Welcome to the summer 2021 edition of Ask the Expert! Please forgive the somewhat hokey title – for some reason I could not bring myself to put anything else at the top of this article. Fortunately, the content this month is extremely thought-provoking and very timely, and I feel confident that it will make up for the small transgression on my part.

This month, we will hear from Dr. Keya Locke, a close associate of mine here at UF Health-Jacksonville and someone who is now seen frequently on the national stage, speaking and writing about diversity issues and fairness in medicine (and in American society). Dr. Locke is a passionate, heartfelt, and thoughtful expounder on these polarizing, crucially important topics, and I am pleased to have her join us.

Remember, readers are encouraged to email me at zdeutch@yahoo.com with feedback of any type.

Keya, welcome and would you please begin by telling us about your current job and responsibilities?

I am currently in my fourth year as an attending at the University of Florida-Jacksonville College of Medicine. I serve as the Assistant Medical Director of Perioperative Services at UF Health North, an academic community hospital. I was recently elected to the UF Faculty Senate, and I am also a member of the UF College of Medicine admissions committee.

What does IDEA mean to you, and what prompted you to become vocal about it?

This type of question often makes me smile – for some, inclusion and equity are topics to be learned. However, for me, having lived as a woman in my skin for my entire life, IDEA means learning how to thrive (and not just survive) in spaces that are predominately white, and often male. I suppose it's a way of life that has now formally been given a name. And since it was named, I felt compelled to speak on it in a true and honest way. I felt the strong urge to try and ensure that there was a very personal and real face behind the conversation in order to avoid IDEA becoming yet another buzzword lacking true resonance.

Could you share some personal experiences of bias/unfair treatment that you have seen in your career?

This story is not unique, and similar things have happened to me throughout my career. But this is the most recent and compelling vignette that comes to mind:

Last year, I was on call and went to change scrubs after having completed a cesarean-section. As I exited the locker room and entered the adjoining OR lounge, I was stopped by a gentleman who asked me in a very authoritative manner, “Did you empty the dirty laundry bins?” I was confused, in no small part because it was 1 a.m. and also because I had a large placard on my badge that clearly read “DOCTOR.” Since I didn't answer immediately, he repeated the question. At that point, my New York/Brooklyn voice took over and I said, “Sir, I'm Dr. Locke, and I have no idea what the [expletive] you are talking about.” He turned red and apologized.

I imagine that, in his mind, the only Black women in the hospital (and roaming the ORs) at that hour are members of the cleaning crew. The possibility of my existence was not a part of his reality, or at least that's how I rationalized the incident.

Is it enough to just be “a good person,” regardless of background, or should we live our lives in explicit awareness of IDEA principles?

Hmmm... this is a tough one. While for me they are one in the same in my mind, perhaps that is not the case for everyone. And maybe we should question what it even means to be a good person. Particularly when we know that silence implies complacency.

Consider this exchange, which I came across online, around the time of the George Floyd murder. An interviewee said, “I'm a good person, and I even have Black friends.” The response from the interviewer was, “If you find that you don't really understand what Black people are going through and why they are so angry, then you don't have Black friends, you just know Black people.”

What do you think organized medicine can/should do to promote fairness and equality for physicians and other health care workers?

I believe a large part of being inclusive revolves around acknowledging the way in which we arrived at this moment and embracing the experiences of all of those within the organization. There is power in the story, particularly when it is given a face and a name. Often that face/name belongs to someone who we work side-by-side with, whose experiences we may be entirely oblivious to.

Additionally, proper representation is crucial to change the narrative. This is an organizational imperative.

What can individual practices do to best position themselves as regards the principles of IDEA?

Let give me some bullet points:

  • Call on us in meetings

  • Vet your talks – make sure they are free of implicit bias and are authentic

  • INTENTIONALLY diversify your ranks and hold your leaders accountable in this

  • Ask yourselves how many visiting professors/guest lecturers in your department this year have been people of color? If the answer is zero or close to it, be intentional about rectifying that situation

  • Representation matters

  • Engage in the conversation: EMBRACE THE UNCOMFORTABLE!

  • Acknowledge that your reality is not the only one

  • Don't be the person who uses IDEA to self-promote.

Since starting your medical career, what successes have you witnessed in the search for fairness and equality?

Right now, in a number of institutions, the silence has been broken. The uncomfortable conversations have begun on the local and national stage, and that definitely makes me hopeful.

Speaking honestly, do you see the future as bright, murky, or to-be-determined?

I think a quote from Barack Obama summarizes my outlook best: “If I remain hopeful, it's because I've learned to place my faith in my fellow citizens, especially those of the next generation.”

Do you have any parting words for ASA members?

We arrived here with purpose and intention, and similarly, it's the only way out of this. What we cannot do is pretend that for generations, people of color were not systematically excluded from the pursuit of higher education, land ownership, home ownership (especially in “good neighborhoods”), and voting. My own grandmother grew up drinking from “colored only” water fountains in Virginia. It is hollow now to claim that all people are free to pursue their own fulfillment and happiness, and then to turn around and call that “equality.” Equality cannot exist without equity and access.

Inclusion, Diversity, Equity, and Access: let it become the foundation on which we build a bright future membership of physician anesthesiologists. We are stronger together!

Zachary Deutch, MD, FASA, Cardiac-trained Anesthesiologist, and Medical Director of Perioperative Services, UF Health North, Jacksonville, Florida.

Zachary Deutch, MD, FASA, Cardiac-trained Anesthesiologist, and Medical Director of Perioperative Services, UF Health North, Jacksonville, Florida.

Keya A. Locke, MD, MBA, Assistant Director of Perioperative Services, UF Health North, Jacksonville, Florida.

Keya A. Locke, MD, MBA, Assistant Director of Perioperative Services, UF Health North, Jacksonville, Florida.