“How do we embrace everyone across difference?” Dr. John Stone asked the auditorium of surgical residents and faculty on the early morning of January 26. “How do we maintain high levels of both ethics and professionalism?”
Dr. Stone, MD, PhD, whose career as a cardiologist has also included acquiring a PhD in philosophy, was the featured speaker for the Department of Surgery’s Diversity Grand Rounds on January 26, 2016. As issues of diversity, inclusion, and cultural competence increasingly confront medical students, trainees, and physicians alike, Dr. Stone agreed to weigh in on these crucial issues with a morning lecture, followed by a question and answer session with residents.
Dr. Mona Fouad introduced Dr. Stone, highlighting his extensive and storied career. After earning an MD John Stone with residents 2from Johns Hopkins and his PhD in philosophy from Brown University, as well as completing his residency and fellowship, he practiced cardiology in Missoula, Montana where he co-founded the Institute of Medicine and Humanities. He subsequently served as Associate Professor with the National Center for Bioethics in Research and Health Care at Tuskegee University, where he collaborated in NIH-funded programs to address health disparities; he then moved to Creighton University Medical Center, where he co-founded and co-executive directs Creighton’s Center for Promoting Health and Health Equality.
These rich and varied experiences have given him an extensive foundation from which to speak about the values inherent in the pursuit of diversity and inclusion. “Issues of professionalism and diversity are with us every day in our work,” he told the assembled faculty and residents. “Responsiveness to patient needs supersedes self-interest. How we build relationships with patients has a lot to do with their comfort and confidence, and whether they’re likely to tell us if they have a problem.”
Stone emphasized that addressing issues of diversity and connecting with people who are unlike you is a journey, not a quick fix. In this journey, faculty support and awareness are essential. “We must ask ourselves, are we, as faculty, supporting diversity efforts, or are we, in subtle ways, putting them down?” he said.
He also suggested that perhaps the value of cultural humility should replace that of cultural competency. He emphasized that it was important to realize that there were experiences that minority colleagues had, and perspectives they had gained as a result, that were fundamentally different from those of the majority and which could only add critical texture and understanding if they were heard. In working at Tuskegee, at which most of his colleagues were African American, Stone emphasized that his colleagues would often bring up something that “I hadn’t thought of, because my background and experience was different. I appreciated how different their life experiences were – but I also appreciated how much I didn’t get it.”
Data indicates that surgery residency programs nationwide have not placed much emphasis on diversity. In order to adequately serve patients and to grow professionally, Dr. Stone emphasized that this must change. “Buy-in is critical,” he stated. “If you decide diversity is important, you will look for subtle ways to pursue diversity and enhance your learning every day. But all too often, as faculty, we don’t know how to address these issues. We need training. And all of the faculty have to support this effort.”
“UAB Surgery is committed to fostering a culture of diversity among faculty and trainees,” said said Herbert Chen, M.D., chair of the Department of Surgery and surgeon-in-chief of UAB Hospital. “As an Asian American, I’ve faced diversity issues throughout my life and agree with Dr. Stone that promoting understanding and continual learning is a necessity. The emphasis on diversity at UAB, especially the work of Dr. Fouad’s Office of Diversity and Inclusion, positions us to be a true leader in this area, which will in turn enhance our abilities as care providers, educators and researchers.”
Following the lecture, residents met with John Stone in a smaller group format for discussion. Residents expressed concerns about dealing with difficult or racist patients; they articulated concerns about knowing the best ways in which to be culturally sensitive.
In answering, Stone likened cultural humility and competence to the practice of surgery itself. “How many times do you have to do a particular operative procedure to become excellent at it? You must do it many, many times. Pursuing an understanding of diversity is like that. The work is complicated, learning is slow, and mistakes are many. But if you have a mental tag – I care about diversity, I care about working with people who aren’t like me, you will get better at it. Use collaborative leadership by joining with folks who also care.”