A White Male of the Worst Kind

“So, why are you doing this?”

It’s the usual question, combined with a skeptical look. I’m researching perceived barriers to career advancement for female academic surgeons. I’m curious, I tell them. And why shouldn’t I be? I’m going to be an academic surgeon myself. Shouldn’t I better understand the system of which I’m a part?

The problem is I’m a white man – a white man of the worse kind: educated and privileged. I’m the establishment, the status quo.

We dominate academic surgery. Surgical leadership is depressingly homogeneous. One thing I’ve learned from my time at the Kennedy School is leveraging diversity is crucial to innovation and progress in business and public policy. So in what ways am I, a white, male surgeon, going to hold surgery back? It's cause for introspection, and a question I hope to answer.

If we are going to improve the system, we must understand it first. This starts with becoming aware of the dynamics within our systems. Ask yourself, "What does my own profession look like?" There is difference everywhere. But do we see it?

Jennifer Boylan examines this beautifully in her recent New York Times piece, One Classroom, Two Genders. Boylan has the unique experience of being a college professor as both a man and a woman. For the first 12 years of her career, she was a man; for the past 13 years, she has taught as a transgender woman. She notes how her students now perceive and interact with her differently. They ascribe traditional gender traits to her; she is “safe,” inviting, and able to share feelings.

Boylan begins her piece by discussing her favorite teacher in high school, an experience we all share. She wonders if her relationship with him might have been changed in a different gender dynamic. She comes to no conclusions, but asks us to think more critically about who we are in a system. She asks us to “see” difference.

So why do I do this? I just want to be more aware. Being curious is my small way of moving surgery forward.

Mission Statement

We are four physicians committed to the core principles of integrity, compassion, empathy, humility, respect, and the delivery of holistic care. ______ is a forum in which we hope to explore and promote humanism in medicine through thoughtful written reflections, based on patient and provider experiences with health, illness, life, and death. Medicine is complex and touches all of our lives, at one point or another. It challenges us. It cures us. It fails us. Yet through careful listening, self-reflection, and narrative, we strive to acknowledge and advance the powerful role of human experience in healing.

Deep Listening

(this was a piece that I wrote that was accepted to Academic Medicine; I will post a link here when it is published)

Madison County, NC

I literally could not understand the first patient I saw in clinic. His accent was so thick I had to use every ounce of active listening power to comprehend his statements and questions. At one point, I just laughed and nodded because he did. I have been hanging out in the city way too long. A year in Boston will do that to you. Even Chapel Hill (pretty close to the dead center of the map, pictured above) is too far away.

I began my final rotation in primary care last week. After this month, I will spend four months in class and on the interview trail, then finish my MD with four straight rotations: Radiology, Nephrology, Palliative Care, and Neuro Trauma ICU. It's a busy last few months of fourth year, but the goal is to not be an idiot when I start as an intern. This month, though, I want to firm up some of my primary care skills, taking care of patients with the usual array of chronic medical problems: high blood pressure, diabetes, congestive heart failure, depression, anxiety, etc.

While I have done some chronic disease management, I have actually spent most of my time as an urgent care / emergency medicine medical student. Many of my preceptor's patients use his clinic much like I would use urgent cares and EDs. On the average day, one or two patients will roll in with a deep laceration to the leg, hand, or face, and we will just sew them up right in the office. In fact, I've done more sewing in my first two weeks here in Mars Hill than I did during my entire Pediatric Surgery clerkship. I am also sharing time with a third year Family Medicine resident, so we will sew and do procedures while our preceptor works up patients. It's a good gig and super efficient.

Originally, I thought that doing two rural rotations as part of the Asheville Longitudinal Curriculum might be a burden. But these clerkships are turning out to be some of the best hands-on experience I'm getting as a medical student. I spent my first surgical acting internship in Linville, NC, where I truly felt like an intern. I had all the responsibilities that the interns at UNC had on Pediatric Surgery (except for the fact that I could not sign my own orders, which was probably a good thing). And here in Madison County, I'm in a similar boat. See one, do one, teach one.

After finishing up clinic on Wednesday, I flew to New York City for the weekend. My friends were appalled with my "southern accent." Apparently after two weeks here (and another two months in North Carolina), I was speaking reeeeeeaaal slooooow. And yes, I say "y'all" - something I promised my sister I would never do after she came back from Furman University in South Carolina saying it. In New York City, I'm just a country boy.

Funny. Because all my friends at Carolina call me a Yankee.

#whatshouldwecallfourthyear

HOW I FEEL AFTER FINISHING MY FOURTH YEAR SUB-INTERNSHIPS...

Roadhouse.