I am very excited to introduce you all to Dr. Laverne Thompson. She is the first physician in her family. w Nice job from Rochester School. She attended Allegheny College in Meanville,
Dr. Thompson's Background and Residency
00:00:15
Speaker
PA. She attended medical school at Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York. and then continued on to her surgical residency at Keyes Western Reserve University city Hospitals Program in Cleveland, Ohio, which is where I got to meet her.
Cultural Humility Series Creation
00:00:29
Speaker
She is a powerhouse of a person as during residency, Dr. Thompson was able to actualize her vision of supporting diversity in medicine while creating professional cultures of understanding and support. She created the Cultural Humility Series in the Department of Surgery to teach faculty about systemic bias, health care disparities, and microaggressions.
00:00:50
Speaker
The series continues to review patient outcomes affected by bias and find strategies to improve the healthcare care system. This is where, you know, we've talked so much about disparities, but Dr. Thompson is actually doing something about it, which is why we were here today. She's held several leadership positions in her local GME office and has been appointed as the administrative chief resident for her program. For those of you not in medicine listening, this is like Grey's Anatomy. This is like the top person in the class.
Dr. Thompson's Personal Interests
00:01:16
Speaker
I'm Bailey, essentially. Oh, yeah, Bailey, yes. this and totally Top the residents. And you know, usually this is given to someone who is extra responsible and does a great job. And of course, outside of the hospital, Dr. Thompson has a number of interests. She enjoys exploring new restaurants, playing board games, socializing and spending time with her cats, aptly named Laverne and Shirley, which I love.
Importance of Diversity in Medicine
00:01:41
Speaker
yeah Thank you so much, Dr. Thompson, for being with us today and so welcome. Let's just jump in. Yeah, I wanted to talk to you about, you know, why is diversity inclusion important? Why are all of these different divisions and titles and jobs actually popping up? in the last, I don't know, five to 10 years, when people are stopping and paying attention, realizing we need actual individuals who do this work to help everybody else. So talk to me about what you've been doing and why this is needed. Absolutely. So if we are going to call ourselves physicians that practice evidence based care, we have to understand that there's a significant body of evidence to suggest that people who have been minoritized, women, people who are gender diverse, they all experience the medical system very differently.
00:02:28
Speaker
And their outcomes can be markedly different from people who come from different cultural or socioeconomic backgrounds. And it's our duty as providers to make sure that we are eradicating the biases and the effects of those societal biases that are contributing to these issues. The same way that if we notice that certain group of people is getting wound infections or we need to change our workflow in post-operative care, that's the same care that we need to take care of for our minoritized patients.
Genuine vs. Performative DEI Efforts
00:02:56
Speaker
So now that there has been this body of evidence and of course the mounting social pressures from different activism movements in the United States, a lot of places are being forced into re-examining
00:03:10
Speaker
how their culture, how their practices actually combat systemic bias and if they are doing enough to make sure that they're responsible in that front. And younger workforce employees are expecting that at their employer. So you're seeing more and more of this work being done. and Unfortunately, you're seeing a lot of it being done in a performative sort of way where people just come together, they just talk about it, they check their box, they keep moving. but finding budd that is actually invested in doing the work and continual analysis of their outcomes is rare to see. So I met with Dr. Leslie DeSette. She helped develop the cultural complications curriculum out in Michigan. And I had already been brainstorming with some faculty at UH,
Residency Challenges and DEI Initiatives
00:03:53
Speaker
Dr. Stein, Dr. Steinhagen, and we thought to ourselves, we need to find a way to teach these skills to the faculty and as much as we like to think about leadership and diversity and professionalism as the soft skill so to speak, a lot of people struggle in that realm. A lot of people don't have the tool set or the understanding of these concepts in order to walk other people through it or address real change.
00:04:17
Speaker
So I met with Dr. DeSette, we talked about the goals for my own curriculum, I was able to get some mentorship from her, and we went forth to develop our own cultural humility series, as I've now called it, based on the work that they've done in Michigan. Cool. And just for everybody listening, I mean, residency is one of the most grueling times of any physician's life. I can tell you, I did not create really anything nearly as elaborate or sophisticated as this during my residency. I was just trying to survive. You know, we're working crazy hours. When we're not working, we're supposed to be studying and diving into journals or research. I mean, you have done all of that plus this. So just to kind of let people know how much work you've done, this is tremendous. And to do this while you're a resident is so admirable. So
00:05:06
Speaker
Thank you for doing this, but what I really appreciate even beyond that is that you're not just talking about it. You are looking at outcomes and making sure that we are making adjustments to have a different outcome in the future. So tell me a little bit more about, is this the review system that you're doing or what is it that you're doing to implement the
Real-World DEI Applications in Healthcare
00:05:27
Speaker
chain? Yeah. So the first step of the curriculum was we spent a year giving a series of lectures to really outline the fundamentals of systemic bias in medicine, where it comes from, etc. Different concepts within the DEI space, and how we can recognize and respond to microaggressions as they come. And, you know, different sort of more generic things about how to make the department and the system as a whole more diverse. And now that everybody sort of had that foundational knowledge, we're now applying it to our morbidity and mortality conference. And so for those who may not know, that is a conference that every department holds in order to discuss any complications that they've had, any patient deaths that they've had, and make sure that there isn't more that can be done either individually, in the broader care team, in the broader hospital system, what have you. in order to prevent other patients from having the same complication. So now we're taking those DEI fundamentals and we're applying it to an M&M format. So we discussed some cases where a patient could have had a bad outcome, may have actually had a bad outcome,
00:06:30
Speaker
and talked about what we can do systemically to change that. So we discussed the case of a nurse who was subjected to racial slurs from a patient and we are now saying to ourselves, well we claim to have a zero tolerance policy for racism, what does that actually mean? How do we hold patients accountable? And so now our administration is drafting more tangible steps for how to do that, going from just performative policies to actual policies. We have changed the workflow in our trauma base so that we can provide more trauma-informed care. care for patients who are first of all victimized by their current injury, but also may have a history of previous victimization, may have a history of physical assault. And this came up because of a case of a patient who was really disrespected in her trauma bank. And our typical protocol is whenever somebody comes in, we usually strip off all their clothes, sometimes cutting off all of their clothes.
00:07:27
Speaker
in order to make sure that we can examine them and rule out any serious injuries. And for most patients, that's you know certainly not a fun time. But for one patient in particular, it seemed to be particularly stressful. And the response from a lot of the care providers was to simply take it out on the patient, be annoyed, be more forceful. And I said to myself, what are the odds that this person has been a victim of sexual assault? What are the odds that this person who does not present with the typical gender presentation that I would expect a young lady to present with? quote unquote What are the odds that this person has been assaulted by the medical community or other communities in the past? yeah Do we need to strip off all her clothes? Do we need to ask her why she's upset? Do we need to do something else to make our patients more comfortable? We've changed our workflow in the trauma bay.
00:08:12
Speaker
We've had issues where residents have been subjected to sexism from the nursing staff and there have now been conversations with leadership in nursing and with the CMO of the hospital.
Empowering Workforce Against Discrimination
00:08:22
Speaker
So really, this has been something that looks not only in our own microcosm and our own sphere of influence and broader into the u each system to make sure that we're helping not only our patients but ourselves. You bring up a great point. I mean, we see discrimination, unfortunately. a lot, right? And in multiple different directions. Not only do we see it affecting health outcomes with biases towards race or gender, but even within the workplace, we see discrimination. And we are unfortunately in a field that really discourages people from speaking up about it. And I love that this framework that you have developed and are implementing is not just in one direction. It's not just provider to patient. It's also the entire staff and how people work together and even patient to provider, right? Like you should not tolerate racial slurs coming from a patient towards a healthcare provider. That is truly remarkable. And I think probably all of our institutions need to examine themselves because there's a lot that doesn't get discussed in everyone's experience, especially when you're in a hospital where there's a hierarchy going back to Grey's Anatomy, right? That hierarchy is real and it's historical. It comes from
00:09:34
Speaker
hundreds of years ago, and it is very pervasive in our hospital culture of, you know, who's in charge. And unfortunately, when you have a power differential, you have even more opportunities for discrimination. Overcoming that hurdle and the inertia that's generated by the hierarchy has been challenging, but certainly I make sure that our junior residents especially because they're sort of at the bottom of the totem pole if you will. yeah I really want to make sure that they know that they are empowered to talk about this. They have an ally somewhere in their community and that these things are taken seriously and while the wheels of change may spin a little bit slower than we would like certainly there's a voice there and so since starting this curriculum I've noticed that more interns look to me or look to other peers in their class to talk about these things and it's not swept under the rug we don't just go home internalize it and
00:10:23
Speaker
try to tackle things the next day because the more that we shy away from this issue, the more it contributes to physician burnout, the more it contributes to hospital staff turnover, the more people start leaving the field and not just the field of mercury, the field of medicine. So we owe it to ourselves and to our colleagues to do a better job
Addressing Pushbacks and Documenting DEI Efforts
00:10:44
Speaker
supporting one another. No, no, do you get pushback of people saying, Oh, this is just, you know, about people's feelings. And we're dealing with life and death in the hospital. Like, have you have you had people push back in that area? Sort of. And I think that in the times that people push back, it's that they just need a little bit of education.
00:11:04
Speaker
And so in the times that people think, oh, you know, this is just you talking about feelings and trying to sort of grind an axe against this service or that service or these people or those people, I just remind them that, no, this has nothing to do with me personally and everything to do with the data that comes from how many people are subjected to these incidents a year. what the outcomes are for people who have been in similar situations and the fact that there's literature behind this. This is real medicine. It's not just how do I feel. It's ah how do I defend my patients and how do I protect myself so that I can be the best practitioner I can be for them going forward. And when you frame it that way, oftentimes people are very supportive and they realize, wow, this is bigger than
00:11:49
Speaker
what I think other diversity programs tend to make it out to be. This isn't supposed to be just some kumbaya, let's all hold hands. This is about survival. This is about us being empowered to fight back against workplace violence. And all of us at the table can say that we felt that way in one regard or another. And when we find that common ground, and remember that at the end of the day, this is about the patience, people are willing to move forward. Yeah, that's great. And I'm most familiar with the obstetrics and gynecology literature where, you know, we do see really, especially racial bias affect health outcomes. I am sure there's more for gender bias as well, and all sorts of biases. And it just depends on people looking to actually do the research. And I i assume that that's in the general surgery literature as well, or you're contributing to the literature by documenting all of this.
00:12:42
Speaker
Correct. Yes. ah We haven't started a study yet because were it's such a new program. We've only had the one year of lectures and this is our first year implementing the M&M component of this, but soon coming to a journal near you. Yeah. You need to document this and publish it so that you can cite it and I can cite it for you and then the program will spread because I can guarantee you're going to find improved outcomes when people are made aware of the situation and getting their buy-in with showing the numbers. is unfortunately important when it comes to scientists and healthcare. People want to see the numbers, they want to see the data, and they're there. It's frustrating when you do DEI work and it gets held to a higher degree of scrutiny than any other form of initiatives or other clinical interventions that you may propose. But certainly a little bit of preparation goes a long way. And I'm lucky to be in a situation and in a position where there isn't anybody who's you know morally opposed to this who isn't willing to try, who isn't willing to engage. So having that underlying current of support and people who are willing to acknowledge the problem, they just need
00:13:55
Speaker
first learn how to find it. Yeah. What would you recommend for a hospital system or even just a workplace in general that may not think they have a problem or may not be aware of the problem? How would someone get started? I would have them start by sending out an anonymous survey. And it's really hard to get people to buy into that. Sometimes people doubt the anonymity of something when it's been asked of them to report anything that may ruffle some feathers or potentially lead to retribution against the person reporting. But I would start by saying, let's send out an anonymous survey, let's welcome people to share their experiences, share their stories, and you'd be surprised what's there. I think that we can all say to ourselves, there is no issue with sexism, there is no issue with racism, whatever. But it's really hard to say that there isn't. When I said, hey, I'm putting together a lecture about sexism for the next M and&M, can you guys send me some examples? And I have two full slides of lists of things that residents have experienced over the last five years. So you have to first give people a voice to say what they've experienced and make sure that they are safe when they voice it. And then there has to be transparency and effort going forward. Because it's one thing if you put people through the the emotional labor of revealing something terrible that's happened to them. If you then take those stories and you do nothing with it, it's completely insulting and it shows that you don't really care about it. So you have to be willing to actually hear them. You cannot interrogate or try to diminish the validity of those stories.
Understanding Microaggressions in Healthcare
00:15:29
Speaker
you have to do the work to investigate what happened, bring justice to the person who was victimized, and create a system that prevents this from happening going forward. That's so important. I really appreciate you saying that and honestly, corporations, hospitals, whatever workplace you might be part of really should be incentivized to do this work because it could save them a lot of money in lawsuits down the road. More and more of people are feeling empowered and realize that they should not have to stand for this or they might leave their job or or you have their job threatened, etc. The legal implications are not small. Can you tell us a little bit about microaggressions? Because I think that is something that people don't necessarily recognize. So microaggressions are any sort of comments or actions that are made either toward you or your environment.
00:16:24
Speaker
that send a signal of bias to you in some way, shape, or form, even if they are not intentional, even if they are not, you know, explicitly malignant in some way. So if somebody says, oh, you're pretty for a black girl, or they say, you know, you need to man up, we don't take that kind of girly stuff around here. if you've noticed over time that they are treating the male staff one way and the female staff another way. When the male staff are addressing the nurses or whatever staff that they're addressing, they're always referred to as doctors so and so, but the women get called by their first name or are assumed to have a different title. Yes, these sorts of things. And they can be very subtle and they can sometimes feel almost silly trying to defend it, but people have to acknowledge that if something feels like an insult,
00:17:12
Speaker
It was insulting, the end. And whether that was intentional or not, the impact remains the same. And calling those things out, being accepting when you are the person who was called out is important. Working through that area of conflict so that you can maintain a collaborative relationship going forward is so vital. People think that these sorts of comments don't mean anything, but it's kind of like death by a thousand paper cuts, as Dr. Steinhagen puts it. It's never the first patient who says, oh, hey, beautiful in the morning. It's when you've had a clinic of 20 patients and 10 of them have had something to say to you and you get to number 11 and now that's the last straw. And when women in the workplace are subjected to this kind of bias and the mental task and emotional task of dealing with that kind of insult several times a day, day in, day out,
00:18:05
Speaker
it contributes to burnout, it contributes to cynicism, it can lessen their relationships with their colleagues, their partners, it can seep into their personal life. And as I said, people are leaving the field of medicine because of this. can and I'll just give a couple examples. I had a patient whose husband asked me at the end of the visit, you know, they said, thank you for taking care of my wife. So is it miss or misses? He was asking me if I was married is what I'm asking.
00:18:39
Speaker
I was just like, I was like, what do you, who would ever say is
Reflecting on DEI Impact and Challenges
00:18:43
Speaker
it Mr? Like, I was just so shocked. I was happy that I hadn't come back because most of the time I'm just thrown off. And I'm like, yeah, would you ever ask your male doctor, are you married? Like, that's the equivalent of what you're asking. It's just the same. like On my own patients, it almost invariably, there will, every single morning, I round on them at 6 a.m., I say, hello, I'm Dr. Thompson with the surgical team. And then usually by day and three or four, they they'll say me and they'll say, oh, hey, so when do I see my doctor? Hi. It was it was me. Still. It's it's it's still me. but Yes. And if you didn't think I was the doctor, why did you let me do this whole maybe examine you, talk to you about your surgery? Exactly. how What do you think was happening here?
00:19:27
Speaker
Oh my gosh. There are things that could be even, like you said, more benign or not malignant and they just add up. like I knew a very old school male surgeon, OBGYN, who referred to all the residents as Barbie dolls and said, oh, there's a bunch of Barbie dolls over there. and you know Basically saying that they weren't tough. and They were very sensitive. yes It's the accumulation of the microaggressions, like you say, and recognizing them and how harmful they can be even when they seem small. It's so important to not let them accumulate and then become a larger problem.
00:20:00
Speaker
Anyway, there's a lot of work to be done. I'm so proud of what you have done at our hospital and so excited to see, you know, what you do next. I'm hoping that the work that you started at our hospital will continue with your department, but also spread to other departments. I think that would be amazing.
Closing and Encouragement
00:20:17
Speaker
And thank you for doing all of that work. It's so important and I know it's exhausting and you're already and doing an exhausted job as a surgical resident. Keep doing it and thank you so much for your time today. Thank you. I appreciate it.