#TalkAsianHate

YouTube: Eugene Lee Yang of the Try Guys

When someone is unfriendly to you, how often do you attribute it to your race? How often does the possibility cross your mind?

Since I was a kid this has always been in the background, and it was worst in elementary school.  Second and third grade stand out:  Kids would pull the sides of their eyes up and down, chanting, “Chinese, Japanese, dirty knees,” or make fun of my name: “Ching-Chong-Cheng.”  In high school one boy in particular referred to me as “Cheng,” and always said it with a sneer.  It could have been innocent—I found him generally sarcastic and antagonistic in the most annoying way.  When I told him how it made me feel uncomfortable his demeanor changed immediately; he apologized and never did it again.  Looking back, he and his friends referred to one another by their last names, and often in that competitive, confrontational, adolescent male way.  So maybe that was actually his way of including me?  I think he harbored no specific malice, but his impact strayed far from any benign (ignorant?) intention, I think based on my own past experience.  I remember the encounter vividly, and to this day appreciate both my own courage to bring it up, and his willingness to accept the feedback and change.

I think my family and I experienced minimal direct racism as I grew up. But I have always felt self-conscious whenever bad news comes from China, like when babies were dying from melamine-tainted formula, and when thousands of dead pigs floated down a river in Shanghai. I hesitate to even mention these stories here, for fear of negative stereotypes they may incite or confirm in readers’ minds about Chinese people. We humans generalize about and denigrate groups we perceive as different from ourselves, often based on minimal information (and these days, more and more disinformation). When these events occurred I asked my friends, and they reassured me that the news was inconsequential.

Not so with coronavirus.  A close family member was verbally assaulted in the mall a year ago, by a white adolescent girl.  She just walked right up to him, two generations her senior, and started yelling, “This is all your fault!”  How entitled, how arrogant, and how brazen—to think you can just attack an elder stranger like that with no fear of consequence.  That is the privilege of membership in the dominant culture.  Hard for me not to feel defensive and alert to threat, not to mention rageful, after that. 

For the past several years, and especially the past year and the last two weeks, acute awareness of what makes me visibly different, and thus a potential target of prejudice and racism, occupies increasing space in the front of my mind.  Our family just road-tripped to Colorado and back.  Driving through the rural Midwest, I found myself thankful that Husband wore his university hospital, orthopaedic surgery logo jacket into the gas station stores.  I spent as little time inside as possible, made sure to be friendly, and felt noticeable relief every time someone smiled and treated me with kindness, or even just common courtesy. 

This hesitation–the vague and disconcerting paranoia I feel–is justified. It’s not debilitating, but I’m frustrated, annoyed, and angry about it.

* * * * *

How important is it to you that all people, including people of color, women, LGBTQ, indigenous and other marginalized groups, feel accepted and welcome, and treated with respect and dignity, everywhere they go?  How can you help?  Below are my suggestions.  I’m tired, friends.  Whatever you can do in your spheres of influence is much appreciated.

Educate yourself.  See links below to multiple articles and a very well-done video (I recommend the video most) to familiarize yourself with current and historical aspects of the Asian-American experience(s).  Talk to your Asian-American friends, if you have that kind of relationship.  But understand that they may not want to rehash their experiences just for your benefit.  Look for published stories to foster your empathy.  Then, if you can muster it, find ways to tell your friends and any other marginalized folks, “I see you.”

Seek diverse perspectives.  Asian-Americans are not a monolith.  Despite some overlapping aspects of culture, Chinese, Korean, Thai, Vietnamese, Indian, and all other groups have divergent histories in and out of the United States, and each individual in any group manifests their own unique experiences.  If you’ve met one of us, you’ve met one of us.  Resist the urge to oversimplify and overgeneralize.

Look at your own biases with self-compassion and accountability.  Biases are human.  We all have them.  It does the oppressed no more good for you to self-flagellate over yours, than if you ignored them altogether.  What matter are your awareness and self-management of your biases, and then your ability to help others do the same. 

Commit to doing the work.  This does not mean expecting perfect words and actions from yourself all the time.  We will all open mouth and insert foot; we will all fall into old habits of thought and assumption.  But we must persist; abandoning the work helps no one.  Every failure teaches us, if we let it, and this helps everybody.

Find a supportive community to hold you up and accountable in the work–friends, tribe members who love you through your struggles to reckon with yourself.  These will most often be people who have committed to doing the same work themselves.  Hold them up in return.  This is a group project; we all depend on one another to succeed.

The One and the Many

How do you change your words or message depending on your audience?

Weeks ago I read an article sharply criticizing public health messaging throughout the pandemic, and took a hard look at my own communication over the past year.  A year ago I wrote a series of posts on COVID, which were generally well received.  I have consistently taken a very conservative approach to mitigation, admonishing people to avoid gatherings and travel, mask up, and be patient.  In my public messaging, I have not directly addressed the mental, emotional, economic, and social costs of all of these measures. 

But what about in my private conversations?  How are they/am I different?

I thought of two groups with whom I interact:  Those whom I know personally, who trust me, and who think similarly to me, and those whom I don’t know, who may not trust me, and who think/believe differently from how I do.  Okay so six groups, not two—and they can overlap—I have patients who trust me and think very differently—but I think my messaging generally takes one of two approaches depending on my audience.  And in the end, I think it comes down to trust.

The One

When speaking to one person whom I know, or someone who agrees with me, two assumptions are at play: 1) they trust me, and 2) I trust that they trust me.  It sounds semantic, but I think it matters.

In this situation, I’m probably much more willing to admit uncertainty, and to ‘negotiate’ my position because I trust that my counterpart understands and respects my concerns.  So I’m willing to show vulnerability in my expertise because I trust that they know I will incorporate new information and update my recommendations.  I also trust them to know that it’s not because I’m stupid or gullible or on some kind of power trip—we’re all just learning and trying to balance everything that matters in a rock vs hard place situation.  When engaging in mutually trusting conversation, even in disagreement, openness, curiosity, and ambivalence can be taken as humility and seeking truth rather than weakness and lack of conviction, and both parties may be more likely to walk away with broader, more nuanced perspectives.  And best of all, the relationship can be strengthened, allowing for continued engagement, learning, and growth.

The Many

Posting to the blog or on Facebook, I think I run a much higher risk of being misunderstood.  I am responsible for providing clear and concise context for any expression or opinion.  My audience is diverse, and depending on any reader’s mood or context themselves, my words may be interpreted very differently one day or one moment to the next—and I have no control over that.  Do they trust me?  Can I trust them to assume my humility and good intentions?  Unclear.

In this space, depending on my mood, perhaps, I may feel defensive, and/or a deep desire to prove myself right.  I may be much less willing to admit to gaps in my knowledge or flaws in my reasoning, for fear that my expertise will be wholly discounted if one aspect of my interpretations or recommendations is imperfect.  If I assume my audience does not trust me, then I’m less likely to trust them to receive my intended message, to take my advice, and achieve my primary goals.  I get preachy, narrowing my perspective and failing to see more than my own point of view.  I ask fewer questions—that is always a red flag.  I make more assumptions, defensiveness increases, and my mind closes further.  It’s an emotional hijack of sorts, resulting in further disconnect and polarization.  Yikes.

Or maybe, just because I don’t know how my message will be perceived, I qualify and hedge, and lob ideas much more passively, inadvertently conveying that I don’t really believe what I’m saying, that I’m actually not trustworthy, just wishy-washy. 

So what should I do?

I think one solution is mindful attunement and differentiation.  As a communicator in relationship of any kind, but especially when I’m the expert, it is my responsibility to manage this dynamic polarity intentionally.  Face to face, I can make sure the other person feels seen and heard, by asking more questions, paraphrasing, reflecting their values and goals back to them.  When writing for an audience I cannot see or hear, I can respectfully acknowledge opposing opinions and their validity, before presenting my own arguments.  Above all, I can hold a larger space for everyone’s values, concerns, and objectives.  I see you.  Please see me.  What do we both care about?  What trade-offs are we willing and not willing to make to achieve our shared goals?

Results from my Think Again quiz, March, 2021

Adam Grant’s new book, Think Again, will be my personal and professional bible for a while, I think.  Its central tenets are intellectual humility and cognitive flexibility.  I may speak and write like a preacher about things that matter deeply to me.  But I will strive to think more like a scientist, seeking truth and connection above winning arguments and/or proving other people wrong.

In the end, as I practice myself, I will observe and apply these principles in other arenas.  Can we keep attunement and differentiation in mind when we hear leaders and politicians speak?  When a constituency is diverse, and an issue complex, can/should we expect a public figure/expression to convey nuance in generalized statements?  I say yes, absolutely.  I think we should hold leaders, as ourselves, to a much higher standard for acknowledging complexity and uncertainty.  Oversimplified sound bites divide and incite, and we should all reject them, strongly.  We can address complexity and uncertainty without inciting mass panic if our statements also clearly convey conviction to core values, and what we are for more than what we are against. 

We can all/each elevate the quality of both private and public discourse if we help one another feel connected throughout.  That means earning trust, and there is no substitute for the work it takes to do this.

The Value of Comradery

I’m having a party!

Well, not really.  I’m inviting colleagues to convene on video in the name of professional community and connection, so it’s almost a party.  It’s also my homework!

These six weeks I get to take Stanford’s inaugural online Physician Well-Being Director Course, along with over a hundred other physician leaders.  What a privilege and pleasure!  I’ve already learned so much, and we’re only one third of the way through.  I may have made a new friend—we bonded over our shared tendency to stress eat, and that we are both using the Noom app to overcome it.  It happened during a breakout session to sample a Comradery Group.

Turns out there is clear evidence that community building, done intentionally and purposefully, promotes clinicians’ overall well-being.  “Well, duh,” you might say (I have).  Why did this have to be studied formally?  But I get it now.  When there is objective evidence for direct benefit and a positive cascade (well physicians tend to have higher engagement, higher patient satisfaction, happier teams, and systems that thrive—relationally as well as financially), healthcare organizations are more likely to invest resources to execute the well-being programs shown to work. 

In a Comradery Group, the objective is more than just venting.  It’s about finding meaning, fostering growth, and supporting one another through empathy, querying, and sometimes even challenging—all in a psychologically safe environment.  Groups meet to discuss particular topics and are admonished to stay on task.  There is usually a facilitator.

I have always found communing with colleagues nourishing—particularly across specialties.  More and more, we toil in silos.  Advancing technology accelerates complexity of both diagnostics and therapeutics at breakneck speed in almost every field.  Everybody can barely keep up with their own work, let alone understand what’s happening in anyone else’s.  And with in-person conferences and other professional gatherings banned for the past year, our sense of community wanes further and faster.  Our disconnection propagates insidiously, and we will all pay in the end, physicians and patients alike.

So what better moment to tend and strengthen our connections?

I have a few colleagues from internal medicine, OB/gyne, ophthalmology, and orthopaedics ready to gather in meaning on Microsoft Teams.  Can’t wait can’t wait!  The first rule of Comradery Group is that what’s said here stays here; holding confidence is key to connection and trust.  We can set other rules at our (first) session.  The homework assignment is only to experience a group once, but my secret hope is that my colleagues will get enough from this meeting to consider doing it again (and again!). 

I’ve proposed some sample topics below.  I’d love to discuss any of them, and I’m sure my friends will suggest others.  Take a look—how could you adapt these questions to your own profession?  How are you and your colleagues at risk for burnout, and how do you imagine Comradery Groups could help?

Here’s something new for the blog:  If you answer one of the questions in the comments, I’ll share my own answer to the same in reply (or a separate post!).  Please also feel free to offer a different question, one that holds meaning and importance to you.

Times are hard and complicated.  We humans are social creatures.  The better we can maintain and strengthen our ties to one another, the less we will suffer—no—the more we will flourish

Onward, friends.  We are all we have.

  1. How has doctoring the past year through a global pandemic impacted your professional and personal outlooks?
  2. What lasting lessons from the past year do you want to keep front and center?
  3. What do you want most from your colleagues in other specialties?
  4. How would you change medical education?  Why?
  5. How have you seen medical culture evolve over your career, for better and/or worse?  How has this impacted your personal experience of your work?
  6. What concrete changes have you made to the way you do things, over the years and the past year?  What do you miss and not, about the way things used to be?
  7. What makes a hard day at work?  An easy day?  A good day?  A bad day?
  8. What is your preferred leadership style, as both a leader and one who is led?
  9. What is the value of DEI initiatives at work?  What are the barriers?  Pitfalls?
  10. What’s foremost on your mind right now for your own well-being?  How are you upholding it?