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Episode #17 of the Charged podcast
As an obesity medicine specialist, Fatima Cody Stanford, MD, MPH, MPA, understands the implicit and explicit biases that her patients deal with daily. As a black female doctor, she’s also familiar with the biases she faces each day. But it was one particular day on a recent Delta flight that she will never forget. The power of both implicit and explicit bias was readily apparent when flight attendants questioned her credentials as a doctor as she provided care to a fellow passenger who was having a panic attack. In this episode, Dr. Stanford discusses this experience, how going viral affects her practice and the importance of both speaking out against biases and promoting diversity in medicine.
Fatima Cody Stanford, MD, MPH, MPA, FAAP, FACP, FTOS, is an obesity physician at Mass General’s Weight Center. Aside from her clinical and research work, she writes for and has been featured in national news broadcasts, magazines, newspapers and websites on issues related to weight and the complexities of obesity.
Dr. Stanford is advocacy co-chair of the Obesity Society and a member of the Diversity and Inclusion Board of the Department of Medicine at Mass General.
She is the 2017 recipient of the Harvard Medical School Amos Diversity Award and the Massachusetts Medical Society Award for Women’s Health. Upon the completion of her MPH in 2005, she received the Gold Congressional Award, the highest honor that Congress bestows upon America’s youth.
Dr. Stanford earned her BS and MPH at Emory University as an MLK Scholar. She earned her MD at the Medical College of Georgia School of Medicine. She holds an MPA from the Harvard Kennedy School of Government where she was a Zuckerman Fellow in the Harvard Center for Public Leadership.
Q: Dr. Fatima Cody Stanford knew she wanted to be a doctor as early as three years old. She received her first research grant at age 14 and that led to a summer in the lab conducting biomedical research. She has excelled throughout her academic and medical endeavors, becoming a respected leader in the emerging field of obesity medicine early on in her career. Fatima is regularly featured in the media, sharing her expertise on weight, weight loss and the complexities of obesity. However, recently you may have seen her name in the news for reasons that had nothing to do with her academic or scientific work. Her story went viral after her credentials were questioned by a Delta flight crew during a medical emergency, largely because she is black and because she is a woman.
So, welcome, Fatima.
A: Thank you for having me.
Q: You made a lot of headlines recently on this Delta flight, so I wanted to start there. Can you talk us through what happened?
A: So, I was on a flight, flight DL5935 from Indianapolis back into Boston after some meetings on October the 30th. It seemed as though it was going to be a normal flight. I fly quite a bit for talks, lectures around the country and around the world, so this is very standard for me to just be flying back into Boston.
About 15 to 20 minutes into the flight, the woman directly to my left seated at the window, began to hyperventilate and began to kick backwards and forwards. It drew quite a bit of attention, and the immediate surrounding seats were quite alarmed by what was going on.
As I was immediately to her right I immediately went into action to just figure out what was going on and how I could intervene. When that happens, we’ll call her flight attendant number one comes towards me and says, “Well, are you a doctor?” after which I replied, “Yes I’m a doctor.” I immediately hand her my pocket license, just so that she can get that out of the way and I can tend to the needs of the patient.
She then proceeds to walk towards the back of the plane. Then flight attendant number two comes towards me and says, “Well, do you mind if I see your license?” I handed it to flight attendant number two. She observes it for a slightly longer period of time, and then flight attendant number two walks towards the back of the plane.
As this is all going on I’m still trying to tend to the patient. I’m recognizing that this appears to be a panic attack, and I need to do things to create more space for her. So, I’m in the process of getting her calm enough to switch seats with me as I was on the aisle. As I’m getting her situated in what was initially my seat and I’m in now her seat both flight attendants, approach us once more. Flight attendant number one asked the question, “Are you a head doctor?” after which I replied, “I’m not-- I’m not sure what you mean.” And she repeats the question again.
I said, “I’m not certain what you mean.”
And then she finally follows up with that by the question, “Are you an MD?” after which I replied, “I’m confused about why you’re asking me whether I’m an MD when you just looked at my license for the Commonwealth of Massachusetts Board of Registration Medicine, which indicates that I’m a physician in active practice.”
After which the second flight attendant now asked me, “Is this really your license?”
And I replied, I said, “Why would I be carrying someone else’s medical license?”
I think that she recognized that that question may have been out of place, did not apologize, but both flight attendants then left our side and I was able to tend to the patient for the rest of the flight.
Prior to our final descent into Boston, flight attendant number two comes back up to me and says, “I just want to let you know we don’t need to see your license again because you seem to do a good job with the patient.”
I really didn’t know how to respond to that, so I think I may have just looked at her in a bewildered state. And as we were exiting the plane the passenger who I was attending to was directly in front of me and as we were leaving the plane flight attendant number two asked, “So are you sure she is really okay?” And I state she is really okay. But Delta Airlines appeared not to care, because I was the one that got her off the plane and got her to her next flight.
The final thing she says to me was that, “I could not have gotten through that flight without you.”
Q: Hearing the story I have so many questions. And one thing I have been wondering is is it common for doctors to carry a license? In reading about it I was surprised that you were able to produce it.
A: Well, no I don’t think it’s common, but I will explain the context of why I have chosen to carry my license. So, in 2016 a similar incident happened on a Delta Airlines flight where a black woman physician was questioned about whether or not she was a physician and not allowed to render care to a patient on a flight. After that happened I thought to myself, “Well, self, maybe I should just always have my license.” And Massachusetts tends to issue a wallet size license.
So I said, “Well, you know, that’s fine. It’s the size of my driver’s license. I’ll just carry it adjacent to my driver’s license.” So, I do carry it and I’ve carried it continuously since that time. The ironic portion of me carrying it is that Delta Airlines in 2016 revised their policy such that medical professionals, including physicians, nurses, etc., would no longer need to produce their license in order to render care. So, despite the fact that the rules changed, I felt as though it would just be easier to have it and make it available readily so that there were no further questions, which is what I thought I was doing when I immediately gave the woman my license without being asked.
Q: Yeah, so sort of answering the unanswered questions.
A: Absolutely, absolutely.
Q: How did you feel as it was happening? Was it in the moment that you felt the bias or was that later with reflection?
A: No I immediately knew what was going on. Unfortunately it is these types of biases are a part of my daily life, so I recognize them, but I usually just push through them. And I felt as though this was one of those situations where I needed to just push through. The patient needed me.
Whenever I was not directly speaking to her, so I spoke to her throughout the duration of the flight, that is the only thing that seemed to keep her calm. I know that she needed me more than I needed to be frustrated in the moment. And while I was frustrated I felt I can deal with that a little bit later. Hence, me tweeting about this situation after the flight landed. I was then able to focus on what my frustrations were.
I felt comfortable that the patient at least during the duration of our flight was fine, but now I am able to vocalize what I felt.
Q: Yeah, and so I guess the second piece of the story is since then this story has, it really went viral.
Q: Yeah, can you talk about that experience and what it’s been like?
A: So, yeah, I really have to thank my husband for suggesting that I take this public, because that was not what I was planning on doing. I came home. He asked me how my meetings went in Indianapolis. I told him, “Oh they were fine.” I said, “But let me tell you about my flight.” As soon as I finished with that conversation he says, “You should tweet this.” So, I immediately sat on my sofa in my home and tweeted.
The next day, the next morning I was starting to get calls already from The Boston Globe, FOX locally, and then after that it really spiraled into a national and international story with news coverage from ABC, CBS, NBC, CNN, People, New York Times, Fortune. Really I was doing on average 15 to 20 interviews a day to keep up with the volume of what was going on.
I think part of the reason why this may have gotten the level of attention it is is because as people actually looked at what my qualifications were I think they were even more appalled at the actions of the flight attendants on this particular flight. I didn’t feel as though it was necessary for me to produce my Harvard or Mass General identification at that time. I thought that my license should suffice, and actually it really was not even necessary with Delta’s policies, but I think that is part of why there was such an outrage.
And the support that I received from the medical community, the American Medical Association, the National Medical Association, the American College of Obstetrics and Gynecology, all of these organizations have come out directly and made statements.
Q: And has Delta responded?
A: So, Delta’s response was quite lackluster and subpar. I spoke with Delta only once and that was the day after this incident. I had to be in four cities that week, so I was at the airport waiting for a flight going into Pittsburgh. So as I sat there I spoke with a woman who was on the executive staff for Delta. And I’m going to just summarize her key points. Number one, the flight attendants wanted to ensure that I was not a therapist. Number two, they are working on this at the highest levels of the company. Number three, they wanted to thank me for being a Delta Sky Miles member. And number four, they want me to fly Delta again soon.
And that is the only direct communication that I have received from Delta to this date. I can tell you that when I am looking at news stories, I have heard that Delta has said other things to me. So I am watching NBC Nightly News with Lester Holt and I’m like, “Wow, that is what Delta said to me? I don’t know where that came, because I haven’t seen it in any form in my either email inbox or via postal mail.”
So, their communication and their abilities to really address this issue I feel as though have fallen really subpar in terms of just the reaction.
Q: Is there anything about the viral response and all the people that have jumped in, has that been surprising?
A: Not necessarily. My husband, when he told me to tweet it he said, “This is going to go viral.” So, I tend to trust his judgment. He lives a bit more in that space than I do. So I wasn’t 100% surprised, just because I listened to what he said and responded accordingly, but I was very, I guess, I would say I was most surprised and maybe most thankful for the response from the medical community. When the American Medical Association found this out, which of course is the largest medical organization representing physicians, for them to come out, immediately contact me and say, “Look, we’re launching the whole social media campaign where we profile stories that we have done of you over the years, and we are trying to decide what is the best strategy.”
And when a letter came out directly from their CEO and from their Chair of their Board of Trustees directly to Delta on my behalf, but representing all physicians, I can tell you that felt like such significant support. The National Medical Association, which represents all physicians of African descent, also had a similar response. And to have these big bodies there to support me, recognizing my service to those organizations over the years, but also recognizing how this would affect the quality of life of their members I think was really, really important.
So that was very surprising. And when I arrived at the AMA meeting soon after this happened, I was going to get some food, and I saw this big streetlamp sized poster of myself, and that was quite welcoming. But I think these were all gestures for the AMA to indicate, “Look, we’re behind you. We support you. We support physicians of color. We support women physicians.” And they made a strong stance in that direction without any hesitation.
Q: Something that has been really cool to me in watching it unfold is how, as you said, there is these national organizations that responded but also so many of your peers have jumped in, and it’s people of all types. It’s other women of color, but I also saw white men say, “I recognize this would never happen to me and I’m appalled that this happened to my colleague.” Can you talk through what that has been like?
A: Absolutely. You just spoke about my white male colleagues, and I really think about this as them being an ally for me. Often as a black woman, as someone that appears much younger than I actually am, people don’t perceive me to be who I am in terms of my profession, in terms of my qualifications, but my white male colleagues, if they make a similar statement about how they are appalled by something that has happened to me or someone that has similar demographic people I think are more likely to listen.
And so I see them as allies and very important voices to this conversation. Of course there is the hashtag #HeForShe Movement. I think this kind of expands beyond that when we’re looking at persons that are of racial/ethnic minorities being supportive, and their support I think has really resonated with the community as a whole. As white men, as physicians reflect on the fact that, “I never thought to even carry my credentials. Often I’m in torn jeans. I don’t look the part either. But no one has ever questioned on any flight that I’ve been on.”
And I’ve had people from deans of medical schools state that, “This is just bewildering,” because they have never had to live that experience. And so their support has been obviously extremely important and many of them have spoken on interviews to really, to give a different perspective. I think my perspective is the lived perspective, of going through this, but for those physicians that have come out in support, they’re able to give an alternative viewpoint which allows others to maybe be more willing to understand some of the biases that existed.
For my colleagues that are either women or minorities, they often have lived similar experiences and are able to share their stories, but what I want to vocalize to them is I want their stories to be heard. And they may not, they’re likely not going to go viral in this way, but hearing other stories, not from just this one woman who happens to be at Mass General and Harvard, hearing their stories really supports the work that needs to be done in this space.
Q: How are you thinking about connecting those stories and what opportunities do we have? I think there is often this divide of my lived experience versus your lived experience. So how do we--
A: How do we bring that together?
Q: Yeah, how do we bridge that gap?
A: So, one of the things that I have leveraged, and I think I will continue to leverage is the media. So, the New York Times was one of the first print news outlets to cover this story, and the New York Times is doing a follow-up piece where they are capturing the voices of other individuals that have had similar experiences.
Other advocacy groups have also reached out to me directly, because supposedly there was a bill passed which spoke to the FAA and looking at issues surrounding diversity that supposedly passed within the last five to six months. There has not been any report out with how the FAA and airlines have done, but this story speaks to some of the inadequacies within the airline industry regarding these issues.
You know, I think using these groups to speak on Capitol Hill, to propel this message, to bring together other people in the conversation, my voice is what has gotten this started, but let’s hear the voices of other persons. So, these groups are working with some of these other individuals of all ages, of different racial and ethnic background, maybe different religious backgrounds, let’s say being Muslim and wearing a hijab there are certain biases that are implicit and explicit to those individuals. So getting all of those voices as part of the conversation both in the medium and in concerted efforts to propel this message and actually enact change on Capitol Hill is really the strategies I’ve utilized.
Q: Yeah, absolutely. This is one isolated incident, but we have seen other incidents, like the Starbucks incident a few months back. How do we connect these pieces of this isn’t just a problem within the medical community, it’s not just a problem at Starbucks. Implicit bias exists.
A: Yeah, and I think it’s implicit and explicit. And I think unfortunately with our political climate explicit bias has become more apparent. I think it was always there, but people feel empowered to speak their voice against people that don’t look, sound like them. So, I think both implicit and explicit bias is quite pervasive throughout the community, and unfortunately what our country was built on.
And how good are we doing at these issues looking at diversity, equity, and inclusion if we really, we’re accepting these individuals but they can’t feel safe in their own community? So, I think more needs to be done, not just like, “Oh let’s really consider making our student body more diverse or our hospital more diverse.” Once they’re here, do they feel supported? Do they feel like they’re really a part of the community?
And if not what are we failing at? And I think that every institution I have been a part of has failed dramatically at that part of the puzzle.
Q: And I guess the question often comes up then, whose responsibility is it? And me, I’m not a person of color, so what role can I play and how can we support-- I do want this to be a welcoming environment and I want people to feel-- I recognize that we all prosper when we have more diversity, so--
A: How do you make it--
A: So, I think that traditionally, right, we look after our own selves, right? So, ultimately our goal is to make sure that our personal selves, our families are well taken care of. And often someone like myself might not fall within that immediate surrounding, so we’re not conscious of things that we might need to do if and then that is of our interest to promote and propel better diversity, equity, inclusion in institutions.
But I think that starts, for example, looking at pay equity. We know that women physicians are paid on average $100,000 dollars less than male physicians. And when we throw in someone that is a racial and ethnic minority, that drops dramatically even further to maybe a fourth of what a white male physician might make.
So, if you are in positions of power, why not evaluate are we paying persons within this space or domain in an equitable fashion? If not how might I change that? Because the people in power really have the ability to make that change. There should be no reason why I should be making a third of what individuals that have no training or no advanced degrees are making, but that is my reality every day.
So, why is that? Who is not looking after that? If I bring it up, I can’t change it, obviously, but the persons that are in positions of power have this unique ability that they need to utilize.
I think our voices aren’t being heard. And when they are heard, there is no change that happens. And so we become frustrated, we become stressed. That leads to poor health outcomes for ourselves as people that really should have optimal health, because we have maybe the resources to really look after ourselves. But racism in and of itself can be a significant factor that plays a role in disease.
So, why are we not doing a better job at the top tiers of leadership? Why are promotions less easy to come by if you are a racial/ethnic minority? Why have there only been five females in the history of Harvard Medical School that are black females that have become full professor? Why is that? I think that that shows that this is systemic and something has to start at the top, because what can-- I can’t promote myself. But these things are things that have to happen.
I mean if we look throughout history that is what we’ve seen. I mean when JFK finally during the Civil Rights Movement decided to really take action with the Civil Rights Act of 1964 that’s when we started to see a shift. And it wasn’t, it wasn’t overnight, it didn’t happen overnight when the Emancipation Proclamation was issued. But there needs to be this concerted effort amongst the whole community, not just persons that look like me, because I can only do so much.
Q: Yeah. I think it’s a good reminder too that I think especially we feel like we’re in these turbulent times and there are so many things happening and it’s chaotic and uncomfortable, but this is a longstanding, complicated problem, so it’s going to take a while.
A: It’s not going to happen overnight. I had a friend who actually happens to be a woman of color who says, “Well how are we going to solve this?” And I was like, “Well, I don’t think I have the answer for like the immediate like how we’ll solve this tomorrow, but I do think that we can take steps and I think we have to be diligent, right?” We have to persevere. We have to recognize that me doing a one-off interview with one person or another person is not going to lead to sustainable change.
For me this particular circumstance, I think has allowed me to have a voice, to speak in areas where I have been maybe not considered to be you know the expert in that area, but now have this experience and this platform to get the conversation going and then help keep it moving.
Q: How does this feed back into your career and your clinical practice? You’ve had this big viral story--does that change your day to day?
A: My patients became aware of this pretty quickly and I think for them they felt really hurt. The physician that they have a lot of trust in, the physician that many of them feel has been the person that has been their greatest ally in their lives was, I guess, attacked I think was how they feel.
And you can tell that when I’m having a patient visit that there is a focus that is on me as opposed to them, and I want to obviously push the focus back to them. But I do think hearing their voices and their voices propagating about, “Look, this is my doctor and I have received this high level of care. You must respect her. And I never looked at her for what her race or ethnicity was or what her gender was, but what her expertise was in this field and how that has impacted my life.”
So, that is from what it feels like in a patient interaction standpoint. I do think that this particular incident, has likely changed my course in medicine. I think that I will obviously continue to do my work in obesity medicine, but I think it does allow me to have a bigger platform where maybe media becomes a much larger part of my everyday career.
I think that my ability to communicate issues surrounding whether it be diversity or around chronic diseases in both adult and pediatric population is, I think, one of my strengths and I really want to explore and expand that a bit more. And I think I have the platform with which to do that now.
Q: And I think I’m struck in talking to you, this is a really uncomfortable topic, but you’re able to address it with openness and with honesty and talk about something that most people don’t want to talk about.
A: One of the things I’ve realized as we have gone through this interview is that I want other people to have their voices heard, but I recognize that this topic is not one that people feel comfortable talking about, even if they have experienced similar situations and experience them daily, much like I said I have. And so I see myself as giving a voice to the voiceless. I am not reticent about addressing these issues. I feel, I think, as comfortable as one might feel in addressing these issues, and I realize that if I don’t address them and if I keep them to myself then only I will hear that voice.
And since whether or not I chose this to be the case I realize that I have become the face of this movement, and I am comfortable being in that space, recognizing that my life has been challenge after challenge after challenge through which I have just continued to persevere, and that this is just an additional challenge that, I think, will have a huge defining moment in my life.
Q: And where do you think we go from here? What should we be doing next?
A: So, I really think that we should be looking across the broad community. And what I mean by that looking in government, looking in schools, education, health care, business, etc. and looking at what we’re not doing. A lot of people are quick to name a diversity officer or this or that in organizations and applaud ourselves for what we’re doing. I think in applauding ourselves for what we’re doing we’re missing the things that we’re not doing. We’re missing the fact that if you look really with a fine tooth comb on the ground there is a lot of missing pieces. And so it’s not that I don’t want us to recognize the victories we’ve had regarding issues surrounding diversity, equity, inclusion, but I think that we often use that to be a shield or a cloud cover to push aside the things that we’re not doing.
And so I think we need to really be transparent. Let’s be actually honest. Let’s listen to the people that experience these things every day. But not just listen, take action. And so that is really what I think we need to do.
Q: And how do you maintain hope? If you’ve continued to have these experiences, how do you look forward with positivity?
A: Well, you know, so I was born as this person, right but this, I have lived in this vessel which is my body and with this voice and whatever for my life, and so this is what I have been given. If I have been able to persevere and accumulate four degrees and do two residencies and do two fellowships and do all of the media and all of the publications and all the teaching that I’ve done, why stop now?
I have been able to push through other areas of adversity in my daily life. This is part of who I am. I am a fighter. Why stop now?
Q: Yeah, it’s not the first mountain to climb.
A: It’s not. Let’s just keep going.
Q: Well, thank you so much. It’s been lovely to talk with you. Before I let you go I have my final five questions.
Q: What is the best advice you have ever gotten?
A: I would say the best advice that I have ever gotten is don’t be afraid of who you are. Each of us is different, each of us is unique, but the uniqueness is what I think makes us amazing as a human race, and so don’t be afraid of who you are and always just live your life as you see fit.
Q: The name of this podcast is “Charged.” What does that word mean to you?
A: I see charged as maybe a word that represents being vivacious, being willing to be in front of the scenes to carry or propel a certain message, in my case propelling messages regarding weight bias and stigma, but also in this most recent time, regarding issues surrounding racism, sexism, ageism. And so using my voice to charge forward in a vivacious fashion.
Q: How do you recharge?
A: For me recharging is a lot about spending time with fitness. Fitness is a huge part of my life. It’s the one thing that has really kept me grounded, so I make it a non-negotiable. There are people that may want to meet with me and it may take them two months to get a meeting with me, but if they want to come work out with me I could probably make that happen today. So it’s a big part of me and I think it helps me to recharge, it helps me to feel sane and feel like myself.
Q: When and where are you happiest?
A: I’m happiest when I’m spending time with my family, especially my husband. My husband and I are high school sweethearts, so we’ve been together for what will be 25 years in just a few months. And when we’re able to actually spend time without mobile phones and emails and things of this sort I really feel most centered and most myself.
My family, my mom, my dad, my sister are huge parts of my life. They live in Atlanta, but I talk to them literally every single day. And so the four of them, we have a text thread through which we like are always communicating.
Q: Great. And what rituals help you have a successful day?
A: So, other than working out, I think that prayer is important for me at least, and spending time like as a Christian reading scriptures is something that I do start my day with. I don’t feel like I get as much time as I would like in that space as my schedule has become one in which 85 hours a week is the norm, but that is very important in addition to like, like I said, my fitness.
Q: Great. Well, that concludes our conversation. Thank you so much.
A: Thank you.
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