NEUROLOGY & NEUROSURGERY

AAN 2021: Diversity, Equity and Inclusion in Medical Education

April 21, 2021

Like most people, Dr. Ericka Greene, neurologist at Houston Methodist, was horrified by the police killing of George Floyd that set in motion last summer's national reckoning over continued racism in America. But she recoiled from the conversation, upset by the polarization.

This week, Dr. Greene, an African-American, will assume a more prominent role in the conversation, presenting a talk on implementing diversity, equity and inclusion as a core value in medical education at the American Academy of Neurologists' virtual conference.

She spoke to Leading Medicine last week about her personal experiences with racism, the progress and lack of progress in the diversity effort and her prescription to cure the biases that afflict academic medicine.

Q: What do you hope to accomplish with this presentation?

A: From a Hippocratic and medical ethics standpoint, it's our obligation to make sure that there's equity and access as well as empathy and fairness in the practice of medicine. Addressing the issues that impacts equitable and fair delivery of health care is also an accreditation and certifying requirement. My presentation is about where we are now, what the standard is, and how this is an opportunity to make equity a core value in the mission and value of institutions. That is the only way we are going to change the culture.

QCan you talk about your own experience of racism?

A: People who often experience the effects of implicit bias, racism or microaggression — these new terms we are becoming familiar with — are so used to it that it seems normal. I can remember events now that I didn't think much about at the time because they were so common. Just being a woman, for instance, I was often boxed into being a certain kind of doctor. I was discouraged from going into surgery because it wouldn't give me time to raise children. I've been referred to as a nurse, called by my first name when others are not and people are quick to critique my look. Further, what's unclear is the amount of covert aggression — for instance, the discussion about you behind closed doors or the possible missed opportunities. You never know if your race or gender had anything to do with it.

Q: But you haven't experienced some of the more horrifying stories many minorities talk about?

A: Others have had more extreme experiences. They've been told to change their hair, lose weight or change the way they communicate. As a physician and educator, I am aware of the bias against doctors from foreign countries — "I can't understand them, I don't want to work with them, I don't trust them." Some programs may reject a person's application due to sexual orientation, gender or ethnicity because of a view of "that's not who we are." Preparing this presentation made me think about these matters more than I normally do. It made me pay attention to things that, honestly, I am used to and, admittedly, may not have responded to.

Q: Did last summer's events heighten your awareness?

A: Yes, they did, of course they did, but at a level beyond my role as a doctor, just as a person. Last year was not the first of these cases by any means. We hear of these cases several times a year. The Floyd killing got the attention because everyone witnessed it. It brought a lot of needed attention. For me, these events were challenging because they were also so hurtful. I was not only upset by the climate in our country, but also by the extremes of opinion that were unproductive — on both sides. I forced myself to not actively seek debate or discussion because the environment was so toxic. This needs to change. We need to have these conversations in an environment of respect and mutual consideration.

Q: What did you think of the reaction in the medical world?

A: Across the country, the response of the medical community was unexpected and impressive. People took a knee and posted it on social media, even those who may have had differing opinions. Often, it was led by administrators, including those at our Houston Methodist hospitals. I appreciate, respect and am thankful for it, but my concerns are that the momentum will fade and that institutions that aren't "in the street" may not make as much of a change as everyone else unless there's a mandate. Beyond some take-a-knee pictures and conversations for a few months, will all of this actually translate into policy change? Is my talk or this interview just filler because it's topical? I think medical institutions are truly committed to moving forward, but only time will tell.

Q: How has the landscape changed over the years?

A: There have been significant strides since I was a little girl, since my parents grew up with the Jim Crow laws. There's no question of that. The problem now is that racism is covert, implicit — which is harder to identify and address. Implicit bias contributes to racist behavior and leads to a series of events where there is currently no consensus on meaning, impact or response.

Q: Why do you think in the decades since the great Civil Rights achievements, there's been so little progress against less obvious racism?

A: This phase is harder because when people aren't aware of their prejudices, there are no checks and balances. I can justify my behaviors and not be aware of the prejudices behind them. How do you fix that?

Q: I don't know. Can you?

A: It's like Alcoholics Anonymous. You have to admit there's a problem. The key is to be open to the possibility that each of us has biases and prejudices that can negatively impact those around us, how we practice our profession, how we interact with our colleagues. If we're not willing to be honest with ourselves, there's no way we will change. This probably is one of the most uncomfortable things for humans to do — actually face ourselves and say, that's "ugly" or that's "wrong." That requires permeating the culture with conversations, and choosing to see others' perspectives and experiences as credible. We can't be afraid to have that conversation and listen to each other.

Q: Do you fear that could cause a backlash, make some people tired of the issue?

A: Yes, I have colleagues and friends who feel that way. No matter what you do, you're going to get that. But you're also going to capture what we call the early and late stakeholders. You have the early adopters who jump right on, the late adopters who require a little time and the people who never adopt. You do the best you can, try to reach as many people as you can, and over time it does have an impact — we've seen that. Not everyone was onboard with the Civil Rights actions, but Jim Crow was done away with and overt discrimination is illegal.

Q: Anything you want to add in summation?

A: This is not just a minority issue, patient issue or gender issue. It's a human issue. Whether one is a physician, a patient or a politician, it's important to take this momentum and create change in our individual spheres of influence.