9 minute read
How Social Identity Impacts Clinical Leadership in Emergency Medicine
By Anita Chary MD, PhD and Melanie Molina MD
As emergency physicians, we are leaders. We lead traumas, codes, and the resuscitation of the critically ill; however, we often receive differential recognition of our leadership based on our social identities. In the United States, the societal vision of a doctor remains White and male, and this has been reflected in the demographic composition of emergency medicine physicians. As two female resident physicians of color, we have noticed the ways in which social identity has impacted perceptions of leadership, both for us and for our colleagues. We have witnessed Black physicians being mistaken for non-clinicians such as transportation staff or patient sitters. We have experienced senior female residents being silenced during traumas in favor of male junior residents. We have had patients refuse the care of our Black and Brown colleagues. In light of these realities, we held a panel with a few of our experienced mentors to discuss how social identity impacts clinical leadership in emergency medicine. Here are some excerpts from our conversation.
How do your social identities influence your clinical leadership style?
Dr. Adaira Landry: I have various social identities. I think the leading one for me is being a Black person. That’s number one, two, and three. When I walk into a room, I am being observed as a Black person before I am being observed as a woman. I think that has carried over into my experience as a physician as well. I have been in the room with women who are not of color. I have seen them questioned less about their credentials compared to me and doubted less as to who’s going to be doing the procedure. I’m also aware of when I want to bring in a different identifier, such as being a mother. There are some situations where that is the part of me that I’m bringing forward. Sometimes it’s being a woman. It can transition a bit depending on the topic at hand or the situation at hand. Dr. Dan Egan: I’m a White man and coming from my space as a gay man, it’s not as obvious as it is for my colleagues who talk about walking into the room and immediately being identified as Black. I haven’t had the same experiences of not being trusted that I’m a doctor; however, every single job that I’ve had, I’ve been called the name of the other gay doctor, who at one hospital, was Asian. I’ve been called “faggot” by patients. I’ve been told by male patients, “You can’t do my rectal exam.” Over time, you have to develop a way that you’re going to respond. That intrinsic anger needs to translate into a professional response.
How do you approach the situation when your clinical abilities are questioned — whether by patients or other colleagues in the emergency department (ED)?
Dr. Adaira Landry: That’s happened with me and residents in this program
About the Panelists Adaira Landry, MD, MEd, is the assistant residency director of the renowned Harvard Affiliated Emergency Medicine Residency, assistant professor of emergency medicine at Brigham and Women’s Hospital, ultrasound fellowship director for the department of emergency medicine at Brigham and Women’s Hospital, and advisor and associate director of the Walter Bradford Cannon Society at Harvard Medical School.
Alden M. Landry, MD, MPH, is an assistant professor of emergency medicine at Beth Israel Deaconess Medical Center, assistant dean for the Office for Diversity Inclusion and Community Partnership, associate director and advisor for the William B. Castle Society, and director of health equity education at Harvard Medical School. He also serves as senior faculty at the Disparities Solutions Center at Massachusetts General Hospital and is the founder and codirector of the nonprofit organization Motivating Pathways.
Dan Egan, MD, is the program director of the Harvard Affiliated Emergency Medicine Residency. He is the former vice chair of education for emergency medicine at Columbia University and the former program director for Mount Sinai St. Luke’s and Mount Sinai Roosevelt in New York City.
when we’ve gone into rooms together. You want to think the best of everyone. A Black male resident and I went into a room once, and the patient literally asked both of us, “Where did you go to medical school? Undergrad? What year are you in training?” It is hard to not respond with frustration, but I don’t. We lead by being professional. We lead by going high and not low. We lead by just taking care of the patient. We lead by holding people accountable for social injustice. And that is our goal. Dr. Alden Landry: Recently, in a trauma activation, I was letting my residents go about their set up when the trauma attending looked at me and said, “Hey, ortho, we should probably have you wait outside. We want to minimize the people in the room.” I looked around to try to find where that orthopedics resident was and then we just looked at each other and the trauma attending realized I was not the ortho resident. Ultimately, he apologized. It was a good learning opportunity to recognize who’s in the room. The appropriate way to talk with others in the resuscitation is to introduce yourself, then ask for clarification if you don’t know who the person is. This time I was considered a physician. But many times, I’m perceived as the person that’s getting the patient a bedpan or the person who’s going to be taking them to x-ray…not the physician. I still struggle with this. It’s interesting now how my residents, when I walk into the room of a patient I’m assessing, will always introduce me, “This is Dr. Landry. He is my boss. He is my attending.” They are aware and make that effort.
Who were your role models in clinical leadership?
Dr. Adaira Landry: The interesting thing about being in emergency medicine is that when I was a junior resident, there were no senior Black women in my department. My mentor at the time, Uché Blackstock, was a junior faculty member. In our department here, I am the only Black female faculty member. For our residents, it’s tough, because you don’t have exposure to senior level Black women who are department faculty. The absence of that is a disadvantage because when it comes to leadership styles, you learn from those who are above you; those who have experience, who can teach you about all sorts of perspectives because of their experience. It’s tough when you are a resident and you don’t have someone incredibly experienced to teach you, compared to, say, our White male residents who have multiple faculty members with various styles from which they can learn.
Are there aspects of yourselves that you have had to change or modulate in order to succeed in clinical leadership roles?
Dr. Alden Landry: Part of what you’re getting at, I think, is “code switching,” when you go into a clinical space and talk differently, use a different tone, and measure yourself a bit more before you make a statement. It’s interesting how much I recognize now that I do this, even in how I reply to an email. If I write a strongly worded email, if I raise my voice, it is assumed that I am the angry Black man. What I’ve actually started to do now is try and do less code switching and curtailing of my true emotions and more challenging people for making those assumptions, calling me angry, and saying I’m yelling. I explain to them that they are interpreting me in those spaces when I’m actually not angry and I explain to them how that is detrimental to those spaces. My emotions matter. My feelings about a situation matter. Dr. Adaira Landry: This is the downfall of academics and the professional workplace in general. I really hate that I often feel tempted to hide the most honest part of myself. Like Alden, I do it as well. I’m definitely a more casual and informal person around my family than in the professional setting. When it comes to advocacy, that’s where I feel like most of us walk on eggshells as far as calling out something that is unfairly being done to us or a situation that is obviously unfair. We have to frame it in a way that, like Alden said, is friendly, softened, muted, more commercialized, and less raw. It’s really sad that for us to speak the truth we have to package it up and wrap it in a bow. It shouldn’t really be on the victim to make sure their speech is palatable to the audience that’s about to hear it. I do think that people of color—Black people specifically in this country—have a very narrow window of allowable emotion which applies only to being angry but also to being excitedly happy. When my brother was in elementary school he was jumping on a table because he was happy and got a note that his teacher was fearful of him. That’s how we can be perceived when our emotions go out of the expected range. It’s really challenging and quite disappointing.
How do you work to support trainees with marginalized identities in clinical leadership situations?
Dr. Dan Egan: It’s important to be that person who doesn’t allow things to take place that make you fearful and/ or uncomfortable, but what’s found to be even more effective is bystander intervention. All of us should be committed to speaking up when we see inequity. In my life growing up as a gay person, I constantly had a fear of someone finding out. My whole life going to Catholic school I was always scared that someone else was going to judge me, exclude me from situations, or not want me to be there because of who I was. And that has translated 100 percent into clinical leadership, especially in cases of resuscitations. I’m concerned about others being excluded and losing focus on the patients. I think about times I was scared to go to a doctor because I was scared to tell them I was gay. I remember at times mapping out if I had to go to the hospital, where I would go so that no one would ever find out. I think it’s important to make sure that we’re paying attention to the human that’s in there, that everyone on the team feels valued and included, that we know their names. All of those things come from a place where that wasn’t always the case for me.
ABOUT THE AUTHORS
Dr. Chary is the Chief Resident of Harvard Affiliated Emergency Medicine Residency and coleader of the residency’s Social Emergency Medicine Interest Academy.
Dr. Molina is a resident physician (PGY-4) at Harvard Affiliated Emergency Medicine Residency and coleader of the residency’s Social Emergency Medicine Interest Academy.
