“The eye sees only what the mind is ready to comprehend.” – RD

Photo Credit: Maryam Elmi

The topic of diversity and inclusion has always been of great interest to me. I’m not sure why, though. Let me explain. I was born in Puerto Rico, which obviously makes me a Hispanic, which in turn makes me a minority. On the other hand, I’ve been relatively successful as a radiologist in the continental US, both at UAB and at UT Health San Antonio. So far, I have never perceived any professional road blocks. On the contrary, I’ve been helped multiple times along the way with incredible opportunities, great mentors and fair/timely challenges. This dichotomy never rests on my unconscious mind and makes the topics of inclusion and bias relevant.

Nowadays, most institution go to great extents to increase diversity and promote inclusion. Many do a good job increasing diversity, but only a few become truly successful at promoting inclusion. Diversity is just a headcount and easy to measure. Measurable problems usually have straight forward solutions. Inclusion on the other hand is incredibly difficult to identify and even much more difficult to quantify. Inclusion efforts can be seemed as sensitive or inappropriate and, in some cases, can make people mad. This is because inclusion has a direct relationship with bias. And bias is the biggest threat to the unconscious ego of “good people”.

In her book “The Person you Mean to be, How Good People Fight Bias”, Dr. Chugh expertly explains the root of “good people” bias, which I’ll try to summarize here. Psychologically, we all claim different identities throughout life. For example, I consider myself a Puerto Rican, a teacher, an athletic person and an overall good human being. Not surprisingly, most people will claim to the moral identity of “good person”. This self-proclaimed identity becomes part of our psychological self. Consciously and unconsciously we constantly seek for self-identity affirmation. When we don’t get it, we just get upset. This phenomenon often creates a false illusion of the person we think to be. For example, if I think to be a good person but somebody challenges the notion, I would probably assume they’re wrong or that my intentions are just misunderstood. Furthermore, moral identity is a measure of whether we care about being a good person and not whether we are in fact a good person. In most institutions, the dilemma of “good people” moral identity becomes the road block to achieving true inclusion. Good intentions by good people is not enough.

Many minorities feel marginalized at work, not so much by what people say, but by an environment that doesn’t fully understands them. Unspoken words, lack of action and perceived lack of interest and empathy. In theory, the term minority is supposed to reflect just a mere percentage and nothing more. There are statistically less Hispanics and African Americans than Caucasians in the United States. This is a fact. Unfortunately, it would be naïve to assume that there are no negative social and psychological implications to the term “minority”. In medicine we take it even further and classify blacks, Hispanics and Native Americans as “underrepresented minorities”. The intention of this classification is undoubtedly affirmative and understandably created with good intentions. But does that mean my perception as a minority is all positive to this good intention? The answer may surprise you. Many minorities internalize this type of classification as a handicap. Also, it reminds us of ever present and hard to understand cultural and racial differences. This is precisely the basis of systemic bias; when a marginalized group cannot explain what is clearly visible to them, but invisible to others. This situation is not exclusive to minorities and it also applies to women, people from different countries and cultures as well as the LGBTQ.

I’ve recently read several books about systemic racism (the twin brother of systemic bias) and the so called “white privilege” (I would recommend The Hate That You Give, Between The World and Me and Born a Crime). It’s easy for people to assume that racism is just a thing of the past in this country. Likely because we don’t frequently experience explicit acts of racism, particularly in the workplace. But systemic racism/bias is much alive everywhere in our country. A problem that we all need to acknowledge, even if we don’t fully understand it. Minorities, in particular African Americans have suffered centuries of oppression and abuse that cannot be corrected overnight or by simply changing the law. After much reading, I could list hundreds of reasons that would support the presence of systemic racism or give plenty of examples of “white privilege”, but I won’t. Instead, I will share my story even if raw and painful.

Of all the minorities in the United States, I consider myself one of the most privileged. I’m an educated male physician with a good enough salary to live in one of the good parts of town. Even so, I’ve experience indirect racism and prejudice. I’ve been told not to apply for a country club membership solely because of my race. I’ve also been told that people like me downgrade good neighborhoods, converting them to ghettos and eventually decreasing the value of properties. And most painfully of all, I had to endure somebody unintentionally calling my daughter a “half-breed”. This may not seem like much to you, and I would understand. But for me, it’s painful. Not because I personally feel inferior or less than others, but because of the fact that some consider me a lesser human being due to circumstances of which I have absolutely no control. Some nights I pray my kids grow up proud of their heritage and certain that I passed them something valuable and not a disease that would render them inferior. Situations like these won’t brake me, but they will affect me – like systemic bias would.

We should all strive for diversity in the workplace. But diversity without inclusion is just talent without opportunity. We can only achieve true inclusion by recognizing the presence of our own unconscious bias. Not by fully understanding the nature of our bias, but by knowing that is there, always in the background. Much like everything else in life, bias is not static but ever changing and ever adapting. The quest to be a good and inclusive person is eternal and often challenging. But we need to work at it, every day and with every human interaction. It will always be a work in progress, and is the only way forward.