March 28, 2023

The Price of Silence

Annette Joe, MD, FACR, Clinical Associate Professor, Radiology. Division of Breast Imaging, University of Michigan

Annette Joe, MD, FACROver the years, many efforts have been made to address discriminatory practices in the workplace. Continued complaints by medical trainees reveal and remind us that the academic environment is no exception to this problem. It shouldn't surprise anyone that medical students, residents, faculty and staff often find themselves faced with the question of "what to do and how to react" when confronted with the reality of discriminatory comments or behavior by supervisors. Sadly, most victims decide to do nothing. Those that do report an incident often receive a pacifying response or a polite warning concerning possible retaliation.

It is still crucial for individuals who are targets of discrimination, whether microaggressions or blatant racism, sexism or religious discrimination, to speak up — not only directly to the perpetrator, but also to those higher up in authority. It is essential for any witnesses to also speak up.

Remaining silent at all levels has severely damaged the potential progress of Diversity, Equity and Inclusion (DEI), and is an insult to its principles. DEI is about opportunity — specifically growth opportunity — academic growth, institutional growth and, most importantly, personal growth.

If the issue of discrimination is not addressed, the status quo will truly remain alive and well, without significant consequences, as it often is today. The current approach to DEI has let leadership off the responsibility hook, remaining out of focus with little to no accountability.

Yes, our system is not only flawed, but frozen as well, in a state of suspended academic animation. If this surprises you, then the dark ages have returned. This does not bode well for the future, because we have not been able to face our past. In the late 1960s, the concept of DEI was adopted and intended to be the path forward in addressing and hopefully eliminating discriminatory behavior. This goal has not been accomplished. In many cases, the main thing programs do is protect institutions from Title VII violations. The seventh amendment of the Civil Rights Act of 1964, Title VII, prohibits employers from discriminating against employees and job applicants based on race, color, religion, sex and national origin. To date, almost 60 years later, many DEI programs have little to show that can be identified as progress and certainly have failed to address how to deal with the adverse behavior of individuals in power. These individuals serve in various capacities in the training of medical students, residents and fellows. The bottom-up approach has not provided subordinates the support they deserve, mostly because there is a lack of top-down interface. This has resulted in the troops not believing in the leadership and certainly not buying into the concepts and principles of DEI. This behavior now repeatedly allows individuals to avoid taking personal responsibility and promotes the delusion of inclusion.

In essence, it is the failure of leadership to impress upon faculty and staff the necessity of fair treatment to all — and to make the potential consequences of adverse behavior clear.

This article represents Dr. Joe’s individual views on the subject matter and not the views of the American College of Radiology.