What does woke heart surgery look like?
The American College of Surgeons (ACS), founded in 1912, recently sent its members an email with its Report of Recommendations by its Task Force on Racial Issues. Fresh off the press in November 2020, the report opened with this phrase, "Following the killing of George Floyd"  the holy year zero. Even surgery is now connected to George Floyd. The report recommended an "Office of Diversity" and a "Regental Committee," along with ten other "Critical Enabling Habits." The ACS then created a "Diversity Pillar," one of five pillars of the ACS, to be addressed by a Board of Governors Diversity, Equity, and Inclusion Initiatives Workgroup and a Surgical Workforce Diversity, Equity, and Inclusion Workgroup. The Society of Thoracic Surgeons, a specialty group founded in 1963 that includes heart surgeons, has undertaken similar initiatives. As a practicing cardiovascular surgeon for 25 years and member of both organizations, I look with deep regret upon the embrace of woke ideology and obsession with skin color. It will lead, I suspect, to diminished membership appeal and prestige, a distracted focus and mission, and less respect for surgical heritage, in time, in both organizations. The elite surgical leaders, working within academia, have ignored the surgical majority in the ACS who do not support this political dogma or identity politics in general. As a kind of secular religion, woke ideology dictates that a person (in this case, a surgeon or a patient) is considered not as an individual, but rather as a member of a group, a category, based on skin color or sex or both. Woke ideologues reduce all persons in society, it seems, to the simple binary categories of white and non-white skin color, which are defined further as oppressor and victim groups, respectively. A person as an individual becomes irrelevant. The profession of surgery, in my opinion, needs to disregard this harmful ideology, preserve meritocracy, and maintain race and sex neutrality. To the operating surgeon to the patient in need, individual merit is what matters. Meritocracy is the enemy of woke ideology. While on a walk on a hot Saturday afternoon, I stopped to chat with a police officer adjusting his new Kevlar vest, waiting for a partner to arrive to search a home. The discussion went to the distinction of treating a person as an individual or as a member of a group, as a category. Indeed, a surgeon treats one individual at a time, does one operation at a time, provides one consultation at a time, sees one clinic patient at a time. We do not operate on a group of one skin color or another, or a victim group one day and an oppressor group the next. These are not even considerations. Woke ideology does not fit the profession of surgery, or, indeed, the field of medicine. All individual lives matter, one at a time. No group is singled out as more or less important. As every patient would say, my sidewalk consultant also said, "I want the best heart surgeon operating on me." As a heart surgeon at a large institution, I do not hire, fire, train, treat, or refer based on race or gender. While standing over a beating heart draped in an operative field, I could not identify the race or sex of the patient without prior knowledge. The heart of each human being is subject to the same diseases. To a heart surgeon, skin color is irrelevant in the operation and in practice. No patient asks for a surgeon who is hired because of skin color or sex, or to satisfy a Committee on Diversity, Equity, and Inclusion. Race-based and sex-based policies are detrimental to all parties. No one wins  neither the surgeon nor the patient, neither the majority nor the minority, and certainly not the organization. No one would wish to be considered a "Diversity Surgeon," which is to say a surgeon preferentially hired or promoted because of non-white skin color or female sex. When this phenomenon happens, and it has, even in historically great programs, referrals for heart surgery crash at that institution. Everyone knows why, and no one dares speak of it. High-quality surgical colleagues migrate elsewhere and let it burn. New surgeons are eventually hired to rebuild and restore reputation. For the "Diversity Surgeon," skin color or sex is the career subject of interest, the topic of talks and articles, a path to the spoils of leadership. Involvement in these diversity matters, indeed for all skin colors and both sexes, is a kind of check box for academic advancement, no matter how disconnected from reality. The goal of race-based initiatives in surgical societies, it would appear, is to force, or pretend to force, top-down change in surgeons, instead of nourishing bottom-up change in students. Pursuing the former, however, is no remedy for neglect of the latter. Perhaps the two surgical organizations could start with students in Chicago, the headquarters of both, a city that had 43 gunshot victims last weekend  treated, no doubt, by members of the ACS. As the saying goes, "one can never be woke enough." It should be added now that "an organization can never be diverse enough"  that is, to satisfy a Committee on Diversity, Equity, and Inclusion. Once established, the committee is here forever. Its chair and members will never, ever close it down. Instead, they will double down, expressing perpetual dissatisfaction. The goal of the committee will remain lofty and vague so that it is never achieved. We will never know. At a recent coronary bypass operation at my institution, the six team members in the room, half women, were from six different countries  the USA, Peru, Iran, Vietnam, China, and the Czech Republic. Each heart team member brings individual talent to the operating room, together with an individual experience on Planet Earth, as does the patient. Woke ideology, with its skin-color obsession and binary white and non-white categories, is simply irrelevant. In the operating room, diversity of personnel evolves naturally, standards of excellence are applied to all, and individual merit is the only measure. Image via Pixnio.