The COVID pandemic and the burgeoning push for social justice are inextricably linked. While the stress of the pandemic on neurosurgery is unprecedented, the clarion call for social justice may be the defining mark of 2020. Given this, the authors were motivated to jointly express, as neurosurgeons and as individuals, a few thoughts regarding this transformative moment in American and neurosurgery history.
Social Justice-A Voice of Today’s Generation
The theme of humanity is thoughtfully discussed in a commentary written by Nwando Eze in the New England Journal of Medicine.1 She notes that when interacting with patients of differing backgrounds, the meaning of being human is called into question. While the ‘black lives matter’ movement is focused on police brutality, the greater theme of social (in)justice is the needed conversation that is currently emerging. As physicians and neurosurgeons, each day, we interact with patients, address their problems, and hear their stories. If one listens carefully, each individual story informs us about ethnicity, culture, gender differences, and struggles that each person uniquely faces. Too often, these remarkable stories and their lessons are lost within the milieu of hard-core science and the ‘business of medicine’. We may listen, but perhaps we do not always hear. Then, we evaluate traditional and non-traditional methods of healing, primarily through the lens of Western science. Insurance providers, bundled care, and reimbursement driven care models further dehumanize the delivery of healthcare, moving our conversations from “how can we help?” to “how will we benefit from treating the patient?” This is the essence of the difference between volume and value-based care – i.e., being rewarded for how much we do versus being rewarded for the good we do. Residents often find it difficult to swim against this tide and remain true to the right principles. However, each of us must strive to provide unbiased and equal access to neurosurgical care because it is right for our patients and allows us to remain consistent with our own social values.
Through the White Coats for Black Lives Movement, healthcare workers across the country staged kneelings to demonstrate togetherness and their support for social justice. The power of social media allowed us to witness demonstrations of empowerment, such as circulating videos of underrepresented minorities demonstrating their roles as leaders in their community and in healthcare. Numerous commentaries and opinion pieces have been written describing the interplay of healthcare and social injustice. Clearly, healthcare should have been leaders in this realm, but alas, it arrived late to the party. However, there is no greater time to evaluate mechanisms for personal and organizational improvement than now. Each neurosurgeon can start with the simple pledge to listen more closely to the nuanced tales of her/his patients. When they entrust themselves to our care, we must respond by taking the critical first step, listening with a non-prejudiced and non-judgmental ear.
Social Justice: A Voice of a Prior Generation
Where did we go wrong? As a society, we have offered a blind eye and a deaf ear to the subliminal, but ever present and often well-disguised racism and hate for too many years. When surveillance mechanisms and social condemnation of social injustice are “relaxed”, the always present undercurrent of hate and prejudice are exposed and allowed to be expressed without a check and balance. For too long we have remained silent perpetrators, through our failure to speak out and speak up.
We must fight to maintain this critical check and balance regarding the monitoring of social injustice. We must seek to suppress hate, racism, sexism and prejudice regarding sexual orientation. But how, you might ask? The Dalai Lama puts this in perspective with his statement:
“A lack of transparency results in distrust and a deep sense of insecurity.”
We should expect our leaders to be transparent. We should elect leaders who see the vulnerabilities within themselves and who are willing to share them with others, i.e. with all of us. Friedrich Nietzsche further frames this discussion by stating:
“The most common lie is that which one lies to himself; lying to others is relatively an exception.”
Self-awareness, honesty, transparency. We need leaders who do not fear transparency and honesty.
Where did we go wrong? The answer resides in the election/selection of leaders at all levels over too many years who are/were afraid of being vulnerable and thus did not deal honestly with the media, the public or other leaders. Each of us holds the power to begin the process of change. First in ourselves and then choosing the leaders who have the capacity to insure we forever maintain the critical checks and balances for our nation.
The Past and the Present Unite: Unintended Consequences
Change will require mechanisms that bridge not only racial, ethnic, gender and sexuality divides, but those that bring the generations of our country together. The wisdom obtained through listening to these different voices can inform a new day. There is the need to look within in order to fight against societal pressures and particularly as physicians/neurosurgeons allow the voices of our diverse patients to help raise us up to a new level. In addition, we must battle everyday as part of the system to establish and help nurture honest leaders who will maintain the checks and balances so crucially needed to guarantee that every individual feels there are viable surveillance mechanisms and that societal condemnation of social injustice prevails. Through deep connections like these, we can create and nurture an enhanced mechanism of fighting social injustice.
References
1. Eze, N. (2020). Equality Is Our Last Hope. https://doi.org/10.1056/CAT.20.0358
