122. Narratives in Cardiology: Diversity, Implicit Bias, and #BlackMenInMedicine with Dr. Quinn Capers IV
Worldwide cardiovascular disease affects the lives of hundreds of millions dedicated cardio nerds everywhere are working hard to fight this global epidemic. These are their stories. Hello carter's it's welcome back and thanks for joining us for the cardi. Inert narratives and cardiology series designed to promote diversity and inclusion in our beloved field because our differences do make a strong in this powerful discussion. With dr quinn. Capers fourth led by dockers arena. Sharla and greg. We discuss the importance of diversity for health equity clinical excellence and research innovation. We also discuss imposter syndrome. Implicit bias and strategies to diversify our field as we dive into the personal narratives of these incredible individuals. We discuss the experience of being. A black man can cardiology. We are so thankful to the one. And only doctor. Kimberly manning for providing an incredible introduction to the man who needs no introduction stock capers. So dr manning the fourth doctor leah docker pocono. Thank you so much for elevating the cards narratives and cardiology series and thanks to dr pamela. Douglas for sowing the seeds and providing incredible encouragement and mentorship in developing this entire program. Hello cardio nerds. Thanks so much for joining us. As we continue our narrative series highlighting the different paths and stories of pioneers. In the field of cardiology. We are so excited for today's discussion with a truly special guest someone who's been a tremendous influence and mentor in my life and training path dr quinn keepers the fourth. Welcome to the show dr keepers. Thank you so much. Serena is such a pleasure to be here to talk about things that i'm passionate about and added pleasure that it's you and i to have this conversation dr capers. It's an absolute pleasure to meet you. I've been following you throughout my internal medicine career. And as a cardiology fellow. I feel completely honored and humbled to take part in this cardio nerds episode in regards to seeing people in cardiology that represent minorities. I would have to say you are at the pinnacle you have shown that as possible. Her north to be successful in cardiology. And i truly appreciate that. Well gregory humbled me with your words very moved by. What you just said is truly a pleasure to meet you and you gotta surpass anything that people like me done i can. I can feel it. It is such an honor of heavy with us your support advocacy and impact has been felt by countless men colleagues and cardi everywhere. We feel privileged to have you as an adviser for this very narrative series. I know this will be a very special discussion and so to get started. We asked an equally special individual to help us introduce. The man requires no introduction. She herself is an incredible advocate and educator an absolute change maker of visionary of our times who has inspired so many of us to be better with that. I'd like to share a few words from the doctor. Kimberly manning professor of medicine programs record for the transitional year residency program and a vice chair of diversity equity and inclusion for the department of medicine at emory university. School of medicine. Hey cardio nerds hold up. Wait a minute. This is doctor kimberly manning. And y'all i am so excited to have the opportunity to introduce the amazing dr quinn capers. The fourth listen you got to say the fourth when you're talking about dr capers. Okay that's lesson number one today. Let me tell you just a little bit about this. Amazing human being and leader. Dr capers grew up in dayton ohio and left his home town to do his undergraduate training at historic howard university. H you. He became his journey in medicine at the ohio state university and went on to do residency. Cardiology fellowship and interventional cardiology training at emory university. School of medicine. After his graduation he worked for eight years in private practice and made the switch back to academics and came back to his home state of ohio to join the ohio state and continue his career in two thousand nine. Dr capers was named associate dean of admissions. And in ten years the college of medicine went from thirteen percent. Underrepresented minorities to a whopping twenty six percent of the two thousand nineteen entering class and and the last six years. Women have outnumbered men in the incoming classes at the ohio state in two thousand and nineteen. Dr capers was promoted to vice. Dean for faculty affairs received the award for professor of the year. And the diversity. Champion award from the ohio state university most recently. The state of texas gained an absolute jim as dr. Capers moved his time his talents and his family to join the. Ut southwestern school of medicine as professor of medicine associate dean of faculty diversity and the inaugural vice chair of diversity equity and inclusion in the department of internal medicine. He has an expansive list of accolades and awards. Dr capers was awarded the american heart. Association's lennox clinician educator award in two thousand eighteen. He was recognized as the two thousand and twenty recipient of the exemplary leadership award of the group on diversity and inclusion from the association of american medical colleges double amc. He's an inaugural member of the american college of cardiology diversity and inclusion task force and in two thousand and twenty one. He received the pamela s. Douglas distinguished award for leadership in diversity and inclusion. Dr capers has had an impactful presence on social media where he created the hashtags hashtag black men in medicine to counter the negative stereotypes of black men and hashtag take a woman to the cath lab to show that women. Of course are bosses. Dr capers is a passionate advocate for enhancing diversity and inclusion a champion for improving health equity and devoted member to countless trainees. He's also a committed. Father committed husband and i have to say is the reason why. My military push-up game is much stronger. Thanks to his hashtag drop and give me twenty campaign helped me do twenty push ups a day just to keep up with him on twitter. Y'all it is my privilege to introduce this amazing leader human being and one of my personal heroes. Dr quinn capers. the fourth. i'm stunned so dr. Manning is one of my favorite people on the planet that was just so incredibly kind so incredibly warm a now. I kind of lost some of the things in my mind that i wanna talk about but to be credible introduction. Thank you thank you documenting. We'll catch up later for sure. Now with an incredible introduction and i myself have been so fortunate to been able to start off my medical education with the support of your doctor capers and personally from the moment i heard your voice on the phone and you call to personally tell me that i had been accepted into the ohio state university college of medicine. I just knew how passionate you were about your work and your presence in the hospital especially as immediately felt by everyone you bring a smile to everyone around you trainees look up to you as an inspiring mentor and remember being in the cath lab with you. Patients feel an instant common. The cath lab during an emergency situation. So we are so excited to have you on the show. Thank you serena so proud of you and everything you've done and thank you for such tided glowing words all right so set the stage. I would actually like to start by reading an excerpt from a perspective paper that was recently published in the new england journal of medicine by. Ls at all. Jackson highlights common concepts that black applicants like myself experienced during interviews. The paper starts off like this sata conference room with a long wooden table black residency. Applicants sat next twelve applicants on interview day. None of their peers of black across the table. Hong photos of faculty members including the program director medical director and department chair number black in the corner of the room administrators. In coordinators were monitoring the agenda non of them were black rosters with descriptions and headshots of the faculty interviewers were attributed. None were black later. Residents spoke applicants over lunch and nurses set at their workstations during the tour. None were black during the course of the day. The black applicant was asked whether they were lost in twice was assumed anyone applicant. They were told they had an unusual name in that they were articulate at the end of the interview. The black applicant wondered twyford in here. dr capers. To be honest after reading this article felt like extra from my personal life the hard to pronounce last name comments of how speak all of it in medicine. We go through the interview process so frequently to med school residency fellowship normalize some of these experiences certainly not for every single interview but it was actually pretty common reading. This article is reminder that although it is common it doesn't mean it should be the accepted norm. Thanks for sharing that greg. Such a powerful visual striking portrayal of how this could so negatively impact an individual's perception of the program and more importantly their own confidence and self esteem. Training is hard enough as it is without these external factors dodger capers. What are your thoughts on this. I'd i'd like to think that these are isolated. Instances the exceptions rather than the norm. But what's been your experience. So first of all i'd like to thank the authors because these are thoughts that need to be out there. People need to hear these internal monologues. What strikes me about that narrative that you just read is that the academic medical centers where they were interviewing probably think they're doing a good job of being fair probably they're doing a good job of treating everybody equitably so. This is an example of a structural bias or structural racism where we say structural racism. The way differs from individual. Racism is you can't point your finger at one person and say this is because of joe or this is because of mary. It is structural institutional and very often institutions might not realize that there are carrying on something that that simply extends a legacy of bias an exclusion so for example it might be at a medical school that at one point excluded people of color. So what that means. Is that the department chairs in the luminaries. The deans are all going to be people who are not people of color. And so if your conference room you hang portraits of the luminaries. You aren't gonna have any people of color now. That medical school will say i wasn't doing anything to make anybody feel an imposter syndrome or to be a bias. All we're doing is honoring the heroes of our medical school while that may be but at one point your medical school excluded women were excluded. People of color and so the point is that as a medical center as a division of cardiology as department of medicine. You have to actively undo some things. You can't just start from where you are in say. Well i'm of the person. And i'm the chair of medicine and so i'm going to be sure. We don't discriminate. You've actually got to put him some work to actively undo some of the things that are extending a legacy of and racism. That's what i took from. That took both from what this person was feeling. Did an excellent job outlining their feelings. But what i took from that also. Because i've seen it. Is that the person who is the fellowship director or the internal medicine residency director or whatever program is person was interviewing from. When they read it. I would bet you got a little defensive. Because they'll probably felt no. We treat everybody the same but again i'll just in my comments on. We need to actively undo the structural racism biased just in the air in the atmosphere at our institutions. Thank you dr capers. And i appreciate you talking about how the history behind some of these structural racism the bias insidious and not necessarily from malignant intent. But no less harmful and you start off by saying that these conversations are important to have actually having these narratives discussions has been a little bit of a coming of age for for my own self when we first started designing these gregory to know because we had a lot of conversations about this in the beginning we were a little sheepish about having these conversations so explicitly and so deliberately and i got a call out and out to dr manning because it was conversation i had with her one evening when i was picking up my son and i remember very clearly in she really was the one who gave us a license to go out and have these conversations and be explicit about it because she said look. You don't know what you don't talk about Give a lot of credit for empowering us to bring about the series and you know having these conversations so i'd love to play a game of fact or fiction too. I explore the value of diversity and inclusion and so i will offer a few statements and if you could tell us this is fact or fiction. And why serena you wanna kick us off factor. Fiction minority patients are more likely to follow recommendations of minority physicians. Oh that's a that's a strong fact. That's that's an easy one so it's been shown in multiple studies that minority patients are more likely to get their blood. Sugar checked more likely to get their blood. Cholesterol checked and more likely to get flu shots. Flu vaccinations if recommended by a minority position. And here's a big one for all of the cardiologists out there. Listening black patients specifically are more likely to have open heart surgery if recommended by a black as opposed to non black physicians. And i think we think about the number one medical issue going on right now this covid nineteen pandemic and how we're all wrestling with an all concerned about vaccine hesitancy in communities of color so there's a mistrust of the healthcare system as a group and communities of color and it's will earn right is because they've been historic atrocities committed against people of color wing all the way back to slavery times and so when people of color have some mistrust. That's another way to call. That is very diligent to have some mistrust so we need more doctors of color and we need our white physicians working side by side with doctors of color a so that we can all get more culturally competent to get our patients. Doing the things that we know will help them. But that is an absolute fact. Thanks for asking that question. All right at capers. Here's another one for you. Professional diversity has no bearing on addressing healthcare disparities. That's absolutely false. So it's been shown now healthcare disparities which is an interest of mine. Which by the way. I'll give a shot up to serena co-authored review paper on racial healthcare disparities in cardiology some years ago and she was an absolutely fantastic co author. It is multifactorial when i say healthcare disparities. I'm talking about when two groups of people with the same diagnoses get different levels of treatment. Get different levels of quality evidence based care that kind of healthcare disparity is a real embarrassment to our healthcare system. That is something that really drives me to do. So much of what. I do well as multifactorial so in a lecture that i've been given to i you. Medical students for over a decade now and radio was in those lectures. We talk about healthcare disparities. And then i'll put up a blank slide and we say now. Let's come up with a list. A list of potential culprits. And then. I'll put another sides in a. Let's come up with a list of potential action items so that we can get over these healthcare disparities and i only say that i mentioned that just because there really are many things at least healthcare disparities but there is no doubt greg that one of them is a lack of diversity amongst providers and some of that leads back to the question that i was just asked about patients of color having evidence based care. That is more likely to happen if we have more minority physicians. You know that really speaks to this. Wonderful conversation. Recording just shared with dr princess brewer in. She talked about this amazing impact. She's having with a program called faith partnering with community churches in communities of color to improve and enhance preventive measures. You know she's doing this. The community based participatory research in. She talked once you talked about the lack of trust that even she met with she first began to the community so she herself so dedicated head to build the trust but one thing that she said but really spoke to me is the way she worked at. She said these communities that i am blessed to serve right and so even though she's putting heart and soul to project she's working so hard spending so many hours of every single day her perspectives that. It's her blessing to be able to serve the community. And i think that really speaks to this calling. People in is so important. I couldn't agree more. I love that terminology we're served. Physicians are servants. I couldn't agree with dr brewer more. We're the lucky ones. It's wonderful okay. So the next statement diverse research teams produce more innovative science published in higher impact journals. That is a fat so excited about does research study. It was actually published twenty eighteen. But i recently discovered it by professor shibley. Hope i'm pronouncing that correctly. Where in this study. They actually went after that. Very question does diversity of the research team have anything to do with the impact of the resources produce and they defined impact by the number of citations of the paper and so they looked at nine million scientific papers. Science technology engineering and medicine papers nine million and what they were looking for to see was do the citations a number of times. The papers have been cited. Doesn't have anything to do with diversity. On that research team. They looked at diversity of affiliation. So if people were from different universities diversity of how long you've been in academia. They looked at gender diversity and they looked at racial ethnic diversity. All of those types of diversities had some impact on citation but the number one driver the strongest indicator of the number of times a paper would be cited was how diverse was the research team racially and ethnically diverse so racial and ethnic diversity on the research team drives the impact of the research. Which just makes sense with what we know about. Decision making what we know from a literature from the business world that executive boards of businesses where there is extreme. Everybody came from a two parent family. And they're all white males and they all wear brooks brothers suit to work every day. And you have this homogeneity. Those boards make decisions that are less profitable less profitable than if there is some diversity on that board so it brings. Innovation brings a creative tension which can lead to really innovative ideas. And so i'm glad that That that's been proven. So that statement that you just made is a fact yet. This is all very consistent with what we learned from. Dr pamela douglas in our first narratives episode so it seems incontrovertible that diversity enhances patient care it reduces healthcare disparity. It improves the impact of our signs. In our research it increases creativity. So if that's all true and it is. It should stand to reason that the intermediate goal would be to improve the diversity within our own workforce so in a recent article that you published in java a survey of cardiology program directors revealed that while sixty nine percent respondents endorsed the belief that diversity is a driver of excellence in healthcare. Like we're discussing only six percent of the respondents believed that diversity should be in the top. Three list of priorities recruiting. So how can we work to address this so that cardiology as a field is diversified as physicians. We are evidence based wanna make decisions based on evidence. And so just like. I'm not going to stop using one look thinner and start using another one just because a pharmaceutical sales rep says to do so when they tell me that i'm going to say show me the data show me the data that one outperforms the other and that's what will drive my decision making the same thing we we have to do with our colleagues who are fellowship program directors residency program directors admissions committee members. We've got to be very active and almost missionary about showing them the data showing some of the data that we that we just discussed. I personally think that being on one of these. And i like to call them. I think of them as gatekeepers. The people who are at that gate who decide who goes forward and who does not. That's search committees for leadership. Positions academic medicine search committees for new faculty fellowship program directors and s election committees residency program directors and their selection. Committee's admissions committee members college admissions committee members. If you want to go all the way back to grade school the teacher who has the responsibility of deciding which of the fourth graders will be referred to the gifted and talented programs and which ones will not gatekeepers as well. I think a lot about these gatekeepers. I think it's an honor and a privilege to be on a selection committee with us residency fellowship or faculty or admissions committee to medical school. And so that honor should come with some responsibilities other committees. We have no problem. Being on other committees and other types of committees will say well on this committee gotta get everybody up to speed so everybody read these five papers or everybody do these modules these online learning modules. I believe we should have the same kind of strategy for our admissions committees residency committees fellowship selection committee. If you're going to be on this committee there's some there's some responsibilities you have to read these papers or go to these modules or attend these lectures Etc so. I think to answer your question the way that we will get over that hump and turn a needle is by making more data that shows the diversity enhances quality. But we've got a ton of it already making sure that our gatekeepers are aware of this data. He and they're all great points record keepers and you know just to kind of speak to that a little bit from my own experience in medical school. I was fortunate to be part of the admissions committee as a medical student and myself. Remember taking part in implicit bias. Training that was required for all members of the medical school admissions committee. Just how i opening it was in general to realize that many do have unconscious bias. And i think this doesn't necessarily mean that you're racist or discriminated against someone but it does reveal an implicit bias which may be affecting your behavior and i read a statement that you had made an article about how admissions committees are the front door to medical schools so they have a strong impact on the health of this nation. Can you explain a bit about what you meant by this sure so you don't get to become a physician until you get by so to speak that medical school admissions committee a so what that means if you look at the hundreds of thousands of physicians practicing in the united states all of them at one point or another. We're given the thumbs up by an admissions committee so our admissions committees as the front door as the filter might be another way. You say it have an incredible responsibility because they are crafting. Our nation's physician workforce which has so much to do with the health of the nation. So again it goes back to what i was saying. It's an incredible honor to be on an admissions committee or a fellowship or residency selection committee. Dr capers thank you so much for that comment and rena would also like the piggyback off of your statement. Earlier i was also able to play a role on emission comedians student and also during residency as a hospitalised. Now i'm actually impressed by the fact that you are offered courses on implicit bias on emissions committee. I think extremely important to have some of those things highlighted. Because you're absolutely right. It makes a huge difference on how we evaluate. It can how we choose certain applicants. It's impressive that even on the residency level in an highly academic institution. You would think some of these things would be set in place to prevent implicit bias this from happening. But i think it's very interesting topic. And i think something that should be done on the cross all admission communities throughout the nation because as you said dr capers. It's we are the gatekeepers. We are the people who allow. who are essentially shaping. The future workforce a physicians and if biases are kind of set in place. Certain people won't be able to be offered an opportunity and our vision workers would be extremely homogenous and patients may not be able to get the most appropriate care that they need or greg. So there's hope tell you that a lot of people are doing just what you've suggested. So i'm aware of paper where radiology residency training program. I forget what university. They're doing something similar to what we did at ohio state with implicit bias testing and then implicit bias. Mitigation training oven coast to coast talking to academic medical centers about this in many residue programs are considering it or starting to do the same thing so i think the future is bright. That's excellent and the kind of piggyback off of this how you can help. Recruit individuals from diverse backgrounds. Early in their education exposure is so so very important for young people. I mean if you think back to when you were a youngster what you saw was so important in what you aspire to be right so i mean if you if you see superheroes on television you know you wanna be spiderman and if you see police officers in a positive light you want to be a police officer so we have to expose. Young people want to compete with other professions. We have to expose them to medicine. I was always a big big fan as a student as a youngster of career. They always get very excited On career day were people of different professions will come and talk to us about what they were doing. We all need to make sure that we're still doing those kinds of things because you know in the day to day routine work of say a fourth grader or a fifth grader. You really can. They could lose sight of why they're working why it's important to do their homework. Wise important to listen to the teacher and then incomes of cardiologists to say you know. This is what i do. It's a blast. I saved people is the number one cause of death. And i really feel like i'm making a contribution but it all starts with you as a fifth grader fan to your teacher doing your homework. That's very powerful. And so i think we have to be working on two fronts simultaneously. I've spent a lot of time as universal cardiology fellowship program director and as an admissions dean for a decade. I spent a lot of time on what we call the in game. Two selection process working with the gatekeepers but equally as important is working on the pipeline. Trying to shore up that pipeline. Get more and more young people interested in becoming doctor going back to that perspective paper we had discussed earlier. There were many topics and concepts raised that applied to individuals of diverse backgrounds at interviews including stereotype threads tokenism micro aggression and imposter syndrome as a woman in cardiology imposter syndrome. In particular is sort of a common topic of discussion in various forums and at women in cardiology seminars. Something that i myself has have experienced at times in my training. Have any advice for trainees that experience. This just this impostor syndrome. Which is you know. Just a wonderful term. It really is a description of this feeling that you may have that you know what i don't really belong here. I'm not really smart enough to be here. I don't know if they know it yet. They might know it. They might find out and boy. I don't want them to find out. That's that's a terrible burden for somebody to carry around with him thinking that if i answer the question wrong. They're going to discover that. I'm not smart enough to be here or if i do something. Make a mistake with this procedure. They're gonna find me out. I don't belong here. I think the best way to deal with that is to talk to people who share your background. And if you can't talk to somebody to shares your background read about somebody that shares your background because we don't all have to somebody who shares are exact culture who is doing what we wanna do but learning about the reading about them can kind of help with your confidence. And then what i want to say on the other side. Now that i'm on the other side of that those of us who are medical educators out of our way to make sure that shy person over there in the corner on rounds that they're not feeling that that we can do the best we can to make them say you do belong here and it takes all types capers spot on. I completely understand what you mean. When you say some of these things arena i felt this during residency and even as a as a fellow here coming into this huge world renowned institution and the only black fellow many times. I think when they find me out. Won't they spot me out. But you know i've looked to successful people in color in cardiology like dr capers yourself. Clyde yancy someone in research dr gary gibbons at the age all successful widely productive men who are just like me so research exactly like you said dr capers. I look you all up. I see what you all do. I follow you on twitter to gain some of that assurance that i am in the right place and that i was like before reason and their potential to do great things. Like the people before me is there. I'll have to work hard. Great thanks for sharing bad. And you know that's a perfect high into this next portion as you switched over to the narratives portion of the talk where we get to learn. More about the leader's who inspire us. Great which you kick us off dr capers. We saw a recent twitter post of your showing a picture of you taking the ninth grade and what was on your mind back then including football basketball science spiderman trying to cool in a mission to become a doctor. Think back story. Do you remember the moment. You decided that you would or could become a cardiologist cardiologists. I i do. It was my biology class in high school freshman year. My first biology class. So i'd already knew i wanted to doctor. You know we talked earlier about calling. So medicine is a calling for me. So i never really wanted to do anything else as a profession so i knew from the time i was a toddler that i wanted to be a doctor would cardiology came into my life with my very first biology class in high school and for some reason this biology class. We did the circulation last so we started. You know with the nervous system and you know for somebody who wants to be a doctor. It's all interesting so i was like. Wow this is pretty cool. Too nervous system. And then we did the musculoskeletal system. And i said wow. This is pretty cool and then we did the digestive system and it was all cool but then we got to the heart and the arteries and veins. My mind was blown. I loved everything about it. I loved how the heart and the arteries and veins they talk to each other. When the heart gets weak it sends a signal to the arteries to dilate so that it doesn't have to pump against such force and ways that they're speaking to each other. I found that fascinating and sometime at freshman year first semester Found out maybe through something. I heard on the news. That heart disease is the number one killer in the nation. Then i was hooked said. Not only is this something that i'm extremely passionate about but but it's the number one killer. So here's what i feel like. I can make a difference now. I didn't know the difference as a freshman in high school between a cardiologists and cardiac surgeon to me. There's this heart doctor. So i knew at that time that i had to be a doctor that was involved in taking care of people with heart. Disease love that story. Dr cooper's so you have accomplished so much in your career. How do you manage to keep it all balanced with work and making time for family. You know what i think is so important as read reader because i absolutely adore my family and i put a high priority on family time but i also feel like i'm on a mission in my professional life and often they're long hours and so the way i balanced. It is by early on appreciating in saying to myself that every day is not going to be balanced so if the ideal is for you to spend let's say fifty percent of your day thinking about your career and fifty percent of your day loving on your family. Every day is not going to be fifty fifty not seven days a week. It's just not possible for people who are distributed in their career but if by the end of the week or by the end of the month it averages out then that's okay so in other words with a very long week. I made it my business that while. It might want to sleep in on saturday morning. I'm not gonna sleep saturday morning. get up. i'm gonna make my wife breakfast in bed. Then we're going to get the kids up. We're going to the zoo and then after zoo. I'm tired we're going to watch disney movie. I know more about disney princesses that any man is about disney princesses. I've seen them all and then after that then to get ice cream and then it's walk in the park and so by the end of that week you know the fact that i was getting home at nine o'clock every night during the weekday by the end of saturday and sunday it kinda evens out so that's kind of how i balance it and also about having a wonderful partner my life you know we. We made deals one deal. I make was. I want to put the kids down to bed. I want that to be my job. Because i knew i wasn't going to be there a lot during the day and so that time and story time was was was my responsibility so if i didn't get home until nine o'clock it was okay because the kids knew that daddy is gonna he's gonna. We're gonna get bath time which is fun to just splashing bubbles all over the place and put on our pajamas. Sarah prayers and then have a have a fun story. So that's the way i balanced but you know it could be as individual as many people as you asked that question but i think what was key was realizing that getting back to that analogy. Not every day is going to be fifty fifty. You have to be okay with that. If monday to thursday. You don't get to see your spouse as much as you'd like. Then you gotta make up for it on thursday five saturday and sunday but it should all hopefully come close to evening out. I love the papers and you know. I think it's his trying to balance kids and work and all these other things like being able to anchor at one activity that you're going to have with them. You know bedtime story time bedtime. Something that you can hold onto and i love everything you said except for one thing when you mentioned about giving your wife breakfast in bed i think if my wife or that i'd be in hot water so i have to decide whether going to leave that in the recording. You can delete that in on the topic of family. Add like to ask you about a painting. Your daughter drew and painted that you share social media on your lectures and talks and it features a black man in the middle to his right are coronavirus particles in reno that covid nineteen pandemic has disproportionately affected communities of color to his left. Our policemen who are holding a gun pointed at him in under their feet is a black man in handcuffs laying the floor and we know that some communities of color have also been subject of police. Brutality and behind him is a city on fire. so you know there's there's pain and anguish all around him but if you look at him you know his stances one of strength his pushing on both sides and as you've described the expression on his face is one of determination. And what i want to ask you is as a father you know. I mentioned my son through by two new. Babies are of another and as a father. I would want them to stay innocent for as long as possible. I'd i want them to not feel these these atrocities within our culture for as long as possible. You know when your daughter to this. She's clearly feeling these problems on a whole new and different deep level. So if if i may ask how did you feel when you realize that your children are feeling these things you know like. It's not at innocence be there. How'd you debrief with your daughter and your students. Your men tease when it comes to these atrocities. Thank you thank you. So much for mentioning. That piece of work is very important to me. And i'm very proud of it as you as you can tell and we were really proud when it graced the cover of the journal academic medicine in december twenty twenty. So i'm proud of her. I'm proud of my children. I never had a problem with them. Understanding that the world is not perfect. We keep trying to get it right. And i'll tell you this anecdote about my other daughter. Two daughters episode in two daughters my other daughter the baby of the family one thing that made me really proud was i heard her telling her mother a story about a conversation at school that she might have been in like the fifth or sixth grade and it was an innocent story. White children had heard the inward. They didn't know what it meant. My daughter wasn't in a conversation but one little white girl said to the other little white girl. What does that word mean and white girl said. Oh it means black people so my daughter is then inserted herself into the conversation. She said no. That's not what that means. That's that's a bad word and that hurts black people when you use that word and they said okay then. They all went and jumped rope or something like that. But i was incredibly proud. When i when i heard that so. I never had a problem with much. Understanding the world isn't perfect but we've got a role to play and we keep trying. Keep trying. keep trying to capers. When i first saw that picture i was incredibly moved and i thought it was amazing that you're able to post that picture but it also made me reflect on the fact that many times children of color have to grow up early and we're not afforded that innocent to speak of a helmet from a very young age. We are known that we are different and we face many things may younger. Kids are as me enough to face. You mentioned your daughter. Her young age and grade school wasn't mature person. And explaining that word means this and this word symbolizes pain. Some sure she was in grade school but she already was mature enough to understand and to communicate those feelings. Fourteen year old kids black kids. Kizza color are being murdered and tried as adults. You know it it seeing this picture and you know made me feel all of these feelings and stand that. It's incredibly humbling to see this picture. It's incredibly amazing that your daughter had the maturity to draw a picture with so many different meanings and to show that as a physician a black physician we are standing strong amongst what seems like the world come crashing down on one side. Please rotel their side and you know a fire in the back you know i was truly truly touched on many different levels by this picture and you know i actually wanted to communicate that to you and i met you well. Thank you christian daughter christian capers. Do that. I'll tell her tonight. We very moved as my thank you very much after keepers. You've been described as a physician activist. Do you recall a particular moment in your journey through medicine that made you want to combine your desire to treat patients with improving the world around you with respect to justice inequality. Was there a particular moment where you kind of made that connection or break questions arena. I don't know if there was a particular question. Those two things came together organically because both of them were in me. Like i said always wanted to be a doctor and i always even as a child felt very tinley racial injustice and had a desire to do something to eliminate or reduce to a degree that i can racial injustice so the two of them just went so naturally within me but yeah even young age I wanted to do what. I can to make sure that people being treated fairly logical though for doctors to be activists because as i said before what we're trying to do is is heal our patients and make our patients better and their many examples in history of physicians. Feeling like they wanna do that with the world. They wanna make society better. They wanna he'll society and certainly one of the most malignant diseases in society is racism. So i think it's a natural for doctors to want to go beyond that patient in front of you and think about how society is impacting this patient and then wanting to do something and so being activists might be writing your congressperson. It might be joining the picket line. It might be marching. That you know might be picking up a brick and throwing it through a window. It might be using your your pan. I consider the paper that we wrote together a piece of activism. The town criers to say. Listen we still have. After twenty years we still have these racial healthcare disparities. Let me just give you a shout out is rena what we found and we'll be talking about in that paper. Was that over. twenty years. There have been more than three hundred articles in the literature describing. Black white disparities in cardiovascular. Care twenty year time period. Three hundred papers. But at the end of that twenty year time period and at the end of that three hundred paper things were no better than at the beginning of that time period. So just holding that up as a mirror and being town. Crier is a piece of activism. So you serena your physician. Activist doctor capers. We talked about that ninth grade picture of yourself and what that guy was thinking about at the time if you could you know right now. The arc of your career has been just absolutely exemplary. You've impacted so many people. You're a leader of a social movement. You're bringing out conversations that are changing the way we think about our colleagues and you've had you've had such tremendous success in area if you could go back in time. What would you say to that ninth grade version of yourself in terms of what or how could accomplish things in the future. Well first thing. I would tell him would be. It is really going to happen. Because even though i was a very confident and i felt like it was my calling until you actually get there. You know journey from ninth grade being a doctor in you although this they're multiple steps right so even though i was extremely confident they're always was at least in one portion of my brain this. I hope it happens. I hope it happens. I hope it happens. So if i could talk to at ninth grade or now i say look dude. It's going to happen. You can relax and enjoy the ride A little bit. It was very important to me. I think it is for many people for all of us really to be successful to be a pre planner. I did a lot of daydreaming. And i didn't daydream about the next step. Always daydream d- two or three steps ahead. And i really mean that so even though i knew i wanted to be a heart doctor when i was a pre med student college. I wasn't daydreaming about being a medical student. Daydreaming about being a cardiology fellow. And when i was a general cardiology fellow. i had fallen in love with intervention. Like you greg. I wasn't daydreaming about being an additional fellow l. daydreaming about being an individual attending so it was always daydreaming. Two or three steps ahead. If i say something to ninth grade quinn capers afford. I'd say keep doing that but also be sure to enjoy every stage. You know it's going to happen. Enjoy every stage. You're reminding me of advice. I got from a deer mentor. Subject i who my program director during residency and during our exit interview. When i was leaving baltimore to move to cleveland. He said. I want you to picture. Goal okay so your goal is the the end scene of a movie and imagine all the scenes on that real all the scenes to get to that end scene whatever that nc may be in and think about not just the ncaa. What each of those scenes look on the way to get to that goal and make sure that you plan your day your plan your activities that were you hit each of those mid scenes to get to that ultimate goals. I really appreciate that. I like that very much. Yep your mentor. that analogy dr capers. Been an amazing opportunity to chat with you. During the narratives and cardiology with the cardio nerds. We've learned so much. We've been enlightened. I think a lot of important messages today or were delivered. Things that i think will help. Change medicine moving forward. We thank you for your time and personally for me. And i'm sure you're going to feel the same way you know as an honor to be able to sit down and chat with you and get to do this all through the cardio nurse platform. Thank you very much. Thank you greg. Thank you amid. Thank you serena you you all are awesome. This is such an awesome platform and such an awesome project proud to be involved with it and thank you so much for. Let me have a conversation with you.