The only Black person. The only Brown face. The only chocolate chip in the batch.

Welcome to what I call “The Chocolate Chip Factor”.

What It Is

You know the moment. You walk into the gala (not the NAACP Gala), the surgical conference, the board meeting, the neighborhood association, the required golf retreat for your job, the exclusive invite-only dinner, or an upper-level chemistry class at a predominantly white university…that was my first occurrence. You scan the room, not because you want to, not because you planned to, and the count happens automatically. It is involuntary. It is unconscious math that Black and Brown people have been doing since we were children.

One. Just me. Again.

The Chocolate Chip Factor is what I call the experience of being the singular Black or Brown person in a small, select, or exclusive group. Not a crowd. Not a conference of thousands. A room. A committee. A circle of colleagues. A neighborhood dinner party. The kind of setting where every presence is felt, and every absence is noticed.

And that is both the gift and the weight of it.

The Good News: You Will Be Missed

Here is something they don’t tell you enough: your presence matters more than you know. When you are the chocolate chip, your absence changes the entire composition. The flavor shifts. The frequency is different. Something is distinctly, noticeably missing. Anyone who has ever bitten into a cookie expecting chocolate and found none understands what I am saying.

I have been in rooms where I later learned my absence was felt, where colleagues remarked that the conversation was different, less textured, less challenged, less complete without a perspective like mine at the table. That is not a small thing. That is influence. That is impact. That is proof that diversity is not a checkbox; it is a main ingredient.

Black and Brown people bring something irreplaceable to these rooms. We bring context that others do not carry. We bring cultural intelligence, resilience-born creativity, and a perspective forged in fire that adds dimension to every conversation we enter. We are not just present for the hell of it. We are generative. We change the chemistry of a room simply by walking into it. The chocolate chip does not just sweeten the cookie. It defines it.

The Hard Truth: You Are Also More Visible Than Everyone Else

Now, to be clear, I have to talk about the flipside, because it is real. When you are the only one, you are seen in a way that is exhausting.

Your mistakes are louder. Your accomplishments are occasionally minimized by the unspoken asterisk of “for a Black Woman.“ You are sometimes called upon to represent your ENTIRE race, as if one person can carry the complexity of an entire people into a single conversation. You are watched. You are measured. You are occasionally tokenized by the very rooms that claim to celebrate your presence.

There is a particular kind of fatigue that comes from being perpetually visible. From knowing that everything you do, how you dress, how you speak, how much space you take up, how you respond when challenged, is being filtered through a lens that was never designed with you in mind. Oh, by the way, have you read White Fragility by Robin DiAngelo? You should.

And here is the thing I want to say plainly: I do not walk into these rooms looking to be the chocolate chip. I did not, nor will I, willingly apply for that role. I am not arriving as a symbol or a statement. I am arriving as an accomplished surgeon, a best-selling author, a thought leader, a person with expertise and intention, and a full inner life that has nothing to do with being the only one.

But the moment I walk in and the count happens…mine and everyone else’s, the Chocolate Chip Factor activates and the heat is on. Whether I want it to or not.

The Geopolitical Climate Makes It Heavier

Let me be very direct about the moment we are living in.

The current political landscape has made the Chocolate Chip Factor more charged, more fraught, and more consequential than it has been in decades. When DEI (diversity, equity, and inclusion) initiatives have been dismantled at the federal level, when Black history is being legislated out of classrooms, when the language of “merit” is being weaponized to justify the removal of the very structures that allowed diverse voices into these rooms in the first place, being the only one is different on another magnitude. It is no longer just a social observation. It is a data point in a much larger and more dangerous pattern.

When the systems designed to level the playing field after 400 years of suppression are gone, what do you do? Moreover, when tables that were built for me to sit at are being austentaciously disassembled in real time, I must contend with the new reality of being Black and a Woman in America. The fact that we are still in the room, still the chocolate chip, still showing up, still contributing flavor and substance to spaces that did not always want us…is itself an act of resistance. But let me tell you, resistance is tiring. Have you read Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society by Dr. Arline T. Geronimus? You should. And this is why we are allowed to name it. The Chocolate Chip Factor in 2026 carries the weight of a historic political moment that is actively trying to make our presence in these rooms optional, decorative, or erasable. That weight is real. It deserves to be spoken aloud.

So What Do You Do When You Find Yourself in a Chocolate Chip Moment?

I have thought about this a great deal. Hell, I live it daily. Here is what I have come to, as a physician and as a woman who has been the chocolate chip in more rooms than I can count.

First: Recognize it.

Do not gaslight yourself. Do not minimize the observation. When the count happens, let it register. Name it internally. I am the chocolate chip in this room. That recognition is not paranoia. It is clarity. And clarity is always the first step toward power.

Second: Read the room.

Not every Chocolate Chip Factor situation is the same. Some rooms are genuinely trying to grow. They are at the beginning of a real journey toward inclusion, and your presence is both welcomed and needed. Some rooms are performing diversity without any intention of structural change. You are smart enough to know the difference. Read the room. Not just who is in it, but who is running it, what decisions are made there, and whether your presence is being invited to contribute or simply to appear.

Third: Embrace it, on your own terms.

If the room is worth being in, be fully in it. Bring your perspective unapologetically. Speak when others go quiet. Challenge the assumptions that go unchallenged. You are not there to make people comfortable. You are there because you earned your seat, and your flavor makes the entire batch better. Own that.

Fourth: Who is allergic to chocolate?

You do not shrink. You do not change your composition to accommodate their discomfort. You hand them an EpiPen and keep moving. Their allergy is not your diagnosis to treat. Their discomfort with your presence is not your problem to solve. You did not create their intolerance, and you are not responsible for managing it. If they cannot function in a room where you are fully present, that is a them problem, not a you problem. But if the allergy runs the institution? If the intolerance is baked into the culture, the policies, the promotion structure, the very DNA of the organization? Find a new batch, plain is not your flavor.

Surround yourself with a collective that not only tolerates your presence but is genuinely better because of it. Those rooms exist. Build them if you have to, make your own cookies.

A Final Word

The Chocolate Chip Factor is not a complaint. It is not a victim statement. It is an astute lived observation, honest, nuanced, and necessary.

We bring flavor to every room we enter. We always have. The question is not whether the world deserves that flavor. The question is whether we are willing to keep showing up, keep insisting that our presence is not a diversity initiative but a human right. The answer, for me, has always been yes. But I reserve the right to choose which cookie I’m in.

Sonya Sloan, M.D. Orthopedic Surgeon | Author, “The Rules of Medicine” | Meidas Touch Network Contributor via Ellá Disruptors | Founder, SLOAN STEM+Arts | Co-Founder, National Black Women Physicians Day (#NBWPD)

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The Shift: From Activity to Strategy

Right now, many minority-led nonprofits are still operating from an activity mindset: more programs, more outreach, and more public participation. Now, don’t get me wrong, these are all good things. But boards, funders, and partners are asking a different question:

“How do you think?”

Not:

• What events did you host?

• How many people showed up?

But:

• How are you managing risk?

• What is your long-term strategy?

• Who are you accountable to?

• What system are you building?

If you can’t answer that clearly, your nonprofit will struggle to survive the next decade.

The 4 Lenses Minority Nonprofits Must Master

Allow me to be clear: after owning several for-profit and nonprofit organizations, I can say this is where many organizations are weak. Not because of passion, but because of the structure. Here’s the shift most miss: if you want to stay relevant, impactful, and revenue-generating, you must start operating through four lenses:

1. Risk: Stop Operating Like Passion Protects You

What I’m seeing is that many minority nonprofits confuse mission with immunity. They assume: “We’re doing good work, so we’ll be supported.” That’s not how this works anymore.

The reality:

• Grant funding is tight at best.

• Corporate DEI budgets are nearly non-existent (thank your president)

• Donor fatigue is real.

And organizations without varied revenue streams are exposed and vulnerable. The better question: Where is our mission outpacing our financial infrastructure? Because passion without protection is just vulnerability with nice packaging.

2. Strategy: Growth Is Not the Goal…Sustainability Is

Everybody wants to expand, more cities, more programs, and more impact. But here’s the unpleasant truth: Expansion without discipline can lead to collapse. Strong organizations ask: “What should we stop doing to excel?” Strategy requires the courage to say no, especially when needs seem endless, as in most Black and Brown communities.

3. Stakeholders: Your Community Is Not Your Only Audience

This might sting, but it’s why many minority nonprofits struggle early. Many are firmly established in the community, which inspired their founding. But nonprofits commonly lack a strong stakeholder strategy.

Your ecosystem includes:

• Donors

• Corporate sponsors

• Schools

• Medical care systems

• Government entities

If you limit communication to your community and don’t convey your value to decision-makers with capital, you reduce your impact. Here’s what you need to remember:

The shift: Stop explaining what you do and start demonstrating why it matters at scale. The truth is, funders don’t just invest in your heart or your passion; they put their money where they can see a visible impact through the clarity of a nonprofit’s strategic plans, outcomes, and systems.

4. Culture: Your Organization Is Producing Exactly What It’s Designed To

One of the greatest lessons I learned while growing my first nonprofit came from a program director (thank you, Sharon I.) at a large, influential nonprofit organization in Houston, Texas, previously known as Interfaith Ministries of Houston. And I quote… “Do Not Mission Drift!” Which I later learned means having a strong infrastructure for the nonprofit’s operations. So, let’s talk internal structuring, because this is where things quietly fall apart. Many nonprofits operate on informal leadership, reactive decision-making, and burnout disguised as commitment. Then they wonder why staff turnover is high, execution suffers, and growth stalls. Here’s something I know for sure: Culture and the success of your nonprofit isn’t your mission statement. It’s your operating system. It shows up in: who makes decisions, how quickly you pivot, what gets prioritized, and what gets ignored.

If your internal systems are weak, your external impact will always hit a ceiling and/or never get off the ground.

What This Means for the Next 5–10 Years

Allow me to say this plainly: Some minority nonprofits will not survive the next decade. Not because the work isn’t needed, but because the model won’t evolve. The organizations that will win are the ones that:

• Build revenue beyond donations.

• (think programs, partnerships, intellectual property)

• Operate with board-level thinking, not just community-level execution.

• Track real outcomes, not just participation.

• Develop tactical partnerships, not just sponsorships.

• Treat their nonprofit like a business with a mission, not a mission without a business.

The Bottom Line

Any organization, but particularly minority nonprofits, must take prompt steps to truly deliver long-term, measurable change. Move beyond inspiration, commit today to strengthening your systems, scaling your impact, and securing your nonprofit’s future.

So Food for Thought

If your nonprofit disappeared tomorrow, would your community genuinely feel the loss, or would another organization step in to fill the gap? Your vision deserves more, and most likely, the community or niche you serve needs you. So don’t settle, refuse to be replaceable. Start now: evaluate your model, strengthen your strategy, and lead your organization to be indispensable for the next decade.

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Women’s History Month was never meant to be a celebration. It was meant to be a reckoning. A reminder that the history of women, Black women in particular, is not a gentle story of gradual progress. It is a story of fire. Of being pushed to the edge of everything, citizenship, bodily autonomy, economic dignity, the right to vote, the right to heal, the right to simply exist, and choosing, again and again, not to fail.

I am a Black female orthopedic surgeon. Less than ~1% of the nation looks like me in my specialty. I was trained to fix broken things. And in today’s healthcare system in America’s political climate, I have never been busier.

We Came From Something Unbreakable

Before we talk about today, we have to stand in the full weight of where we came from.

Last year, I walked tearfully, unable to explain or fully express my emotions, through the doors of a Danish Cape Coast Slave Castle known as the “DOOR OF NO RETURN” in Ghana.

This experience changes a person, in character and human acknowledgement of historic atrocities, the world still diminishes today. The totality of the impact for me to stand where my ancestors were stored as cargo and handled as a business commodity was surreal. So let me paint the picture for you, mindful that my words will never do it justice. We came from women who were kidnapped from the African continent, stripped of language, name, family, and freedom. Women who were enslaved, raped, and forced to nurse the children of the very men who held them in chains, while their own children were sold away like livestock. Women who carried entire families on their backs across generations of trauma and still managed to sing, pray, love, build, and survive.

We came from women like Harriet Tubman, who did not just escape slavery… she went back. Nineteen times. Into the mouth of the southern hell monster, to pull others out. That is not bravery. That is a spiritual calling. That is what it looks like when a Black woman decides she is done asking for permission.

We came from Ida B. Wells, who boldly documented the terrorism of lynching when every institution around her looked away and even tried to quiet her perspective. From Fannie Lou Hamer, who was beaten nearly to death for trying to register to vote, and then stood before the entire Democratic National Convention and told America exactly what they had done to her body. She did not whisper it. She austentaciously testified.

We came from the women of the Civil Rights Movement who were told to walk behind the men, organize the meetings, stuff the envelopes, cook the meals, and sit down when the cameras turned on. Yet and still, they kept the entire movement alive anyway.

We came from women who raised doctors, lawyers, judges, and presidents on domestic worker wages. From women who prayed through every injustice because prayer was sometimes the only weapon they were allowed to hold.

We are NOT fragile. We were NEVER fragile. We were just told we were.

We Clawed Our Way to the Table…

Here is what no one wants to say plainly: We made progress. Real, documented, hard-fought progress. Black women voted. Black women ran for office. Black women became doctors, surgeons, CEOs, senators, and Vice Presidents of the United States of America. We published, we healed, we legislated, we led.

And then, strategically and systematically, they started pulling the table apart, removing chairs, and, in fact, gaslighted the same thresholds they said would ensure diversity, equity, and inclusion.

Let’s be honest about what has happened to women’s rights, not as a partisan talking point, but as a clinical diagnosis of a nation in crisis.

Reproductive Rights: The overturning of Roe v. Wade (June 24, 2022) was not a surprise. It was a decades-long political strategy, executed with precision, to strip women, and disproportionately Black women, of the right to make decisions about their own bodies. Let me be very clear: Black women die in childbirth at three to four times the rate of white women in this country. We are already navigating a maternal mortality crisis that the medical system has largely ignored. And now, we are told that the state knows better than we do about what happens inside our own bodies. The same America that enslaved our reproductive labor for 200 years now wants to legislate it. Do not miss the irony. Do not let them bury it in political language.

Voting Rights: The Voting Rights Act, signed in 1965 after Bloody Sunday, after John Lewis was beaten on that bridge in Selma, has been gutted piece by piece. Voter ID laws, voter roll purges, polling place closures in majority Black and Brown communities, gerrymandering, and the deliberate erosion of protections that were written in the blood of our ancestors. Fannie Lou Hamer’s sacrifice is being undone in real time, and we are supposed to stay calm about it. Oh hell no!

Healthcare Equity: DEI programs, the very initiatives built to dismantle the structural racism that was documented, evidenced, and peer-reviewed, are being dismantled under the guise of “merit.” As if the past 400 years were a meritocracy. As if the Tuskegee study were a meritocracy. As if the documented reality that Black women’s pain is systematically undertreated and dismissed in emergency rooms across this country is a meritocracy. This is not policy. This is erasure dressed up as a political regime. Is America Great Again? I think not!

Education: The rewriting of history, making it illegal in some states to teach the full truth of slavery, of Jim Crow, red-lining, of the systemic machinery that built this nation on Black and Brown bodies, is not a coincidence. It is a blueprint. You cannot dismantle a system you were never taught existed.

We have to call it what it is: a coordinated political strategy to return power to those who fear what a fully liberated Black Woman looks like.

In his book 1984, George Orwell warned us, “Control the past, control the future.” When they ban the teaching of Black history in our schools, they aren’t protecting children. They are the protecting power. And they are right to fear it. Because SHE is extraordinary.

The Diagnosis Is Clear. Now Here’s the Plan.

I am a physician, a surgeon. And in medicine, we do not crumble in the face of a difficult diagnosis or chaotic surgical field. We study the anatomy, we understand the physiology, and we read the chart (a.k.a. history). We assess the damage. And then we strategically gather our team and tools, we treat, measuring twice and cutting once.

Here is what I know to be true, standing in the legacy of every Black Woman who came before me:

We have ALWAYS been most powerful when we were most DISRUPTIVE.

Rosa Parks did not politely request a seat. She sat down and refused to move. Shirley Chisholm did not wait for an invitation to run for President. She ran. Mae Jemison did not wait for NASA to decide it was time for a Black woman in space. She became an astronaut and went. Ketanji Brown Jackson did not ask permission to become the first Black Woman on the Supreme Court of the United States. She was undeniably qualified, and she took her seat.

Every single inch of ground we hold was taken by a woman who was willing to be uncomfortable, unpopular, and unapologetically disruptive.

So what does that look like right now, in this moment in history?

It looks like voting, in every election, at every level, every time. School boards matter. County commissioners matter. State legislators matter enormously right now. They are the ones writing the laws that govern our bodies and our children’s education.

It looks like demanding that medicine do better, that Black women’s pain be believed, that maternal mortality be treated as the public health emergency it is, that our daughters grow up in a country where a doctor listens to them.

It looks like supporting Black Women in every room, buying our books, amplifying our voices, funding our campaigns, mentoring our girls, and refusing to participate in the systems that pit us against each other.

It looks like being the disruptor in your own circle. At the dinner table. In the boardroom. In the church. In the school board meeting. In the doctor’s office. Wherever you are, say the thing no one else will say. Show up. Refuse to be silent.

It looks like raising daughters and sons who know their history, the full, unvarnished, magnificent, painful truth of it, so that they are equipped to build a future worthy of our ancestors’ sacrifice.

A Note for the Future

To every young Black girl reading this someday:

You come from women who were told they were nothing, and became everything anyway. You come from women who were enslaved and became freedom fighters. Who were silenced and became the loudest voices in the room. Who were erased from history and built a new history with their bare hands.

You are not the problem. You are not too loud, too much, too angry, too ambitious, or too anything.

You are the answer.

The work is not finished. It may not be finished in your lifetime, or mine. But every generation of Black Women has left the world freer than they found it, not because freedom was given, but because they took it. They disrupted. They demanded. They did not wait.

Your job, our job… is to do the same.

Women’s History Month is not a celebration of how far we’ve come. It is a commission to keep going.

We are not done.

And neither are they. So neither are we.

With love, and an unapologetic, unbreakable spirit

Sonya Sloan, M.D., Orthopedic Surgeon | Author, “The Rules of Medicine” | Co-Founder, Ellá Disruptors contributor of MeidasTouch Network | Founder, SLOAN STEM+Arts Inc. | Co-Founder, National Black Women Physicians Day (#NBWPD)

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Representation matters.
Seeing someone who looks like you in a white coat, a lab, a boardroom, or behind a tech startup logo absolutely matters.

But here’s the part we don’t say out loud enough:

Representation alone does not change outcomes.
Mentorship does.

If visibility were enough, we wouldn’t still be talking about leaky pipelines, burnout, and why so many brilliant minority students never make it from interest to impact in STEM and medicine.

A poster child is not a support system.

The Myth: “If They Can See It, They Can Be It”

We love this phrase. It’s catchy. It’s comforting. It’s incomplete.

Seeing a surgeon, engineer, or scientist who looks like you may spark inspiration — but inspiration without access, guidance, and protection fades fast.

What kids actually ask (even if they don’t say it out loud):

• How do I get there?

• Who explains the rules nobody writes down?

• Who helps when I fail my first exam?

• Who advocates when bias shows up wearing a smile?

That’s mentorship. Not selfies. Not panels. Not one-off career days.

Mentorship Is the Difference Between Entry and Endurance

In medicine and STEM, talent is evenly distributed. Opportunity is not.

Mentorship does three critical things representation cannot do alone:

1. It Transfers Insider Knowledge

Mentors explain:

• Which classes actually matter

• How to ask for research opportunities

• What not to put in an email

• How to survive spaces that weren’t built with you in mind

This is cultural capital — and it’s usually inherited, not taught.

2. It Creates Psychological Safety

Minority students often navigate:

• Imposter syndrome

• Isolation

• Microaggressions masked as “feedback.”

A mentor says: You’re not crazy. This is real. And here’s how you move through it without shrinking.

That validation keeps students in the game.

3. It Provides Continuity, Not Just Motivation

One conversation doesn’t change a trajectory.
Sustained mentorship does.

That means:

• Checking in after setbacks

• Adjusting plans

• Staying present when the excitement wears off

That’s how pipelines stop leaking.

Access Without Support Is a Setup

We love to open doors.
We’re less consistent about walking students through them.

Programs that focus only on exposure — a camp, a tour, a one-day workshop — feel good but often fall short.

What works better:

• Long-term mentor matching

• Academic + emotional support

• Real-world skill building

• Accountability on both sides

Otherwise, we’re celebrating access while quietly accepting attrition.

And that’s not equity. That’s optics.

So What Do We Do During Mentorship Month?

Here’s the challenge — no sugarcoating:

• If you’re visible, be available.

• If you’ve made it through, reach back intentionally, not occasionally.

• If you run programs, measure retention, not attendance.

• If you’re mentoring, ask: Am I showing up consistently or symbolically?

And if you’re a student or parent:

• Seek mentors, not just role models.

• Ask for follow-up, not just advice.

• Choose programs that invest in the long game.

Final Word

Our kids don’t just need to see success.

They need:

• Someone to translate the system

• Someone to advocate when it’s uncomfortable

• Someone who stays when it gets hard

Because in STEM and medicine, mentorship isn’t a bonus.

*Support SLOAN STEM+Arts Inc. | www.sloanstem.com

We talk about moral injury as a clinician’s burden, a term borrowed from the military to describe the psychic toll of doing what’s necessary instead of what’s right. In medicine, it’s when we follow protocol instead of our instincts, or discharge a patient too soon because the bed’s already promised to someone else.

But lately, I’ve been thinking about moral injury from the patient’s side. Because if we’re being honest, the healthcare system doesn’t just break doctors, it breaks patients, too.

Picture a mother with two kids, diabetic and working hourly shifts. Her SNAP benefits just vanished with the government shutdown. The grocery bill doubled, but her paycheck didn’t. She’s rationing food, skipping insulin, and silently praying her body holds out until Congress decides to start caring again.

That’s not irresponsibility. That’s moral injury.
It’s guilt wrapped in survival.

Every time a patient has to choose between filling a prescription and filling a pantry, that’s a moral injury. Every skipped follow-up visit to save on gas, every postponed surgery to avoid a paycheck loss, it’s a choice that eats away at dignity, not just health.

As a physician, I can tell you: hunger and healing do not coexist.
Food insecurity means slower recovery. Malnutrition means weaker bones, thinner blood, and higher infection risk. And when SNAP… the most basic safety net for 40 million Americans, is yanked away mid-crisis, we’re not just watching an economic failure. We’re watching a health crisis bloom in real time.

We will see it in the ER soon enough.
Hypertensive spikes leading to strokes. Diabetic ketoacidosis means increased loss of life and limbs. Kids coming in underweight and inability to concentrate at school. Elderly patients fainting from skipped meals and possible medications as well. This isn’t political theater, it’s physiology.

Moral injury is often invisible. It hides behind polite smiles and quiet apologies.
“Sorry, Doc. I couldn’t afford it this month.”
They say it like they failed me. But really, it’s the system that failed them.

And the irony? Many of these patients still show up for work, for their families, for their communities. They keep pushing, even as the safety nets unravel under their feet. That’s not weakness, it’s resilience wearing thin.

Doctors talk about burnout. Patients live it as daily survival.
Both are moral injuries of the same broken system. A system that has turned against them potentially for their age, sex, race, nationality, and or religion.

Until we build a system that stops forcing impossible choices, between treatment and rent, between food and dignity, we will keep producing moral injury by design.

This isn’t just a shutdown of government. It’s a shutdown of compassion.
And when survival requires self-betrayal, it’s not just a health issue, it’s a moral one.

Reflection:
Next time a patient “refuses” treatment, ask why.
You might discover it’s not rebellion…it’s survival.

Healthcare systems are consolidating. Bureaucracy is growing. Patients often feel like data points rather than people. And for many physicians, burnout is no longer an abstract threat — it’s a daily reality.

So it’s fair to ask: Do physicians still matter in an age of algorithms, apps, and automation?

The answer unequivocally… is yes.
And perhaps more than ever before.

The Trust Factor

Despite the noise, the data continues to affirm what we often forget: physicians remain among the most trusted professionals in the world.

According to Gallup’s annual “Honesty and Ethics” survey, doctors consistently rank near the top, just behind nurses. In 2024, over 80% of Americans said they trust physicians to act with honesty and integrity. That trust hasn’t wavered through political shifts, pandemics, or social upheaval.

Why?
Because medicine, at its core, is still human.

Our patients don’t come to us because of a policy or a platform. They come because they believe we will see them, listen to them, interpret their situation, and act in their best interest. That moment of connection is sacred. It’s not an algorithm. It cannot be outsourced, automated, or scaled.

In an era when misinformation spreads faster than the flu, a doctor’s calm voice and evidence-based perspective still cut through the noise.
When we speak, people listen.
And that’s power, not for self-promotion, but for the public good.

The Power of Presence

We underestimate how much our presence means.

There’s a quiet authority in walking into a room, meeting a patient’s eyes, and saying, “I’m here, and we’re going to figure this out.”

That sentence alone can lower blood pressure. It can change the tone of a visit. It can transform anxiety into hope.

But presence extends beyond the clinic.
When physicians show up in schools, churches, community centers, and boardrooms, something shifts. We signal that health is not confined to the hospital; it lives in the community, in conversations, in prevention.

During the height of COVID-19, many of us became translators, interpreting data, calming fears, and helping families navigate impossible choices. That moment revealed something profound: the physician’s role is not just medical, it’s moral and social. We hold space for truth when others hesitate.

Our presence still matters because trust is built on proximity. People believe those who show up. And we must keep showing up… visibly, consistently, and compassionately.

The Weight of Our Words

A single sentence from a physician can change a life.
Sometimes it’s medical: “We caught it early.”
Sometimes it’s motivational: “You can do this.”
Sometimes it’s deeply personal: “I believe you.”

In a healthcare landscape saturated with noise, headlines, and quick takes, the physician’s voice is still uniquely steady. Patients replay our words. Families quote us at kitchen tables. Communities use our guidance to shape their decisions.

That’s why advocacy matters. When physicians speak publicly about vaccines, nutrition, environmental health, access to care, or systemic inequities, we influence far more than we realize.

Our credibility doesn’t rest solely on expertise; it’s built on consistency.
We’ve earned that platform through years of training, sacrifice, and service. And it’s time we use it, boldly, wisely, and often.

Leadership Beyond the White Coat

Physicians are not just healers; we are also leaders.

When we speak up, policy changes.
When we organize, institutions listen.
When we mentor, the next generation rises.

Leadership today doesn’t always look like a title; it looks like visibility, authenticity, and courage. It’s the orthopedic surgeon mentoring young women of color into medicine. The internist advocating for equitable access to care. The pediatrician is running a local vaccination drive.

In every act, large or small, we reinforce a truth: physicians are still the moral compass of healthcare.

Our advocacy sets the tone for how society defines health, compassion, and justice. When we lead, others follow not because of authority alone, but because our actions build trust.

The Lifeline of Trust

Institutions may falter. Systems may strain. But trust in individual physicians remains a lifeline for patients, communities, and the healthcare system itself.

That trust is earned every day in exam rooms, operating theaters, and late-night phone calls. It’s sustained by humility and humanity, the willingness to admit what we don’t know, to listen before we prescribe, to care even when we can’t cure.

As healthcare becomes increasingly digital, the doctor-patient relationship will remain our most excellent safeguard. Technology can extend our reach, but it can’t replace our presence.

So yes, physicians still matter.
Not because we wear white coats, but because some of us carry light.
In every conversation, every diagnosis, every act of compassion, we remind the world that medicine is… and must remain human.

The Takeaway

If you’re a physician reading this, take heart.
Your role is not diminishing, it’s evolving.
And in that evolution lies our greatest opportunity: to lead with trust, to teach with clarity, and to heal with empathy.

Because even in the age of AI, the most advanced tool in medicine is still the human heart.

Reflect & Respond

Where do you see trust breaking down, and how can physicians help rebuild it?
Drop your thoughts in the comments or share this piece with a colleague who needs a reminder: you still matter.

The Origins of the 3.5%

History has taught us that real change rarely begins with the majority; it begins with a committed few. The concept of the “3.5% rule” was popularized by political scientist Erica Chenoweth, whose research examined over a century of civil resistance movements.

Chenoweth discovered that NO campaign of nonviolent resistance that mobilized at least 3.5% of a population EVER failed to bring about major political or social change.

Let that sink in… just 3.5%.

That’s not the whole nation, not half, not even a tenth.
Just a small, passionate fraction of people determined enough to act.

From the Civil Rights Movement to South African apartheid to Women’s Suffrage and more, these transformative moments didn’t start with the masses. They began with a courageous few who refused to stay silent in the face of injustice.

Why the 3.5% Still Matters Today

In our time of disinformation, fear, and polarization, the 3.5% represents moral clarity in a world that often chooses comfort over conviction.

The question is no longer, “Can one voice make a difference?”
It’s, “Will we be one of the 3.5% willing to speak when it matters most?”

We live in a society where silence often feels safe. But silence can also be compliance. When people are denied dignity, when systems discriminate, when truth is twisted into convenience, the silence of the good becomes the shield of the unjust.

The power of the 3.5% isn’t in noise, it’s in presence.
It’s in collective courage, rooted in moral and civil responsibility.

Standing on the Side of Justice—For All Humans

Moral courage isn’t a performance. It’s a decision.
It’s not about taking sides politically; it’s about taking a stand ethically.

When we speak for those whose voices are ignored, we echo the same conviction that drove generations before us: that all people deserve freedom, fairness, and respect.

Whether in medicine, education, government, or faith communities, we must reclaim the sacred duty of justice for all, not just those who look like us, think like us, or pray like us.

Because being human means being accountable to the humanity of others.

The Call to Action

So here’s the challenge:
Don’t underestimate your voice.
Don’t wait for permission to care.
Don’t assume “someone else” will step up.

You are someone’s 3.5%.

Whether you march, mentor, vote, or tell the truth out loud, your courage counts.
And if enough of us stand together in conviction and compassion, the moral arc of justice will not just bend…it will break barriers.

Because change doesn’t start with everyone.
It starts with enough.

3.5%. That’s enough to change the world.

🩺 Sonya Sloan, M.D. (aka #OrthoDoc)
Orthopedic Surgeon | Advocate for Equity & Humanity
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This mistrust isn’t paranoia. It’s a rational response, shaped by history, reinforced by daily experiences, and worsened by systemic inequities.

The Numbers Behind the Mistrust

Medical mistrust is measurable, and the data paint a stark picture:

• 1 in 5 Black adults in the U.S. say they’ve been mistreated in a healthcare setting (KFF, 2023).

• 56% of Hispanic adults report struggling to find a provider who communicates clearly (Commonwealth Fund, 2022).

• Only 14% of Native Americans believe their healthcare needs are being fully met (Urban Indian Health Institute, 2021).

• Black women are 3–4 times more likely to die during childbirth than white women (CDC).

Trust is not just an emotional state; it has a direct impact on health outcomes. Communities that mistrust medicine are less likely to seek preventive care, adhere to treatment plans, or participate in clinical trials that could lead to advances in cures.

The Roots of Mistrust

1. Historical Betrayals

From the Tuskegee Syphilis Study to Henrietta Lacks’ cells taken without consent, medicine has often advanced on the backs of Black and Brown bodies… without respect, consent, or acknowledgment. Native and Latina women endured forced sterilizations well into the late 20th century. These aren’t distant stories; they live in family memories, passed down like survival instructions.

2. Everyday Encounters

The mistrust isn’t only about the past. It’s about being dismissed when describing pain. It’s about a woman’s maternal warning signs being overlooked. It’s about having symptoms, questions brushed aside, or cultural health practices.

3. Systemic Barriers

Healthcare deserts, long wait times, unaffordable prescriptions, and a lack of providers who look like or understand their patients all reinforce a single message: “This system isn’t built for you.”

Perspectives from the Margins

For many, the exam room is not neutral ground. It’s a place where identity shapes the outcome.

• The Black father who hesitates to take his child for an asthma check-up because he knows he won’t be heard.

• The Latina grandmother who doesn’t refill her prescriptions because no one explained them in Spanish.

• The Native woman who skips care entirely because the closest clinic is hours away, and when she gets there, she feels more like a statistic than a patient.

These stories reveal a more profound truth: mistrust is not irrational fear. It is a survival strategy.

What It Will Take to Fix It

If trust has been broken, how do we rebuild it?

1. Representation Matters
   When patients see doctors, nurses, and researchers who reflect their cultural background and language, outcomes tend to improve. Diversity in medicine is not just a quota; it’s a lifesaving intervention.

2. Radical Transparency & Accountability
   Hospitals and healthcare systems must acknowledge past wrongs and take responsibility for their mistakes. Apologies, policy changes, and community engagement extend beyond silent denial.

3. Community-Centered Solutions
   Barbershops, churches, community centers, and schools are trusted spaces. Bringing health programs to where people already gather, instead of expecting them to step into intimidating clinical spaces, builds bridges.

4. Cultural Competency as Core Training
   Medical education must move beyond “one lecture on diversity.” Understanding bias, communication barriers, and systemic inequities should be treated as essential to diagnosis and treatment.

5. Listening as Medicine
   The first act of healing is belief. Listening deeply, without rushing or minimizing, is often more powerful than a prescription pad.

A Final Word

Medical mistrust is not a wall we can scale; it’s a wound we must carefully heal. History cannot be rewritten, but the future of healthcare can be reimagined.

Trust is not rebuilt solely by technology or policy. It is rebuilt person by person, community by community, and conversation by conversation.

Because in the end, the most powerful medicine is not found in a vial or a pill, it’s found in trust.

If this resonates with you, share it with someone who needs to hear it.
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Let me get straight to the point:
AI is disrupting healthcare; good or bad is still to be determined, but nonetheless, most of us in the medical field are already behind. Not because we’re lazy, not because we’re unwilling… but because the system isn’t built for us to keep up.

While the rest of the world is riding the AI wave, many of us are still drowning in EHR tabs, faxes (yes, literal faxes), and patched legacy software from a bygone era. And even when we do finally adopt new technology (side note: cost prohibits a lot of medical inertia), it often feels like it was designed for us, but not by us, and certainly not with our patients in mind.

This isn’t just about efficiency.
It’s about power.
It’s about bias.
And it’s about the future of care… if we’re bold enough to reimagine it.

Let’s Talk Truth: Medicine Is Behind

Here’s the hard truth. We train for a decade or more in anatomy, pathology, pharmacology, but not in data fluency, AI ethics, or machine learning algorithms, and definitely not in politics or business.
We know how to assess risk in the ER and OR, but not when it’s laced into an algorithm used in predictive diagnostics.

Most of us are users of technology, not its shapers.
And when you’re not shaping something this powerful, you are being shaped by it.

Now Let’s Talk Bias: Who’s Controlling the Code?

AI is not neutral by any stretch of the imagination
Let me repeat that… AI is not neutral (learn more about seeding).

The outputs are only as unbiased as the inputs. And guess who controls those inputs?

• Tech companies.

• Investors.

Engineers who, frankly, often don’t look like us, live like us, or understand the communities we serve. In 2019, less than 2.4% of AI creators were African American, and 3.2% were Hispanic PhD graduates.1

Healthcare AI tools are being trained on data that underrepresents Black and Brown patients, women, rural communities, and people with disabilities.
You think health disparities are alarming now?
Let a biased algorithm guide your triage system and treatment plans.
Let a data set built on wealthy white urban populations decide who gets flagged as “high risk.” This will inevitably limit what and who insurance companies will cover, leading to a great health divide in humanity.

It’s not hypothetical… It’s happening.
And most physicians are unaware of it, because we are not trained for it.

How to Use AI — Without Getting Used by It

I’m not anti-AI. I’m anti-blind adoption. I believe AI can, and should, make our work easier, safer, and more patient-centered. So here is how we can strategically impact the future of medicine with AI:

1. Become AI-literate.
Learn how these tools work. Ask where the data comes from. Know the difference between generative AI and predictive AI. If you don’t understand it, you can’t challenge it.

2. Use AI to reduce burnout, not amplify bias.
Let AI summarize notes, assist with prior authorizations, or translate instructions for patients.
But you stay in charge of the diagnosis.
You ask the human questions.
You maintain the empathy.

3. Advocate for inclusion at the table.
We need more clinicians, public health experts, educators, and patients in the rooms where this tech is being built.
Not as tokens.
As decision-makers.

4. Train the next generation differently.
If your med school or residency program isn’t teaching about AI, say something. If you're a mentor or a leader, incorporate this into your training approach for others. This isn’t optional anymore. It’s a must for the future of medical professionals.

What the Future Demands of Us

The power of AI will not be measured in how fast it works, but in who it works for.
And right now, that power is disproportionately in the hands of people who don’t live the medical reality we do as doctors, nurses, physician assistants, nurse practitioners, and other medical professionals… long hours, complex patients, cultural nuances, human grief, and bureaucratic red tape, that no algorithm can quantify.

If we want AI to truly work in medicine, then we need to stop waiting to be invited into the conversation.

We are the conversation.

Final Thought from #OrthoDoc

Healthcare has always been slow to change.
But that can’t be an excuse anymore.
AI is here. It is not going anywhere. It’s moving fast. And if we don’t lead, we’ll be led… by code written in a boardroom, not a clinic or operating room.

So here’s your call to action, colleague, innovator, disruptor:

Don’t just use the tools. Shape them. Question them. Challenge them. Improve them.
Because the future of medicine should be human-powered, AI-assisted, and equitably built.

—
Sonya Sloan, M.D.
Orthopedic Surgeon. Advocate. Disruptor.
#OrthoDoc |

Public health was never meant to be political theater. It was designed to be a system that safeguards communities… from vaccines to clean water to disaster preparedness. But today, advisory bodies like the CDC’s Advisory Committee on Immunization Practices (ACIP), state medical boards, and even local health departments are being reshaped and dismantled by the GOP's political agendas.

This shift matters. Because when science is replaced by ideology, patients pay the price.

Why It Matters

Every parent who brings their child in for a well visit, every school district deciding on vaccine requirements, and every community hit by a public health crisis depends on these advisory bodies to make sound, evidence-based decisions.

When those decisions are influenced more by politics than by research and data, the ripple effects are enormous:

• Patient safety is compromised — delays in vaccine recommendations, mixed messaging, and inconsistent policies create confusion and mistrust.

• Healthcare professionals lose credibility — if the science appears negotiable, so does our expertise.

• Communities become divided — public health stops being a unifying safety net and becomes another partisan battleground.

The Physician’s Role in Protecting Public Health

Here’s the hard truth: if physicians (and any medical professional with a voice) remain silent, we allow the politicization of health to continue unchecked. But when we step into the conversation, hell…knock some doors down and turn over some tables if you have to….we re-center healthcare on patients, not politics.

Three ways to be part of the solution:

1. Stay Educated & Share Knowledge.
   Stay up-to-date on evolving policies and recommendations, then translate that knowledge for your patients, your peers, and your community. Clear communication cuts through political noise.

2. Engage in Advocacy, Big or Small.
   Advocacy doesn’t always mean testifying before Congress. It can be as simple as writing an op-ed, serving on a hospital committee, or attending a local school board meeting where health decisions are being debated. Your medical expertise has weight and influence.

3. Mentor the Next Generation.
   We can’t just protect science for today; we must invest in tomorrow’s leaders. Guiding medical students, residents, and even high schoolers toward advocacy ensures there will always be informed voices in the room where decisions are made.

The Call to Action

Public health belongs to the people, not to politics. And as medical professionals, we are the bridge, the translators of trusted research and data into care, the defenders of evidence against ideology. These trusted voices can steady the ship when the waters are tumultuous.

Our presence in the conversation matters. Our silence does too.

This week, I encourage you to pick one way — just one — to bring science back to the center of public health. Whether it’s correcting misinformation with a patient, mentoring a student, or raising your voice in a local forum or on social media, know this: when physicians lead, communities thrive.

Because the soul of public health isn’t found in the political headlines, or 900-page documents to benefit a select few… It’s found in the exam rooms, classrooms, and communities we serve, and in the courage of physicians willing to stand up for science.

The diagnosis is clear. The treatment plan is evidence-based. I’ve explained the risks, answered the questions, even looked them in the eye and said, “This is serious.”

Then they nod slowly… and say they can’t do it.

They leave.

Not because they’re reckless.

Not because they don’t believe me.

But because their reality doesn’t leave room for recovery.

And I know better than to call it “noncompliance.”

The Real-Life Cost of “Doing What’s Best”

When a patient chooses not to follow medical advice, we often label it in charts as “AMA” (Against Medical Advice) or “nonadherence.” But in truth, these terms rarely reflect the full story.

According to the CDC, nearly 1 in 3 adults report not taking their medications as prescribed because of cost.

One in four say they delay care or skip appointments for the same reason.

And for Black and Brown communities? The numbers are worse, fueled by decades of systemic inequities, insurance gaps, and mistrust.

This isn’t rebellion.

This is survival logic.

What Compliance Really Means

Let’s be clear: “compliance” is a luxury word.

When you’re a single parent trying to choose between chemotherapy and childcare…

When you’re uninsured and a hospital bill could wipe out your savings…

When your job doesn’t offer sick leave, but that same job keeps your family fed?

You’re not noncompliant.

You’re making a value-based decision rooted in self-preservation and sacrificial love.

“I Gotta Get Back to Work, Doc.”

I can’t count how many times I’ve heard it.

I’ve had patients with broken bones who refuse surgery because they can’t miss work. Others choose pain over pills because they fear addiction, judgment, or worse… unemployment.

In a 2023 survey by Kaiser Family Foundation, 45% of working-age adults said they postponed or went without medical care due to out-of-pocket costs.

Even insured patients are struggling. A recent Commonwealth Fund report showed that over 40% of insured Americans are underinsured, meaning their deductibles or copays are so high that they could literally lose everything with one medical bill.

This Isn’t Ignorance. It’s Informed Decision-Making.

We like to think patients don’t know better. But more often than not, they do know. They understand the risks. They understand what could happen. And they’re choosing a different kind of risk… one that makes more sense to their current reality.

That’s not ignorance.

That’s a calculated, difficult, deeply human decision.

What If We Asked: “What Are You Choosing For?”

Instead of focusing on what patients walk away from, what if we asked what they’re walking toward?

• Stability

• Their kids’ future

• A paycheck

• Dignity

• Control in a system that so often strips them of it

That’s not selfishness. That’s altruistic self-sacrifice.

As a Surgeon, I Know the Evidence. As a Human, I Know the Truth.

The OR is a space of precision and science. But out here, in the real world, healing collides with financial stability, housing insecurity, transportation deserts, immigration fears, and family trauma.

My words and viewpoint aren’t to excuse dangerous decisions. It’s to expose why they’re happening… and why our current system leaves too many patients with no good options.

Final Thought: “The AMA Moment”

Every physician has faced it. That AMA moment when a patient says, “Thank you, but I can’t.”

We sometimes glorify it as healthcare workers, not because we don’t care… but sometimes for our own selfish, exhausted reality as doctors and nurses.

In all honesty, and I am saying the quiet part out loud… it is one less patient we have to worry about if and when things go wrong. We release the anxiety of being written up because they are disgruntled with their care, or worse, they have a terrible outcome at our advice.

So my perspective is to open the dialogue of what Against Medical Advice really means in today’s society.

Let’s stop writing a patient off just because they sign an AMA form and viewing it as failure. Let us start seeing it as a signal.

A sign that the system, not the science, is failing them.

So here’s my challenge to you, my fellow clinicians, policymakers, and even patients:

Next time someone “walks away” from our medical advice… walk with them. Ask better questions. Understand their why. Become the patient and get some bedside manners (The Rules of Medicine: A Medical Professional’s Guide to Success). Treat the human, not just the condition.

That’s where the real medicine begins.

If this resonated with you, share it.

Leave a comment. Tell your story. Let’s un-silence the statistics and shift how we see our patients… not just as cases, but as people making the best decisions they can with what they’ve got.

Spoiler alert: It doesn’t. And never did.

A Quick History: Where Did BMI Come From?

The Body Mass Index (BMI) was created in the 1830s, not by a physician, but by a Belgian mathematician and statistician named Adolphe Quetelet. He coined the formula as part of his work in what he called “social physics,” aiming to define the “average man.”

The formula:

BMI = weight (kg) / height (m²)

It wasn’t about health. It was about creating statistical norms, specifically among white, European men. That’s key. It was never designed to be a diagnostic tool for individuals, especially not women, children, athletes, or anyone outside the narrow demographic of 19th-century European males.

The Rise of BMI in Modern Healthcare

In the 1970s, American physiologist Ancel Keys revived Quetelet’s formula, renaming it the Body Mass Index. Keys warned it was not ideal… but it was cheap, easy, and scalable, so governments and insurance companies ran with it.

Today, the World Health Organization and CDC define obesity and overweight based on BMI. Here’s how the numbers break down:

BMI Range | Category:

< 18.5 | Underweight

18.5 – 24.9 | Normal weight

25.0 – 29.9 | Overweight

≥ 30.0 | Obese

But here’s the problem: BMI does not distinguish between fat, muscle, bone, or ethnicity. Yet it’s used to determine access to care, insurance premiums, and even surgical eligibility.

Why BMI Doesn’t Work for Everyone

Let’s break this down further. Here’s how BMI fails specific populations:

Black Men and Women:

• Women tend to have higher bone density and more lean muscle mass, especially gluteofemoral mass.

• Often categorized as overweight or obese despite low body fat and low disease risk.

Hispanic and South Asian Populations:

• May develop diabetes and heart disease at lower BMIs, yet often go underdiagnosed due to falsely “normal” BMI scores.

Women in General:

• Hormonal fluctuations, reproductive stages, and fat distribution patterns (e.g., thighs vs. abdomen) make BMI an especially blunt tool for women.

• BMI was developed without consideration for female physiology.

Athletes and Muscular Individuals:

• High muscle mass = high BMI = misclassified as obese.

• Think of someone like Serena Williams. Would you tell her she’s unhealthy based on a number?

Visual Aid: Why BMI Misses the Mark

Here’s a basic chart comparing BMI to body composition across races and sexes:

Group | Avg. BMI | Body Fat % | Health Risk Accuracy (via BMI):

White Male | 25.0 | 20% | Moderate

Black Female | 31.0 | 26%| Often Overestimated

Asian Male | 23.0 | 25% | Often Underestimated

Athletic Female | 27.0 | 18% | Misclassified as Overweight

Older Adult (any race) | 22.0 | 30% | Underestimated

The Cultural Blind Spot

Using BMI to label someone as “unhealthy” doesn’t just lack nuance; it often ignores cultural context:

• In many Black and Brown communities, body diversity is celebrated, not stigmatized.

• Fatphobia, often cloaked in “health,” disproportionately targets women of color.

• BMI-centric conversations in clinical settings can lead to mistrust, disengagement, and medical neglect.

So What Should We Use Instead?

BMI alone is like trying to diagnose car trouble with only a gas gauge.

More comprehensive tools include:

• Waist-to-hip ratio

• DEXA scans (dual-energy X-ray absorptiometry)

• Bioelectrical impedance

• Visceral fat analysis

• Cardiometabolic risk scoring

Better yet? Pair those with a culturally competent conversation. Ask patients about their eating habits, activity levels, sleep, stress, and community norms. Listen before labeling.

Final Word: BMI Is a Starting Point, Not a Sentence

Let’s be clear: Health is not a number.

It’s a spectrum of metrics, habits, and lived experience. BMI can inform care, but it should never define it.

In 2025, we can do better than a 200-year-old math problem.

Sources & Further Reading:

• Keys A. Indices of Relative Weight and Obesity. Journal of Chronic Diseases, 1972.

• WHO BMI Classification: https://www.who.int/data

• Freedman DS et al. Racial/Ethnic Differences in Body Fatness and Cardiovascular Risk. Obesity Reviews, 2010.

• Tylka TL et al. The Weight-Inclusive versus Weight-Normative Approach to Health. J Obes, 2014.

• CDC Body Composition Research: https://www.cdc.gov/nchs

Want to hear more about race, representation, and real science in medicine?

Subscribe for more from The Scrubbed-In Mindset… where I dissect data, disrupt norms, and demand better.

This is the class that started medical school in the middle of the COVID-19 pandemic. Their first patient interactions were over Zoom. Their anatomy labs were virtual. Their clinical rotations were shortened, restructured, or canceled altogether. They watched a healthcare system unravel in real time, and now they’re expected to put it back together.

So let’s ask the real questions:

• Are they ready?

• Are we ready for them?

• Will patient care improve, decline, or remain unchanged?

• Who’s tracking this? Who’s accountable? And most importantly… who cares?

A Training Like No Other

Traditionally, medical education is a baptism by fire: four years of science, sweat, and sleepless nights, followed by residency where you learn by doing, under pressure, with supervision, and a deep reverence for the gravity of each decision. But the COVID era disrupted all of that.

These students learned medicine amid chaos. They trained while healthcare workers were quitting in droves. They watched protocols change weekly. Their professors were masked, their classmates isolated, and their hospitals overwhelmed. This isn’t just a quirky anecdote, it’s a fundamental shift in how medicine is taught and learned.

Better Prepared or Barely Prepared?

Some argue that this generation might be more adaptable. They’ve navigated uncertainty, witnessed systemic breakdowns, and built resilience out of necessity. That sounds admirable… and it is, but let’s not confuse coping mechanisms with clinical readiness.

When you’ve missed out on months of hands-on patient care, real-time feedback, or the nuances of bedside manner, something is lost. The question is: what? And can it be recovered?

The Hidden Cost: Patient Outcomes

This isn’t just about intern anxiety or academic curiosity, it’s about patients. Will misdiagnoses increase? Will clinical errors rise? Will disparities in care widen because the system assumed “close enough” was good enough during a pandemic?

We won’t know until it’s too late, unless someone starts paying attention. Unless we collect data. Unless teaching hospitals admit the truth and provide the oversight and mentorship this class needs, not just the credential they earned.

Where Is the Accountability?

Medical schools moved heaven and earth to keep programs running. Accreditation boards adjusted requirements. Hospitals made do. But now that the world is “open” again, are we asking the hard questions?

• Where are the outcome studies on COVID-trained clinicians?

• Are hospitals adjusting residency training to fill the clinical gaps?

• Are patients aware of the difference in training timelines?

Because if no one is asking, no one is answering.

Final Thoughts: Hope With a Side of Vigilance

Let me be clear: I have immense respect for these new interns. To begin medical school in a global crisis and finish it in an overburdened, burned-out healthcare system is heroic. But even heroes need help. And patients need transparency.

Let’s commit to mentoring this class fiercely, watching outcomes honestly, and asking the hard questions boldly, because readiness isn’t just a feeling. It’s a standard. And patient lives depend on it.

Rule #18: If medicine becomes purely transactional, healing becomes optional.

Medicine was never meant to be a vending machine. You don’t insert a copay and get a cure. But somewhere along the way, between the documentation overload, insurance approvals, and corporate healthcare takeover… we’ve reduced care to a transaction.

Swipe in. Speak briefly. Bill fast. Repeat.

And just like that, the most sacred part of medicine, the relationship… gets left behind.

The Rise of Transactional Care

Let’s define it plainly:

Transactional care is what happens when metrics matter more than meaning.

• It prioritizes efficiency over empathy.

• It focuses on compliance instead of connection.

• It treats symptoms, not stories.

And make no mistake — patients feel it. They know when they’re being processed, not cared for. It’s why trust in physicians is eroding and why some of our best young minds are already burnt out.

Relational Medicine: The Antidote

Relational care is slow medicine in a fast world. It’s the doctor who:

• Makes eye contact before they open the chart.

• Knows their patient’s fears, not just their family history.

• Asks, “What matters to you?” not just “What’s the matter with you?”

This kind of medicine changes outcomes. It doesn’t just lower A1Cs… it raises dignity.

It doesn’t just extend life, it restores humanity.

Why It Matters (Especially for Us)

As a Black female orthopedic surgeon, I didn’t always see doctors who looked like me — and patients didn’t either. So when I walk into a room, the relationship matters even more. It builds trust in spaces where trust has been systemically broken.

Minority patients often come in with complex trauma — not just from illness, but from institutions. Relational medicine becomes a radical act of restoration.

How Do We Fix It?

Physicians:

• Don’t just document the pain — witness it.

• Don’t just explain the treatment — engage the person.

• And when you can’t “fix” it, be present enough to feel it with them.

Medical Students & Interns:

• Learn the labs and the lingo, but also learn to listen.

• The greatest clinical skill you’ll ever master is presence.

Healthcare Systems:

• Start incentivizing continuity, not just productivity.

• Stop measuring care by minutes and dollars alone.

• Reward doctors who build trust, not just treat volume.

Faith Note

Sometimes the most powerful thing you bring into an exam room isn’t your degree, it’s your discernment.

Relational medicine makes room for compassion, calling, and care. That’s kingdom work. That’s healing beyond the chart.

RULE REMINDER:

You can’t bill for bedside manner.

You can’t code empathy.

But without them… you’re not practicing medicine, you’re practicing mechanics.

Join the Movement

Tell me in the comments: What moment reminded you that this is still a sacred calling?

And if you’re a med student, intern, or provider feeling stuck in the machine, just remember this:

Real medicine starts when the relationship does.

For women of color, especially Black and Brown women, the idea of a “glass ceiling” was always misleading. It was never just glass. It was barbed wire laced with bias, reinforced with institutional gatekeeping, and dusted in the residue of respectability politics. But at least glass gave the illusion that you could break through it if you hit it hard enough.

Now? In today’s political and corporate landscape, that ceiling has morphed into something slicker, stronger, and more invisible than ever. I call it the polymer ceiling, a toxic, synthetic version of the old problem. It doesn’t shatter. It doesn’t give. And worst of all, it reflects our ambition back at us like a cruel mirror.

The Current Reality

Let’s be real. In a time when diversity and inclusion are being rolled back under the guise of “meritocracy,” many of us are being told we’re either “lucky to be in the room” or “too emotional” to lead. From Supreme Court decisions that undermine affirmative action to corporate DEI layoffs post-2020 reckoning, the message is loud and clear: progress isn’t linear, and our presence is still perceived as conditional.

Even in medicine, STEM, business, or politics, we’re told to "stay in our lane." Not because we lack skills, but because our presence makes others uncomfortable. And heaven forbid we advocate for ourselves or others while being female and Black or Brown. That makes us "difficult." Or worse… ungrateful.

What Is Changing?

Despite all this, we’re seeing glimmers of hope. Women of color are building power in the community, in boardrooms, on ballots, and on our own platforms. We’re creating our own tables. We’re writing books, launching startups, mentoring the next generation, and refusing to apologize for taking up space.

Gen X is tired, and most of us have checked out, but Gen Z is kicking down doors with its unapologetic intersectional lens. Social media has become a megaphone for collective accountability. And truth be told, there are more of us in these rooms than ever before.

But progress isn’t power unless it’s protected. Visibility without voice is a trap. And tokenism dressed as representation is just another trick in the system’s handbook.

Solutions or at Least Survival Tools

We need to:

1. Codify our wins – Fight for policies, not performative panels. That means laws, funding, promotions, and pipelines that actually work.

2. Mentor intentionally – Pull someone up as you climb. Leave no woman behind. Or as I say in my book The Rules of Medicine: Rule #34…Pay It Forward!

3. Speak truth to power – Even when your voice shakes. It carries more force than you know, and others are listening.

4. Call it out – When the ceiling changes, so should the strategy. Recognize when the rules are shifting in silence, like our judicial system.

5. Build your own ladder – And make it extendable. Entrepreneurship, advocacy, media, whatever your weapon…use it. You don’t need permission.

The Caveat

Let me be clear: this new ceiling, the one made of reinforced “optics,” AI bias, and policy erosion, is not your imagination. It’s real. And it’s been engineered to look progressive while maintaining the status quo. It smiles in your face while blocking your path. And when you finally touch it, it doesn’t cut you, it laughs.

The old glass ceiling could be shattered. But what happens when the new ceiling doesn’t break at all? What happens when it’s built from a material that mocks your resilience and absorbs your impact?

You keep swinging. You find new tools. You train the next generation to build wrecking balls instead of ladders.

Because even if the ceiling can’t be broken the old way, we’re smart enough to find another way through.

Let’s get something straight: nobody accidentally becomes a surgical resident.

You don’t drift into THIS. You don’t “find your calling” mid-way through. You either know from the start or get eaten alive somewhere between anatomy lab and Match Day. The process is brutal by design. The unspoken rule is: if the training breaks you, it was supposed to (BTW…shout out to Casey Means, M.D.).

This isn’t a noble profession wrapped in white coats and Grey’s Anatomy soundtracks (I love you, Shonda Rhimes). It’s blood, sweat, and 28+ hour shifts (forget what you heard about the 80-hour work week). It’s your pager screaming at 3:00 a.m. or your cell phone ringing non-stop, while you’re buried under progress notes, trying to remember when you last peed.

So why do it?

Because surgery isn’t just a job. It’s a war of attrition. And some of us like to fight.

The Gauntlet Starts Early

Med school doesn’t prepare you. Not really. It gives you just enough knowledge to realize how little you know. It’s like being handed a scalpel and told, “Good luck.” You memorize pathology, learn the physiology so you don’t kill anyone, and maybe even impress a few attendings. But the operating room? That’s a different animal.

As a med student on your first surgery rotation, you're usually in the way. You hold retractors until your hands cramp. You answer pimp questions with a 50/50 chance of public humiliation. You learn to read the room, the tone, and the hierarchy.

Every nod of approval is earned. Every moment of trust is temporary.

You’re constantly being watched by residents who were just where you are, and attendings who can smell weakness from across the scrub sink.

Match Day Is a Cliff, Not a Finish Line

People cheer when you match into surgery. You do too. Then reality hits.

Intern year is a demolition derby of human limits. No time, sleep, or emotional bandwidth belongs to you anymore.

You run on caffeine and adrenaline. You adapt or you burn out. Your social life withers. Relationships get tested. Some may not survive or ever be the same.

There are nights when you feel like a fraud…but don’t buy into impostor syndrome, we all are newbies at some point. Days when your hands shake in the OR. Moments when a mistake, or near-miss, makes you question everything.

But then there’s that one patient, that one operation, that one attending who says, “Nice work.”

And it’s enough. Just enough to keep going and make you believe you can do this surgeon thing.

This Substack Is for the Ones in the Fire

I’m not here to glorify suffering. I’m here to tell the truth.

Each post will explore a different aspect of the surgical training experience—call nights, impostor syndrome, OR culture, mentorship, burnout, breakthroughs, and what it really means to become a surgeon in 2025.

No sugarcoating. No gatekeeping. Just the real story, straight from the trenches.

Because if you're in or thinking about it, you deserve to know what you're signing up for. I call my perspective The Rules of Medicine. Get the book!

Next up: “The First Cut Isn’t the Deepest…It’s the Most Supervised”

Want to follow the journey? Subscribe. Comment. Share. Or just read and feel seen.

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As a physician who’s seen trauma from both a scalpel’s edge and a soul’s edge, I’ve come to recognize that not all wounds bleed. Some bind. Some twist. And some make us stay in places we should’ve sprinted away from long ago.

So, what is trauma bonding?

It’s the emotional glue that forms between a victim and an abuser during repeated cycles of abuse, punctuated by intermittent kindness or reconciliation. In plain speak? It’s when your nervous system gets hijacked, and your heart starts confusing chaos with connection.

The Medical and Psychological Roots

Trauma bonding isn’t just “bad decision-making.” It’s chemistry. It’s cortisol. It’s a neurobiological cocktail of stress, fear, and relief. Think about this:

• Cortisol surges during abuse.

• Dopamine spikes during reconciliation.

• Your brain, desperate for survival, starts associating relief with attachment.

That’s not love. That’s neurological conditioning.

And over time, it erodes judgment, damages the hippocampus (which is involved in memory and decision-making), and worsens PTSD, anxiety, and depression. Clinically, we see patients coming in with vague complaints—headaches, GI issues, chronic fatigue—but the real problem? Unaddressed emotional trauma manifests in the body.

What COVID-19 Taught Us About Trauma—and Each Other

Here’s where it gets universal.

During the pandemic, we all experienced trauma: isolation, uncertainty, loss, and fear. We were locked in—literally and emotionally. Many of us are bonded to routines, relationships, or even belief systems that made us feel safe, even if they were toxic.

Some stayed in unhealthy jobs or relationships because "at least I wasn’t alone."
Some stayed silent about abuse because they were quarantined with their abuser.
Some of us, especially in healthcare, became numb to the trauma because we had no other choice.

The pandemic didn’t just expose public health gaps—it exposed the fragility of our emotional wiring. It blurred the line between coping and clinging. And that is precisely where trauma bonds thrive.

So yes, even if you’ve never been in a traditionally abusive situation, you likely experienced a trauma bond of your own during the pandemic.

The Hidden Damage

Trauma bonding doesn’t just affect romantic partners. It shows up in:

• Toxic parent-child dynamics

• Abusive workplaces (yes, even hospitals)

• Friendships that run on manipulation

• Medical hierarchies where junior staff endure humiliation for a seat at the table

And let’s be clear—it’s not weakness. It’s trauma. Real. Lived. Physiological. And if we don’t name it, we can’t heal it.

Breaking the Bond: What Healing Looks Like

There is hope, but it doesn’t come with rose-colored glasses. It comes with real steps:

1. Awareness – Naming the cycle is the first cut of the scalpel. Clean and clear.

2. Therapy – EMDR, trauma-focused CBT, or somatic therapy are proven interventions.

3. Boundaries – Learn to say no without guilt. And if that makes you uncomfortable, ask why.

4. Community – Healthy relationships rewire the nervous system.

5. Faith or Spiritual Practice – For many (myself included), healing is clinical and sacred.

From One Healer to Another

To my fellow clinicians…stop calling these patients “difficult.” They are wounded…and many of you are, too. We work in a field that sometimes rewards trauma bonding as “mentorship” or “grit.” It's time we call that out and change the culture.

To my sisters (and brothers) in the struggle, trauma may be part of your story, but it doesn’t get to write the ending.

If this resonates, you’re not alone. And if you’re still bonded to someone who breaks you, know this: healing is not betrayal. It’s survival. It’s sacred. It’s overdue.

They saved lives during COVID. Now they’re saving themselves.

Doctors, nurses, and healthcare professionals are leaving medicine in record numbers—and not because they’ve lost their passion for healing, but because the system is sick.

In the past year, nearly one in five physicians said they plan to leave clinical practice within two years. Nurses are walking away mid-career. Therapists, techs, and even medical students are asking, “Is this worth it anymore?”

This isn’t burnout. It’s betrayal.

What’s Happening?

Let’s break it down:

• Overregulation + under-resourcing: Bureaucracy is choking the clinical day. EHRs and metrics are replacing bedside care and actual patient connection.

• Political interference: From bans on gender-affirming care to restrictions on reproductive health, politics is replacing evidence-based medicine.

• Violence in the workplace: Healthcare is now one of the most dangerous professions, with verbal and physical abuse up 50%.

• Mental health stigma: We tell patients to seek help. But when doctors do? They risk losing their license.

And all the while, corporate profits in healthcare are at an all-time high. Make that make sense.

Who Should Care?

You. Me. All of us.

Because when doctors leave, care gets delayed. When nurses quit, patient safety drops. When healthcare becomes political warfare, everyone loses.

This is no longer just a healthcare crisis—a civil crisis in disguise.

What Needs to Change?

• Decouple politics from medical practice

• Restore autonomy to clinicians

• Protect and prioritize mental health in medicine

• Let healthcare workers lead healthcare reform

• Center the patient-doctor relationship, not profits

Final Thought:

If we don’t fix this now, the next time you or someone you love shows up in the ER, there might not be a doctor on call, not because they didn’t care, but because no one cared for them.

Let’s be the change before we need the help.

—

👩🏾‍⚕️ Dr. Sonya Sloan, aka #OrthoDoc, is not just in the OR—she’s in the fight for the soul of medicine. Subscribe, share, and stay scrubbed-in. ✊🏽

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The answer isn’t just about the virus. It's about what it left behind.

1. Medical Burnout and Delayed Care

The healthcare system didn’t just bend during COVID, it cracked. Millions of medical professionals reached a breaking point. Burnout, early retirement, and moral injury became everyday terms in hospitals. Meanwhile, routine checkups and screenings were missed or delayed. Now, we’re seeing more advanced cancers, uncontrolled chronic illnesses, and a generation more distrustful of medical systems than ever before.

2. Mental Health: A Silent Aftershock

The psychological toll is undeniable. Isolation, grief, fear, and uncertainty triggered an unprecedented mental health crisis. Depression and anxiety rates spiked. Teen suicide attempts surged. The world reopened, but our coping mechanisms didn’t. Therapy is less stigmatized now, but access and affordability still lag far behind demand.

3. The Emotional Weight of Loss

We didn’t just lose people. We lost rituals, routines, and the sense of normalcy. Weddings, graduations, and funerals —moments that anchor us —have disappeared or gone digital. Grief became private and prolonged. And while we learned to carry on, we haven’t truly come to terms with what was lost. Emotional repression is seeping into how we connect, trust, and lead.

4. The Political Pandemic

COVID-19 exposed more than a virus. It magnified political fractures. Public health became political warfare. Science was twisted into slogans. Mask mandates, vaccines, even school openings — all became battlegrounds. The result? Polarization intensified. Institutional trust plummeted. And public health lost credibility with the very people it’s supposed to protect.

5. The New Normal Is Making Us Numb

We scroll more. Sleep less. Move less. Eat worse. Even our social muscles have atrophied. There’s a collective fatigue — a kind of emotional flatline. In a world that was once just about surviving, we never quite made it back to thriving.

So Where Do We Go From Here?

Healing isn't a passive process. It demands intention.
We need policies rooted in equity, not politics. We need investment in mental health infrastructure. We need a national reckoning with how we treat the people who take care of us — and how we care for ourselves.

A vaccine or a mask won’t mark the end of the post-pandemic era. It will be defined by whether we learn how to be well—emotionally, physically, and collectively.

Because survival isn’t the same as health.
And five years later, it’s time we start demanding more than just getting by.

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