19. Esther Choo and the Equity Quotient

Gender and racial bias are pervasive across all aspects of society, medicine notwithstanding.  In this episode, Esther Choo MD, MPH (@choo_ek), a titan for the cause of gender and racial equity discusses: a rubric for deciding 'yes or no', single payer healthcare, why confining medical practice to the bedside can be an exercise in futility, sexism and racism in medicine, the wage gap, workforce vs. leadership demographics, managing overtly racist patients, and why the culture of medicine is ripe for sexual harassment.

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For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

• Esther’s first outward advocacy:  responding to the Trump administration’s attempts to dismantle the Affordable Care Act [03:44];
• How you decide whether to say “yes” or “no” when you don’t have time to do everything that’s asked of you [06:15];
• Why investing in the development of a single-payer health system would provide better care upstream so that we can save on our costly low-value care downstream [11:00]; 
• What Esther will always stand up against:  inequity [17:20];
• The importance of advocating for systems solutions to problems, and how confining your practice to the hospital is an “exercise in futility” [19:00];
• Esther’s pre- and post-game routines before and after night shifts [25:20];
• Lessons Esther tries to impart on her trainees in the ED [29:00];
• The importance of meeting patients where they are, whether they’re a heroin addict, borderline personality, or an a-hole [32:50]; 
• Esther’s podcast, Doctor’s Log, which is a diary of the experience treating patients during the COVID pandemic [34:40];
• How Esther responds when a patient refuses to be treated by her because of her race [38:18];
• Sexism in medicine and how to get everyone (not just women) on board as advocates for equality and reversing disparity [43:55];
• How implicit bias is a side effect of being human [48:30];
• The discrepancy of the demographics in the workforce vs. in leadership positions [58:00];
• Explaining the gender wage gap in medicine [1:03:00];
• Strategizing solutions to gender pay inequity [01:10:00];
• Esther’s company, Equity Quotient, whose mission is to “work with standout health care organizations, employer groups and academic centers to create a culture of equity, safety, and respect” [01:11:34];
• The NEJM article,  Time’s Up for Medicine? Only Time Will Tell, and why medicine is ill-prepared to make meaningful steps toward ending harassment [01:17:00];
• Why change won’t happen if we don’t improve the diversity representation from the ground floor up to the highest leadership [01:19:45];
• The reason Twitter became Esther’s social media medium and how Chelsea Clinton’s comment on her tweet took her to the next level [01:22:56];
• Why patients of surgical attendings who are abusive to staff have worse outcomes [01:27:00]; and
• Esther’s call to action, [01:30:42].