Professor Augustus “Gus” White III didn’t just pioneer the understanding of unconscious bias through research methodology during his illustrious career as an orthopedic surgeon. The author of “Overcoming” & “Seeing Patients” has also spent a lifetime fostering a culture of diversity and inclusion wherever he has worked, often by emphasizing our common humanity – his use of the term “fellow humans” to start speeches has become legendary. In today’s discussion he shares the origin of that phrase, explores some of the themes around structural racism, sexism and -isms in medicine, and explains why embracing diversity and inclusion is part of the solution. Featuring podcast host Dr. Bonnie Mason Simpson. This is a replay of an early podcast from the series, now re-released to a wider audience.
Dr. Mason: I am Dr. Bonnie Simpson Mason, Orthopedic Surgeon, and Executive Director and founder of Nth Dimensions and today I am discussing health disparities and racism with the illustrious Dr. Augustus A. White III, who is the Ellen and Melvin Gordon Distinguished Professor of Medical Education and Professor of Orthopedics, along with the Emeritus Orthopedic Surgeon in Chief at Beth Israel Deaconess Medical Center and Harvard Medical School. Welcome Dr. White to the podcast.
Dr. White: Very happy to be here.
Dr. Mason: Wonderful. We are excited about the topics that we’re going to contemplate today. I’m looking forward to hearing your answers and your input, insight and wisdom around some of the things that we should think about when we’re discussing health disparities, with the overlying context of racism. You know, what are some of the initial thoughts that you have, that our younger generation should be thinking about when it comes to either the context of racism and health disparities or where should we start?
Dr. White: Well, that certainly is a good and important question. And one thing that comes to mind is the following quotation, “We hold these truths to be self-evident, that all men and (edit) women are created equal and endowed by their rights and certain rights of life, liberty, and the pursuit of happiness”. This in my way of thinking healthcare includes happiness, includes the pursuit of happiness. And I think that it is a human right, certainly a of our citizens here as suggested by this quote from the Declaration of Independence, but all humans deserve healthcare as a human right in my opinion. We are a healthy, humane society. And I think that the irony and the impact of this is contrasted by the famous quote of Dr. Martin Luther King, who says, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” And this just accentuates the power of this and the inhumanity. And do we live in a society where our common humanity is cherished and protected for all of our people or do, we live in a sense finally, by the laws of the jungle. And that is if you happen to be adequately, successful financially and you have adequate connections, you end up with one level of healthcare and if you happen to be in one of all too many minority groups, which we will talk about, and you may not have health wealth or at least wealth in order to provide health, you may end up with an inferior quality of care or in some special situations, no care at all, and non-survival, death if you will, as a result of healthcare disparities in our country today on a day-to-day basis. So, sadly I must respectfully make this assertion and I don’t think we can say enough about it. And I think we have a long way to go, and I think people are working as many are in this organization that I happen to have the privilege of working in the Movement is Life. And we want to see justice in healthcare.
Dr. Mason: Absolutely. You know I appreciate your perspective having spanned many decades at this point, serving in healthcare, in orthopedic surgery, but also for the greater good and I really admire the introduction to your book called, “Seeing Patients: Unconscious Bias in Healthcare”. And I read the introduction, and I must say that wasn’t able to get much further than that because I was really moved by your approach in addressing healthcare disparities to the group of the American Academy of Orthopedic Surgery members that you referenced. But I think speaking to the humanity, which is the approach you use in that address, you know you opened with, and you always open your addresses with ‘my fellow humans’. How does that work to almost disarm or address the fact that you’re about to say a few statements that may be a little tough for some folks to swallow. But as we talk about racism, we know very well that we have to start having the conversation. So, how have you been able to address successfully or otherwise your thoughts on racism as you did in this particular address, and what advice would you have for us younger people who see racism, face racism, are conducting and providing healthcare in a society that has yet to address it, openly.
Dr. White: Well, I make sure I get back to that question, but let me first respond a little bit to your comment about the introduction of our book.
Dr. Mason: Yes.
Dr. White: I had the pleasure and the privilege of knowing Dr. Montague Cobb, and speaking of racism, it’s kind of a reflection of the opposite of racism, in that I was the first African American student to attend Stanford Medical School and the only African American student in Stanford Medical School for a period of time. And this may be an example of kind of, I’m going to say reverse racism, but what happened was I got to know one of the professors quite well in Stanford. His name was Dr. Walter Greulich, he was a German, distinguished German professor who came to Stanford as a professor there and he must’ve noticed, well, here’s this young African American guy and no African Americans, anywhere. So, anyway, he said, please if you ever have a chance, look up Dr. Montague Cobb.
Dr. Mason: Yes.
Dr. White: And tell him that I’m a friend, his friend, Dr. Gruelich told you to look him up to seek him out. And so, please do that. Well, to make a long story short, I did do that, and I did call Dr. Cobb. I happened to be in Washington, DC. I did call him up and explained the reason I was calling, and he said, well, can you meet me at the Cosmos Club tomorrow for lunch? Well, the Cosmos Cub is an elite club in Washington, DC, extremely elite. Anyway, he welcomed me, and I had the privilege of knowing him over my professional life and his, and I invited him to Yale when I was on the faculty there and I’ve invited him to Harvard when I was on the faculty there, with the explicit purpose of, I knew what a great speaker he was, explicit purpose of actually inspiring the African American medical students at Harvard and at Yale. At this time, we had more students of course in, and also that was one purpose. The other purpose was frankly to show him off to my white professors, because he was such a wonderful orator and such a wonderful speaker. So, a very long introduction to your question, and he introduced his talk by ‘my fellow humans’. And after having heard that every talk I’ve ever given, I always addressed it with my fellow humans. And it’s, you know our DNA is 95.5 plus percent identical, no matter what our color skin is, where we’re from, or where we are, our common humanity begins there, you know.
Dr. Mason: Right, right.
Dr. White: And it certainly exists in much of my other experience in life, everything from Vietnam combat surgeon to in the streets, racism to all kinds of forms of this. But the prevailing hope, I think the prevailing dream, the prevailing reality is that we are fellow humans. And I think it’s something that’s been recognized by Dalai Lama and Bishop Tutu and others, but it’s a way of saying it should be a starting point for resolving our differences and making better progress as human beings. So, I have digressed considerably would you refocus me.
Dr. Mason: Well, no that’s quite alright because I think, I really appreciate you capturing that particular point of history in tying your evolution as a surgeon and as a scientist to that of Dr. Montague Cobb, who was a distinguished scientist and surgeon at Howard University. I mean, we owe so much to him and his dedication to science. So, us even bringing that, you bringing that to the forefront, so that those listening could see the ties of excellence that stem long before now. And so, just for you to bring him up, as I’m a proud Howard grad, third generation Howard University graduate, I really appreciate that as well. So, you actually did address part of my statement and how do we as the younger generations address, discuss and even broach the subject of racism, especially in healthcare as we see certain disparities continuing to be perpetuated. And even as I was just in Winston-Salem earlier this week, speaking at Wake Forest University, doing this very same thing, addressing diversity and inclusion, unconscious bias and disparities with an all-white department of Orthopedic Surgery, knowing full well who my audience was going to be ahead of time. I think I probably borrowed from your playbook, but I would like to hear your advice and wisdom on how we can broach this very important and necessary subject that, you know if we don’t address it, it won’t change.
Dr. White: Yes. Yes. Well, I’m happy to share my thoughts and ideas about that. I think there, you mentioned diversity. I think diversity and inclusion is a very important reality ideal to address. It has numerous values for institutions, for people who are involved and for making progress in the direction of beginning to eliminate and adjust and correct for and protect our humanity and as well as our ethnic citizenship, if you will.
Dr. Mason: Sure.
Dr. White: And so, I think that it’s a very important ideal, and there are lots of things to know about it, to learn about it. I have a couple of authors, a couple of books that I would, would recommend in that regard.
Dr. Mason: Okay.
Dr. White: And one book describes very nicely, the fact that organizations and places of business that have diversity do better.
Dr. Mason: Okay.
Dr. White: So please, to answer your question to make a contribution to ways to achieve equitable healthcare, I’m suggesting that diversity and inclusion are very good steps along the way and very good principles to address, very important. And there happened to be, I mean there are many references, but there happen to be two books that I think are excellent in supporting this. One is by Joanne Lipman, L-I- P-M-A-N, and it’s called “What She Said: What Men Need to Know and Women Need to Tell Them about Working Together”. And in that book, examples of how organizations that have gender diversity that have women in them, are better and more successful.
Dr. Mason: Okay.
Dr. White: The other book is somewhat similar and it’s by Scott Page and it addresses the ethnic diversity as a way of achieving healthcare equity. And this book is called “The Difference”. The author is Scott Page. “How the Power of Diversity Creates Better Groups, Firms, Schools and Societies”. And that’s a Princeton University Press, but those are two, there are other references that give the same kind of information. But those are two that hit two of the key issues and the key kinds of diversity that are very, very important.
Dr. Mason: Excellent. Excellent. So, as we segue into talking about how to address racism and healthcare, which has led to one of the factors lead to our ultimate level of disparities. What other solutions, recommendations or advice would you have maybe for us as individuals, maybe for us as a society in our various communities, or maybe even on our larger level, maybe to some of your final thoughts on what we can do.
Dr. White: Yes. Well, you were gracious to mention some of my work and I have to in direct honest answer to you about that question is to support the kind of work that you’ve done in terms of providing attention and mentoring for younger people or anyone who’s interested. It makes a tremendous amount of difference and enriches their ability to contribute and to survive. And so, I think education and mentoring of underrepresented minority students is an extremely useful and important thing to do. And to back up a little bit, too, I think it is very important that there be sort of a corporate strategic mission attached to attempts to provide diversity. It’s unlikely to be very successful without that, and it has to be a financial commitment, an institutionalized mission kind of commitment. So, I think doing those things, and as people get more and more involved, people who do get into the system are able to give back and contribute and work in organizations such as we are working in here today with Movement is Life. These things make a difference as a matter of fact, I would go farther and say, we should not underestimate these differences because I think even on rounds, at the cafeteria or in a cocktail party or whoever you may be, to speak up and stand up for what’s right has an effect. I like to call it the ripple effect and sort of stealing a little bit from the idea of Robert F. Kennedy, you’ve probably heard his quote which says that these kinds of pushbacks do make a difference and should not be underestimated, and they make little ripples, and these ripples can coalesce and combat a tsunami as they continue to exist.
So, I think that is something that I really believe in, and I also am reminded of another quotation that I liked very much from Dr. King, which is that “The arc of the moral universe bends slowly, moves slowly, but bends toward justice”. And even though there know there’s a lot of things going on in our society today that are very much in the wrong directions, and it’s interesting, just a little to try to make this point a little more, and I hope I’m going to find this paper better than the last one, but anyway, and that is the 13 groups. There are roughly 13 groups maybe more, I wouldn’t say less but maybe groups of people in our society who experience healthcare disparities, well-documented in the literature, and those 13 groups that are here I can say African Americans, the Appalachian poor, Asian Americans, elderly Americans, members of lesbian, gay, bisexual, and transgender communities, immigrants, Latinos and Latinas, Native Americans, overweight people, people living with disability, and prisoners and women; our mothers, our daughters, our wives, our grandmothers, if you will, all our fellow humans and these groups all experience health care disparities. And believe it or not, you don’t have to look very carefully to see in the last couple of years in our society, how someone is being highly visibly mistreated, if not assassinated, if not shot in a mass shooting, it’s quite stressful. So, it just emphasizes the fact that we want to devote as much as we can of our energy and our goodwill to trying to improve our fellow humans and ourselves, by making our environment, our society more humane.
Dr. Mason: Well, Dr. White, it’s just been an honor to interview you today for our Health Disparities Podcast with Movement is Life. I don’t want it to be lost on our audience that you are one of those persons whose shoulders we stand on. So, we thank you for the ripples that you have created that inspire us to create subsequent ripples, and for everyone listening to understand that you don’t often get to sit across the table from someone who’s made history. And as I progress in age, I’m coming to value these experiences more and more. So, I hope our audience will as well, as well as take home and really think about and act on the recommendations that you’ve made. Not just in terms of reading but creating our own ripple effects and standing up for ourselves and members of those 13 disparate groups here in the US. I think it’s our responsibility and I think we have to talk about it, which is the point of the podcast, so that we can embed that responsibility in future generations. So, Dr. White, thank you very much.
Dr. White: Well, thank you very much. It’s been a real pleasure to meet with you and speak to you and attempt to have this very engaging and enjoyable conversation with you.
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