Katrina Ubell:      You are listening to the Weight Loss For Busy Physicians podcast with Katrina Ubell, MD, Conversations About Racism in Medicine Part Four.

Welcome to Weight Loss For Busy Physicians, the podcast where busy doctors like you get the practical solutions and support you need to permanently lose the weight so you can feel better and have the life you want. If you're looking to overcome your stress eating and exhaustion and move into freedom around food, you're in the right place. Welcome back my friend, I have the final conversation, at least for now, about racism in medicine for you today. And I'm really, really excited to bring you my conversation with Angela. She and I… I'm telling you each of these conversations I've gotten so much out of it. She is someone who is a leader within her organization. She has some really unique perspectives and just a lot of really amazing things for you to think about. I can't even get into them, they're so great, you just have to listen. So make sure you listen all the way through.

I did also want to let you know that the show notes page for this episode will feature the person that she speaks of. There's a person that she refers to their work and we will have that information for you in the show notes page. She's going to be getting me that, and we'll put it in there. I also want to really, really strongly encourage you to share these episodes. If you found them to be helpful, to share them on your social media, to share them in Facebook groups that you're in, and to share them directly with people that you know, who are open to hearing and learning more and thinking about how they can contribute to a solution. I will be coming back to you tomorrow with another episode, but this is going to be from me where I am going to offer you some coaching perspectives on racism and why so many of us white folks are not doing things that move us forward.

So it's not going to be an episode where I'm going to be trying to convince you to do anything, but just more to discuss why you might've been reluctant in the past to do anything or maybe to even think about it, just didn't have it on your conscious awareness on your radar at all, and how we work through racism with a model, and what we can do to help ourselves to be able to do what's required to make a difference moving forward. So be on the lookout for that episode as well. And that will be the final component of this bonus series that I've been doing. I do just want to mention again how much I appreciate my clients for being willing to come on and discuss this subject. And as you'll see, Angela has a renewed energy and commitment to stepping forward, and saying something, and moving forward in her life as it pertains to this. I think that is a really amazing example for all of us.

So please listen, share, the more people who listen and understand it's only going to help to facilitate this whole discussion and not just discussion, but moving forward with real changes. So with that, I bring you Angela and I will be back to talk to you tomorrow. Hi, Angela. Thank you for coming on the podcast.

Angela:               Hi, Katrina. Thanks for asking me to be here.

Katrina Ubell:      I'm super excited that you said yes and you agreed to do this. And I know it's a big asking so seriously, I really, really appreciate it. It's not lost on me that it's a big deal to ask you to do this. So I've been doing this to everybody because I learned this from a video that I watched that we should just not make assumptions, which we know, but we also don't know. And so before we start, I wanted to ask you how you prefer to be referred to, you prefer person of color, black, African American, something else, what do you prefer?

Angela:               Sure. So I personally like black.

Katrina Ubell:      Okay, sounds good. All right, so I usually like to just have people just introduce themselves a little bit in the beginning. Just tell us a little bit about yourself.

Angela:               So, I'm a physician, something I wanted to do ever since I was nine years old. My goal was to take care of people. I'll tell you what's interesting, early on I wanted to be an OB-GYN because I felt like I wanted to really empower women, to know about their bodies, and bringing life into the world, how cool is that? And then I did that rotation and saw that there was also hysterectomy and bladder repairs and decided that's not so fun. So, continued through my training, discovered internal medicine, great faculty, incredible disease processes, both men and women. And really when you think about it, internal medicine is how you have to get to so many of the subspecialties in medicine. So really became this empowering, I am an internist and later practiced as a hospitalist.

Katrina Ubell:      Awesome. And now you have a leadership role too as well, right?

Angela:               That is correct.

Katrina Ubell:      Okay. So I'm totally curious, what happened when you were nine that made you go like, “You know what, I want to be a doctor.”

Angela:               So basically my 4th grade teacher had told me that I was really good at science. And it's because I answered a question that I knew that amino acids help to make proteins. And that was the big thing that was I answered that question correctly. And so then I thought, okay, I'm really smart and I know science. And so then a friend's mother asked me, “What do you want to do when you grow up?” I said, “I want to be a doctor.” And then back then I said, I wanted to be a neurosurgeon because that must be really hard to work on the brain. So just the crazy things you do when you're a kid and how you see yourself in the world.

Katrina Ubell:      And your brain puts things together like, I'm good at this, this is what I'm going to do. I love that, that's so great. Did anybody discourage you when you would say that? I'm just curious if any was like, “You can't do that.”

Angela:               No, I never had anybody discourage me. People were often curious why I wanted to be a physician, wanted to know if I had any physicians in my family, which I do not. So it was interesting, I never had anybody discourage me from wanting to pursue medicine.

Katrina Ubell:      So your family was totally supportive and that's great.

Angela:               Yes, absolutely.

Katrina Ubell:      Good. Can you think of a time when you were growing up where either there was a conversation around race and race differences or racism or something happened to you where it became into your awareness of this is a thing?

Angela:               I would say for me early conversations about race really came around as a child, like Black History Month, during the month of February. And there were always programs and things to go to. I very vividly remember at a very young age, and what I remember is when I was in third grade, it's interesting how I remember everything in terms of a grade, but in third grade, I remember having a teacher who felt very strongly about everybody in the class participating and having a role.

And I remember I had a part, and I don't remember exactly what my part was, but I just remember that she praised my participation in the program that year, so I certainly remember that. Over the years growing up, absolutely. Conversations in general about it and understanding that I'm black, others were white or growing up where I did in the South, others were Hispanic. Certainly, those differences understanding them, but never necessarily seeing it as a barrier at that point. Just saying that yes, there are differences, it is something that people point out, people think about it differently. So absolutely had that experience at a young age, sure.

Katrina Ubell:      And then as you proceeded through middle school, high school that time, did it ever come up as an issue for you? Is there any struggle around that?

Angela:               Sure. I can remember there being times where maybe somebody said something to you that wasn't very nice. And maybe somebody on the playground used the N-word or there was clearly those instances where you knew you were different. Or something that can commonly happen when you're a young girl, is somebody wants to touch your hair because your hair is different, or somebody saying that they're not going to play with you because you're different, absolutely. And I think one of the times I remember, as I was thinking about this, was being a middle schooler I had gone to the mall with my dad, he had taken me. He wasn't with me at that moment, I was in a department store buying a mother's day gift for my mom, he had given me the money, I had picked out a crepe maker to give her.

And I had been looking around trying to find what I was going to give her and I finally had decided on that. I went up to pay for it and I bought it, bagged up, took it, and walked out of the store. And when I walked out of the store a plainclothes officer had asked to see what I had in the bag and if I had my receipt. And I didn't know why he necessarily was asking me that, I clearly had paid for it, I had it in the bag, I had the receipt. And certainly part of the conversation was around because I was a young kid, I was black, maybe I looked suspicious because I was by myself at that time looking for the gift. But little things like that, that happen, that you wonder why is that. Was it because I was just a kid in the store by myself? Or was it because I was black?

Katrina Ubell:      Yeah, definitely. So then what was your experience in college then?

Angela:               So college was the first time for me that I recognized that when I walked into the room, the first thing that people saw that I was black. So even though I knew I was black and these little things had happened over the years, I never thought that was the first thing people saw. And so that was a recognition for me for the very first time, is when you walk into the room, the very first thing is that you're black. Not that I'm in the college of science, not that I'm a biology major, the very first thing, maybe not even that I'm a woman, the very first thing is you're black and then all those other things come after it. So I have to say that was a big wake up call for me because I'd never thought about it in that way and I'd never looked at it that way.

Katrina Ubell:      And so the college you went to was… What would you say in terms of—

Angela:               It was a large public… very small. A large public institution, very small number. I never felt uncomfortable being there but it was part of a bigger understanding for me how people might see me first.

Katrina Ubell:      And so you went through the whole process, the pre-med process did you still find people to be very supportive and encouraging?

Angela:               Yeah, I did. I can honestly say that I did, still count people to be that way. But it was clear that at that time, there weren't very many students going all the way through the pre-med track. We all know there are parts in school where people start to drop like flies, they're not interested necessarily in going in that direction anymore. But I found people to be supportive and even encouraging because there were overall so few students and so people were very encouraging. I also found at times that there was that when people would say things like is there some special information or interest that's being given to the minority students that maybe the majority students aren't getting? So sometimes there was that type of conversation that you'd hear. Or is there any type of special treatment for that a minority candidate or student is getting over a majority. And so you heard that back and forth at times.

Katrina Ubell:      People thinking that basically, you're getting an extra leg up or special treatment or something for that?

Angela:               Exactly.

Katrina Ubell:      And what did you make of that? What was your interpretation of hearing that?

Angela:               I didn't really. And it's interesting because I've asked myself a lot of questions about this lately because it's been a long time since I've really thought about it in that way. And I don't remember thinking necessarily anything of it besides that it was what it was. There was in the college of science, in medical school, there are parts of the dean's office that are dedicated to helping minority students succeed. And why wouldn't you take advantage of those resources when they're there and available? I think more recently, I heard something really nicely stated, Michelle Obama and her documentary Becoming, talked about, there's all kinds of affirmative action whether it's because people want diversity, inclusion.

I love the way she used the word legacy as a type of affirmative action. Like if you're a legacy, you're automatically in regardless sometimes of your credentials or they're not as important. And so I think it's important to remember that there are a lot of different ways we have to get to that point that we want to have a class look a certain way. And I can still say in these classes of about 200 people still the number of minority students was still very, very small, both black and Hispanic, still quite small.

Katrina Ubell:      So when you got into medical school, what was your experience like then being around all the other students?

Angela:               I would say that there were times when those issues came up more. And not so much from fellow students, although that could be there at times, but you started to see it more in the faculty. So if we think about faculty in an academic institution, for the most part, these are people that have been there a long time. If you think about, and it's been a while since I've graduated from medical school, and you think about what their training had been, what they had seen over their careers, then you have these minority students who are coming in. And still small numbers, but bigger numbers than they've seen before, you would definitely see and hear things at times that were alarming. I can remember in the basic sciences, you would hear somebody make a comment about something that my clinical condition that may only be for certain minority group and the way they would describe that would make you go, “Hmm, that was a little biased in the way that they said that.”

Or I can remember in the clinical rotations, the physician, the hematologist who was primarily responsible for taking care of sickle cell patients just said something in a lecture one day that I felt compelled afterwards to say something to one of my colleagues who was also black. I said, “Wow, did you hear what he said? That was pretty racist.” That's not something that you would ever take outside of that conversation with a friend, colleague, you would never go to the program director and say anything like that, you would never escalate that at the time.

Katrina Ubell:      Let me just for clarity sake, because there's going to be someone listening, going, “Why not? Why wouldn't you say something?” So let's be really clear on why you wouldn't say something.

Angela:               Because it was so important to be there and it was so important to show by example. So show that even though you were a minority student and even though somebody might have a certain feeling about that, I am here, I deserve to be here, and I'm going to get to the other side of this where I finished medical school, finished my residency, and then I will be in a position to make a difference. And so you're so worried, for me, I was concerned about getting to that point where I could make a difference. So I'm not going to ruffle a lot of feathers here, I'm just going to keep going and set a different example of myself. For me, that was the feeling.

Katrina Ubell:      And so really ultimately the concern was, if I say something, if I call this person out on it, that will probably have negative implications for me and my ability to be successful moving forward.

Angela:               That's correct. And this person has been here for decades, like all of a sudden I'm going to make a difference?

Katrina Ubell:      Interesting. But I think it's really good to point that out because I think some people think, well then, why don't black people speak up then? Why not be pointing it out to us? This is why. It's hard enough as it is and you don't want to do anything that could potentially make it worse.

Angela:               Right.

Katrina Ubell:      So then when you went onto the wards, what was that experience like?

Angela:               So it's an interesting experience when you get there because you have… The dynamics are so many. So first of all, you're a woman and majority of the nurses are women too, but they've been more used to having these male physicians. So you have that whole dynamic that you're working with. Then you have patients all different kinds, so the patients that are black are so excited to see you and that's true of the majority of the other patients. But every once in a while you'd have somebody who really didn't want you in the room. You're also thinking about the dynamics of your team because you have seen that and you're wondering, okay, there aren't that many minorities, but what if for some reason you end up with the team that's mostly minority and you walk into the room where the patient doesn't want to see you?

Katrina Ubell:      Like how do you cover just even the work that needs to get done?

Angela:               Yeah, exactly. And so you're thinking about those kinds of things. So you're trying to learn because that's part of what being on the wards is all about. You're trying to set a good example and show what you can do for all of those who are so happy you're there. So at the time for the unit secretary who was so happy to see you, somebody who looked like them, for those patients. So you have all of these expectations and you feel like if I don't get this right, not only am I letting myself down, but I'm letting all these other people down. Or I'm standing on the backs of all these other people and if I don't do this well, what will it mean? So there's an incredible amount of pressure that you put on yourself because you're in this place. And so you have all these internal conversations as well as the external conversations that are happening too.

Katrina Ubell:      Did you ever find within the resident teams or the attendings that you were working with where you were like, “Wow, that's surprising that this is happening, I can't believe that person just said that.” Or something like that?

Angela:               Absolutely, those conversations would happen. And it's interesting too that you get to the point where racism in some way, shape, or form, whether it's something just egregious or just a little slight, whether it happened to you personally, or somebody came and told you about their experience, on a somewhat regular basis there was always something. And what I found that I've done over the years is I've just like, okay, I hear that, I see that, I'm going to act differently, I'm not going to engage with that person anymore and I'm going to go on about my business and get it done. Which is why for me, when I heard from you, which is why I said to myself, I always do the politically correct thing in these circumstances, and this time I'm going to have a conversation about it. If this is all happening because it's meant for us to have a big change, then that's what I want to be part of right now.

Katrina Ubell:      It's like what I always say in any situation, how is this happening for me? I'm thinking how is it all happening for us as a society moving forward? Which I love that you're thinking about in that way. So then you went into your residency, your training and tell me about that experience.

Angela:               So I would say in training, then the dynamics change a little bit because not only, you're still learning and especially in the first year as an intern, but later you're running the team. You're a second and third level resident, you're running a team, you'd have students that you're trying to make sure that they're getting what they need, you have an attending, you're trying to meet those needs. And there were times when you have people who I don't want to listen to you. You have a student who has their own bias whose just thinking, I'm not going to listen to this resident, I don't think I believe what they're saying or I think they're competent, that kind of a thing. I can remember vividly that happening one time with one of my interns who finally I told them just to go to bed because they were of no help to me.

And then the next morning on rounds, having the attending come in and on rounds, talk about everything that I had done overnight for that patient was exactly what they needed and was exactly the right thing. And feeling like you have to have somebody else say that you're good for someone else to believe that too, that is something that happens all the time, that continues. And on the flip side, I would have never, as a student or an intern, not done what my upper level said, not had acted insubordinate in any way, but yet this person felt like they could do that. Those are the… And some people might say, well, that was just some intern not following the chain of command or not understanding what to do. And maybe it was, but it just sure seems like that kind of behavior didn't necessarily happen to my colleagues that were majority. And so that's the difference.

Katrina Ubell:      That is the difference, definitely. Now, did you do a fellowship or no?

Angela:               I did not.

Katrina Ubell:      You just stayed in internal medicine, okay. And did you stay academic then?

Angela:               No, immediately I went out into traditional internal medicine, private practice, and then after that went into an academic environment.

Katrina Ubell:      And so what was that experience like? Now you're in charge, right?

Angela:               Yeah.

Katrina Ubell:      Buck stops with you. And what was that experience like for you?

Angela:               So what's interesting is that you have to prove yourself. So when you get there people have to see what are you about, and what are you going to do, and how are you going to interact. And so you spend that initial time proving yourself. And so once people see, okay, she can take care of patients, she's always available, she's doing a good job with teaching. Okay, she's proven herself so she's good, but you have to prove yourself. And part of-

Katrina Ubell:      So you've proven yourself?

Angela:               Yeah, like you have to earn that respect, that's not an automatic based on just training alone. And I think that's different sometimes and other people just come with certain credentials and automatically they're good as opposed to having to earn that.

Katrina Ubell:      If you're a white male with some gray hair, I don't think you have got to work for it the same way.

Angela:               It's different. And there have been times too in the last couple of days I've thought about how much of this is race? How much of it is gender?

Katrina Ubell:      Which I think is interesting to piece apart too.

Angela:               It is.

Katrina Ubell:      And I think it's even interesting in the conversation of, I don't want to call it a double whammy, I don't know if that's the best way to talk about it, but there's two things that you're dealing with rather than just one.

Angela:               And I actually had someone who's a mentor to me who is a white male physician who said to me just the other day, as all this has been happening, he goes, “I now I feel like I maybe have a glimpse into how much more you may have been dealing with.” So not only physician related and then you think about race and he goes, “You think about having kids, the whole nine yards.” At one point the conversation, he goes, “Oh my gosh, he must've been exhausted.”

Katrina Ubell:      You're like, “Thank you.”

Angela:               But for him, that was the first time he'd ever looked at it in that way.

Katrina Ubell:      Did you find any kind of challenges in finding mentors to really support you in the way you needed to be supported?

Angela:               I think it's really interesting not challenging to find when you're looking for people that are black like you and who have the time and the energy to be able to mentor and do that, absolutely people can make themselves available. I know in some of those conversations, since then looking back, they too were having their own challenges yet trying not… They didn't want you to know that. They wanted to encourage you but at the same time, they were certainly going through their own things and I can understand that. You want to be hopeful for the next group or generation even while you may be going through your own stuff. So you're trying to keep that in mind as well and I can definitely see that. But it wasn't hard. And I will say I've had mentors they're black, white, Hispanic, male, female and have given up their time very freely and I've appreciated that. And even in the last couple of days, I've had some really interesting conversations as all of us have looked at this through a new lens, which has been really good.

Katrina Ubell:      Just furthering the whole experience. If you were speaking to someone who was white, who going, you know what, I really could step up my mentorship game, I think I really could give back in a different way. What might you suggest to just think about? Or be aware about? Or a good way to go about that?

Angela:               Sure. And I would say, and I feel the same way about this too, for myself. Is let's call it when we see it. Let's not be so PC about it or afraid to have a conversation. So if I hear a colleague or if you hear, if anybody hears a colleague say something like call somebody a derogatory name, let's just stop at that moment and talk about it right then. Like, why are you saying that? I think that's an offensive name or term. I don't think we should use that. Why do you feel compelled to do that? Or I'm not going to stand for that kind of language. As opposed to going home that night to dinner and telling your husband, or wife, or telling your friend about it, call that person on it right then. That's an immediate intervention and changes the conversation.

I think all of us as attendings at some point in time, when we went into the room and somebody said they didn't want to deal with us or deal with a particular student, having that conversation right then, At this institution, we take care of everyone, all members of this team are competent, this is what we have to do. And usually being able to march forward with that patient, unless they're completely abusive then you just don't want the students to be subjected to that, so you move in a different direction. But let's really have that conversation right now, let's not be so PC about it anymore. And not that we're going to be yelling and screaming at our colleague, but let's just really say it right then, or ask the question, or ask what they mean, or talk about that implicit bias that they might have. Let's just really have a conversation about it right as it's happening or immediately after the meeting, not waiting, or never having it.

Katrina Ubell:      And I think that this has to come from within the white community because I would guess that a lot of this is happening when there isn't a black person around or a minority person around. They know better than to say it in front of the person, maybe, maybe not always. But then they're saying it in this environment where there's this perception of, oh, this is a safe place to talk about that. Or this is where we can really say what we think. And if we leave it to black people to intervene and do this, they're not there to say anything and has to come from within the white community.

Angela:               Absolutely. And I love what you said at the very beginning when you talked about some people feel like if I'm not all in, or if I'm not an activist, what can I do? And some of it is just little things that we do or say. So in training, one of the things I heard talked about many times is about somebody's pedigree. So there are certain people who can do certain things. And that-

Katrina Ubell:      People have discussed my pedigree as well, yes.

Angela:               Oh my gosh. That term immediately makes… For me, is like somehow I'm lesser than because do I have that pedigree? Because people see this type of person can be this type of doctor. And that's very true in certain specialties that people use that word. It's like that dog whistle about who's in and who's out. So I think it's important for us to realize that may have some biases that we need to better understand. And it's not a negative, it's not that someone's a bad person, but why do we think that? Why do we think certain roles belong to certain people?

Katrina Ubell:      And it's figuring out, getting some awareness around what those are. You can't fix them if you don't know what they are.

Angela:               Exactly.

Katrina Ubell:      So you have to ask yourself and find that out. And I just found out today about this implicit association test where you can actually take a test and learn what are some of your biases so that you can have awareness. Have you heard of that?

Angela:               Yes. I actually heard there was a Harvard professor, I think it's Mahzarin Banaji, I heard her speak a couple of years ago. I actually wrote her name down to talk about her today. It's fascinating to hear her talk about how people develop biases and how they may not see them and how it might apply to each one of us. And I thought that was so true like when you meet somebody from your alma mater, you're automatically happy and you want to talk to them even more because there's a connection there. And so maybe a big part of this is do we try to connect with people who don't necessarily look like us, who don't necessarily, at least on the surface, have the connections we think we have?

I know from listening to your podcasts and being in the live events, I know that many of us have very similar things going on. We are more connected than we are divided. But if we don't get the opportunity to have those conversations, we're never going to know that. And so if you don't have any friends that don't on the surface look like you, then you don't get to have the deeper conversation where you find out how connected that you truly are.

Katrina Ubell:      Right, definitely. And what I'm hearing just from clients that I speaking to but then just also with the greater conversation is it's uncomfortable for a lot of people on both sides, but in general it sounds like minority people are open to discussing it, like you have to bring it up. It's okay to say, “Hey, I would like to set up some time to discuss this with you, I want to get to know you better, I want to learn more, I want to see how I can make a difference.” It's okay to ask even especially within your institution because those are the specifics, that's what you have more control over.

Angela:               Absolutely.

Katrina Ubell:      Of cause you have to do your own work on yourself, I think that's the most critical thing, definitely.

Angela:               I think that's really true. And again, so remembering that my response to this previously would have been very PC, would not have said a lot of things. And what I said to myself is this is so big right now, so many people are involved. And the protesting if you look at those crowds, everybody is in those crowds. I think everybody who looked at that video saw that there was something very, very wrong that would happen that is beyond what anybody would think is reasonable. And so for the first time, I'm saying I'm willing to have those conversations in a way that's very real and very raw as opposed to what is the politically correct thing to do so that everybody feels comfortable.

Katrina Ubell:      Like just trying to smooth it over. Which happened like you were saying, someone says something, there's this offensive thing that's said, but it's like, hey, listen, let's just move on.

Angela:               Let's just move on.

Katrina Ubell:      Exactly. And I think you're right, I think that there's an openness and a willingness to listen that is not one that I feel like I've experienced in my lifetime. Because it comes up, it's discussed whatever, but not to this level. And yeah somehow we're ready and I don't know why that is, I'm sure the historians will tell us later. Just hopefully there'll be big changes. But I think that is definitely very interesting. Let's transition just a little bit into personal life stuff. Let's talk about that with raising children, and what are the conversations that you're having with your children?

Angela:               So actually I think that's part of the reason why I'm unwilling to handle this as I have in the past. I have two girls they're 15 and 12. And while I don't have to have the big boy conversation that many of my friends do, one of my girls could be in the car with them when it happens or it could be at the park with them when it happens. And so we certainly have had conversations about how do you interact with law enforcement or anybody who's coming at you because they feel like there may be something, it's a situation where something is wrong. How should you react in a respectful way?

But hearing my 15-year-old say, “I don't think people care about me or who I am.” Or, “Because I'm black, my life doesn't matter as much.” It's pretty powerful stuff that makes you want to have a different conversation. Especially when you think about again, if my whole reason all of these years in being PC was to get to a point to have some type of influence, how am I going to use that influence in what I do every day professionally, but also personally? I want these girls to grow up and feel really confident about who they are. And know what their places in the world. But I certainly don't want them feeling less than, or like people don't care about them just because of the color of their skin. And so that's probably one of the biggest motivations for me as well to make sure I'm on, if you will, on the right side of this.

Katrina Ubell:      I do want to ask you just as you went through, we don't have to go through the details, but how you've risen to the leadership position that you now have, whether that was an issue in some way for some people, was there controversy around any of that? I'm curious how that all went down.

Angela:               So part of it was being at the place where I always say like, “If you are in leadership at the place where you have worked primarily, people know who you are.” So when you get to that leadership role, oh, yeah, I know her, great clinician, always took care of us, always took care of people, she really understands what's happening. So it's really easy to do in that sense. When you go to other institutions, part of it is what is the resume CV that you're bringing with you helps you in that regard. But then there are those times when, again because people see a certain type of person in a role, it's difficult for them to see someone who looks like me in the role. Have I experienced that? Absolutely I have. Was it hurtful?

Katrina Ubell:      So just to be clear, do you think it's because they're thinking you're only there because you're black and you're a woman, not because you're the best candidate?

Angela:               No, not so much that, it's more of because I see the white guy in the role as being more representative of what should be in that role, maybe that's who I'm going to promote next, as opposed to you, regardless of what you bring with you.

Katrina Ubell:      Oh, like merit or what you can contribute or anything.

Angela:               Yeah, exactly.

Katrina Ubell:      Oh, interesting.

Angela:               So I think that's real. And again, just wondering sometimes how much of that is gender, how much of that is race? Which part of that? It's probably just both and maybe they're equally part of it.

Katrina Ubell:      It's mashed.

Angela:               And those things are extremely hurtful, demoralizing, really can shake your confidence about what you can do or what you can do next. And again, another big pivot. And how do learn regardless of what's going on externally, internally how do you feel about it? And what are you going to do about it? And what's your next move? And how are you going to progress in spite of all that? I would say that's something that myself and many of my friends, that's part of our conversations. The happy hour conversation is about how are we going to continue to move forward even though at times you feel like there are forces that are holding us back? Those are part of those conversations.

Katrina Ubell:      And then from within the leadership role, as you are leading, do you feel like you get maybe pushback or…

Angela:               So I'll tell you a couple of-

Katrina Ubell:      …just resistance in ways? Yeah, go ahead.

Angela:               So sometimes you feel like you're getting that. So I've been in a situation where somebody spoke to me publicly in a way that it was beyond condescending, it was almost an attack that I remember leaving that meeting and getting out of the building because I was not in good shape afterwards. I held it together in there but had to get out of the building to where I felt like they didn't care who I was. Just as a person, didn't care enough about me to just think I may disagree with what she just said. I may not like what she just said, I may not even like her, but I'm going to be respectful, appropriate, and professional in this meeting in talking to her. But that they felt like they could dress me down. And I will tell you in that moment, I felt like it was because I was black, I was a woman, I was not at the same level in the organization as them.

I felt like the goal of that was to make sure I knew my place, that I was put down and I knew my place. And I can remember as I was recounting it thinking, gosh, don't they know that I'm somebody's wife, I'm somebody's mother, I'm somebody's daughter, I'm a person here. That they wanted to make sure that I was, and in front of many other people, that I was put in my place. And I'll tell you that feeling of somebody just not caring about you in any way, shape, or form, that they want to make sure that you know your place, that is a very… It's about power, which is a big part of what racism is about. It's about who has the power, who can make the decisions, who can help to make it better. When you think about systemic racism, part of it is about who has the power.

Katrina Ubell:      Yeah, definitely. So after that all happened, I'm just curious, did anything happen? Was someone spoken to? Or did anything come of that?

Angela:               It took some time, but some things have come of it. But it's the fact that can still happen and it was okay.

Katrina Ubell:      We want to believe it doesn't. We want to believe people don't do that anymore.

Angela:               And that the action that was taken was not swift, it took a while for something to happen and it didn't necessarily happen just because of that, but I do think that helped along the way. But can you imagine that can still happen? And the difference might be now, based on what we're seeing is that people want to take swift action. They want to have that conversation immediately, they want to make sure that's not happening to people. That's very real, I think that's very real right now.

Katrina Ubell:      Definitely. And I just want to say that I think it's so great that you're willing to even expose yourself to that. I'm sure as you accepted these roles and made it be known or whatever that you're interested. This is just like you wake up one day and here you are, there's a path and it does expose you. And so you are…

Angela:               Absolutely.

Katrina Ubell:      There's benefits and then there's also the consequences or negatives that come with that. And that, even though you're on the receiving end, hopefully, is moving things forward. People are learning more.

Angela:               Yeah, it is. Helping to move things forward, helping to show that we need diversity of thoughts. We all know that it's better when more people are involved in the conversation, we know that. We know that people do better in terms of their health when they're educated, we know that when people have a job and a home to go to that their lives are overall better. These are just key tenets of good communities that we already know that we are constantly working towards. We're constantly talking about social determinants of health, we're constantly talking about what else we can do better. And I think this is a wake up call to us to say, are we once and for all going to really do this in a way that leads to meaningful change?

Katrina Ubell:      My gosh, I hope the answer is yes.

Angela:               Yes, and I mean it. It almost has to be Katrina because if we allow this opportunity to come and go, like so many have in the past, really shame on us for-

Katrina Ubell:      I thought to myself like what has to happen for something… Similarly with school shootings, literally, oh, a whole bunch of children are a massacred, young children, maybe that will do it, nope. It's like maybe this is it, this is the thing that we've been waiting for. Maybe for it to be so blatant for it to be on film right there, maybe that's what has to happen to really get things moving. Do you have thoughts about this or just experiences to share about how black and African American patients are treated within the healthcare system broadly, but then also specifically by white physicians?

Angela:               So one of the things, when I was first in practice, I was in an area in a practice where the majority of my patients were black. So, for them to come in and to tell stories, stories of why they had picked that practice to come to, because somebody had not listened to them, or they hadn't been treated in a way that made them feel comfortable. For those that were older, that wasn't new to them, so they found a doctor who looked like them where they thought they could be heard. Where the physician had lots of different people that she utilized for consultants, but many of them were black and so that was very helpful to the patients as well. But they would tell stories about not being listened to or felt like they were moved, like their office visit was very quick, just half heard their complaint, quick exam, here's the prescription and go. Or being in the hospital and not having somebody listen to them fully or hear them out about their discomfort or their pain where they had to come back and have another procedure, that is real.

And that's real, those are experiences that people share. We've heard the stories you don't have to be necessarily poor or you don't have to be someone who doesn't know the lingo. This happens every person of color from any walk of life, there are times when they are not fully heard. And we have a huge responsibility to make sure that doesn't continue to happen. So I've heard those stories, I've heard the patients talk about them. I remember vividly one particular patient she was an older black woman. She had gotten dressed up that day to come to the doctor's office, she was undressed in the room with her gown on and I went in to see her and I was doing it full exam. And she had a mass in her breasts, it was so large and it was actually exposed.

And just gently asking her about why she hadn't come in. She talked about how she had been to see a doctor in the past and it hadn't been a good experience. And then her ability to get to the office and all of that. And what was going to be the beginning of a long road for her in terms of recovery, what was definitely going to be breast cancer, definitely going to require a mastectomy and all of that. Because she didn't feel like she had what she needed, she had a clinician to listen to her, she had the resources close enough to her. We're seeing instances all the time of where we have to get to where people are. There's a group that I participated in where we talk about move knowledge not people, move resources not people. We have to go to where they are.

And so if we're saying that we have demographics in the United States where people are not being able to live at their highest potential for health reasons because of how their community looks, because their housing isn't exactly where it needs to be, we do have a responsibility to get to where they are to help them do that. We know that the communities are better when people have housing, and have good health and have literacy. Because our education is going to be met. That's not new stuff and that's old, so how do we really get there once and for all and really start to improve the lives of people so that we don't see these instances of violence brutality that we've seen in the past, so that no one's going to look at another human being and somehow feel like they're not worthy of a good life or just treatment as an equal? It's just, we have to do more.

And I have to tell you, early in my medical training there was a physician who told all of us, one of our attendings, like, “You all must wear many hats, you can't just wear the doctor hat, you need to wear many hats. It's a privilege to be part of this profession and so there's a lot that's being asked of you and there's a lot that you need to do.” And I absolutely I feel that responsibility and probably more so now than I ever have before.

Katrina Ubell:      I love that, it's amazing. It really is, it's really true. Sometimes we think medicine owes us something but we really are so privileged to even be able to be there, I think it's easy to forget that. Let's talk about, if you could have white people's ear for a moment, what do we need to know? What are they like, please stop doing this, please stop saying that or you think this is okay and it's not, what are those things?

Angela:               I would say, so there's a couple of things. There are times when an assumption that if you know one black person you know them all. People are different, the funny thing about somebody will say, “Well, all black people look alike.” There have been times when people have called me by somebody else's name who was a black person, we look nothing alike, we're not even close, how you could even make that mistake is beyond me. And we can laugh about it and say that it's funny, but there's some reason why that happens, there's just an assumption. I think knowing that everybody is different, everybody has a different story. If you don't have any friends that look different from you, then get some, please. Just to have a better understanding.

And if there's something you don't know or something you want to know, ask the question. I think people want… Part of developing that friendship is about understanding each other, understanding where you come from, how you grew up, there'll be many things that are in common, there'll be other things that are different. Don't be afraid to have those conversations. Ask questions about those things that I know bother people like in a community where maybe there's only one parent in the household or maybe where it's a housing project and you're just trying to understand what that's all about ask the question. I may or may not know, but I'm happy to engage in that conversation. I'm happy to go find out the answer together, especially now because it's so important to all of us that we do.

And I think the reason asking the question or saying, I don't know, or for saying that I'm afraid of something, it's important for our kids. Because our kids right now are watching us, they're asking questions they want to know what's next. And so if we can really have those conversations, make them feel comfortable having the conversations, that's part of what's going to help us get out of this as we move into the future. So don't be afraid to ask things that you don't know, don't be afraid to genuinely inquire about what you might do if you feel like I just don't know what to do. Don't be afraid to speak up when you hear somebody say something and don't be afraid to make changes. We're all going to have to make changes but maybe there are people that are just not going to continue to be in your circle because deep down inside you know that they have a bias that to you is no longer tolerable.

Katrina Ubell:      Even as you're saying that right now, there's someone in the periphery of my life let's just say. And here's the thing I've known for a while, that's just not right. I'm glad you brought that up. What are just the things you want to make sure this is the point I want to get across, people need to know this?

Angela:               And I said it a little bit earlier because it's so true for me too, I'm going to stop being politically correct to make other people feel comfortable. I've spent a lifetime trying to be like everybody else, so they could be accepting of me so I can get to this next place. So I am here so what am I going to do moving forward? So I'm not going to be afraid to say black, I adopted the phrase African American. And now I feel like there are genuinely friends and colleagues who are truly African American, they we're born in that continent, lived there, have come to United States, have immigrated. This is where I have lived my entire life, I am a black American. It's very difficult for me right now to embrace that term because I feel like it does disservice to my true colleagues and friends that are African American.

So I'm embracing new terminology. I am embracing what I can do and say, I am going to be more vocal about saying we need to be more diverse and who we have in positions of leadership, and who we bring to the table to help us make decisions, that I want the workforce throughout healthcare and other places to look like the people that we serve. We have very diverse patients, usually very diverse medical staff, sometimes the leadership of our hospitals and health systems, not very diverse. That needs to look different if we're going to continue to have this conversation. I want us to feel like it's important that Americans look and come in every different shape, size, and hue and that we truly embrace that.

And I want to say to folks that feel like all lives matter right now we're saying black lives matter because that is the most recent egregious act that we have all been witness to in that video. And so this is the house that's on fire now, we're going to put that fire out and then we'll move on to the next house, the next house, the next house. This will help us build the foundation that will allow us to get to every group that has been oppressed and has not been allowed to flourish, that's really what we want. And I think one way that as Americans we can look back after 911, we were pretty embracing of one another as Americans because we felt like there was “an external enemy.” Our opportunity to come together and say that every person who's an American, every person in the world deserves an opportunity to be at their highest potential, why wouldn't we want that? Why wouldn't we want everybody to be at their best? Why would we want there to be a majority in a way that's depressing and oppressing others?

And so that's what I really want us to look at and to get to on the other side of everything that's happening right now. Is that we feel connected and we feel a sense of wanting to bring everybody up and everybody along to be at their best. That's what I'm going to really strive for, that's what I'm going to instill in the work that I do both personally and professionally because I feel like it's too important now to continue to just let it go.

Katrina Ubell:      Absolutely. I think it's refreshing to hear that. All of us taking ownership in it because I think so many people think, well, it's the black people's jobs to do that. And of course, the people have been like, oh, we have been for the entire time we could. But it's everybody has to take this on. You can't look at it like this isn't my problem. And just to share something that I've been thinking for myself as I've looked around like, who are the people who I hire to help me in this business? And I'm like, it's so interesting, I never went around and said, “Hey, I don't want any minorities in my business.” But that's for the most part what it looks like. And so thinking to myself even then questioning myself, like, I would never say, well, I don't want to minority my business. But is it okay to say, I want to actively go find a minority to bring in, is that offensive? I don't know. And I'm hearing that it's not offensive. So this is good to know.

Just even being willing to think about that and how would I approach that? Just opening our eyes to things we literally have just never even thought about or considered, this is how things start to change, this is how we make movement, so yeah. And even just having these conversations I think is so good. I love having a hard conversation on the plate, one of my favorites. Even though it's so uncomfortable, I can't even tell you, I just have to tell you. So I asked you when I asked the other women and just for anyone listening, I used a program where I could record a video because I felt like I wanted you to hear me ask you rather than to type it out in an email. But it was individual for each person. And so I had the idea and I thought it was amazing and then I'm like, let me sleep on it.

And then I woke up and I'm like, I think it's a good idea, is it a good idea? I think it's a good idea. Okay, I'm just going to do it, so then I did it and I sent it and then everything was sent. And then my brain's like, let's try to go into a shame spiral about what a horrible person you are. And it wasn't until I got the first response back that was like, yeah, actually I'd like to do that. I'm like, oh, okay. It is hard for everybody that doesn't mean we don't do it. And I'm so glad now I'm like literally my now self is so grateful to my a couple of days ago self who just did it anyway even though I was really afraid that maybe I was going to get the smackdown on what a terrible idea it was. So anyway, we have to be willing to just say this makes… I always feel like when I just call it out, it helps. I may be doing it wrong and apologize in advance.

It's not what I should be doing, but I think we need to talk about it. So anyway, Angela, thank you so much. Seriously, thank you, thank you, thank you, bottom of my heart for being willing to come on here and talk about this. And maybe we can turn this into an ongoing series or come back for the conversations. I want to keep this going, I don't want this just to be a standalone series like that one time I did that thing. I think it's something that we need to keep reminding ourselves of so if you'd be willing to be a part of that, I'd love that.

Angela:               Absolutely. Thank you so much and thank you for being willing to ask. It's a hard question, but it's absolutely needed so thank you for having the courage to do it.

Katrina Ubell:      Absolutely. All right. Thanks, Angela.

Did you know that you can find a lot more help for me on my website? Go to katrinaubellmd.com and click on free resources.