We Can Become Stronger Through Diversity of Thought

In the conference evaluation, one of our members expressed concern about a sponsor at the Annual Spring Conference in Washington, DC. He included his name, which allowed me to reach out to him to further understand his concerns. A comment he made during the discussion stayed with me and prompted this column. He feels that there are members of STFM who do not feel safe expressing their views because those views run counter to a perceived majority view among the membership. It led me to ask, what role do social issues play within STFM? Would it help to create a space where we can more openly discuss these issues with one another?

STFM holds diversity and inclusiveness as core values. When Society members are hesitant to express their views, those core values should be a call to action. I want to emphasize that this is not a call for appeasement. We must stand up strongly to hate and intolerance. All opinions should not carry equal weight. Finding common ground is not an arithmetic average between our current views and an extremist view. As Suzanne Barakat, MD reminded us during the annual meeting, we must all strongly declare, “this is not ok” when we witness hate and intolerance.

This is a call to listen to different opinions with an open mind and a true willingness to learn. This call to action has particular urgency and relevance at a time when our entire nation is becoming more polarized. We increasingly talk only with people who think like us, as David Brooks eloquently pointed out in a recent New York Times article.1 We increasingly read news only from sources that confirm the views we already have. Members of Congress openly ridicule compromise.

As members of a society with about 5,000 members, we are unlikely to single-handedly reverse these national trends. But, as dissident and critical thinker Vaclav Havel said, we must act in a moral and ethical manner regardless of the consequences.2 For him, acting in a moral and ethical manner resulted in a lengthy prison term. Though he could not have anticipated this, the same actions also made him president of the newly formed Czech Republic. Adhering to our core values will make us a better society and model behavior for others outside of STFM.

That raises the question of what to do. What are the actions that will allow us to hold true to the values of diversity and inclusion? How can we give voice to divergent viewpoints? I believe we can find some of the answers from the recent work of political scientist Jurg Steiner, PhD, and others pertaining to the value of deliberation in bringing political adversaries together. I say this not only because he is my dad, but because they have performed impressive controlled experiments where they brought together fierce foes, such as the Colombian Fuerzas Armadas Revolucionarias de Colombia (FARC) guerrilla fighters and Columbian paramilitaries.3 These foes, who had just recently faced each other on the battlefield, were able to find surprising common ground when given a structured setting for deliberation. Fortunately, as members of STFM, we do not hold such widely divergent viewpoints. Still, we can use the lessons from this work.

Stephen Wilson, MD, MPH, our immediate past president, wrote passionately about the value of diverse diversity.4 Phenotypic diversity refers to the different ways we appear; internal diversity is the different ideas and values we hold; expressed diversity is the different abilities and preferences we have. He wrote convincingly that diverse diversity is virtually impossible to achieve for its own sake. It will last only as long as it is enforced or coerced. Lasting diverse diversity is achieved when it is a by-product of working toward a shared vision, purpose, and goal. STFM has such a mission: advance family medicine through a diverse community of teachers and scholars.

We can hasten the process by creating structures for deliberation at our conferences and in our online forums. Deliberation is different from debate. In debate, two sides take opposing viewpoints and each side argues as skillfully and forcefully as possible for its viewpoint. It is for a third party to decide who wins. In deliberation, by contrast, the two parties are intentional about trying to understand each other’s viewpoints. It requires open listening and a willingness to learn. Here are some ideas for being more intentional about hearing diverse viewpoints:

• Within STFM, we can deliberately invite diverse viewpoints to existing forums.
• We can have panels on how our religious and cultural beliefs influence our approach to medical care.
• We can invite plenary speakers with social viewpoints different from our own.
• We can explore new structures within our organization where we can deliberate even more effectively.
• We can listen carefully and with an open mind. By integrating the principles of mindfulness, we suspend judgment and actively listen without feeling the need to respond.

These discussions will not be easy. We will argue and disagree. But we can create a space where we stand up to hate and intolerance and listen generously to opinions that differ from our own. The structure of deliberation allows such generous listening. It encourages a willingness to learn from diverse viewpoints. It also fits well into our profession. From the first days of residency we are encouraged to search out new diagnoses and treatments. We are taught how to evaluate this new evidence critically and incorporate only those advances that will benefit our patients. This is called lifelong learning. Deliberation is another form of lifelong learning. We actively seek out opinions different from our own. We may or may not change what we do. Reaching consensus is not the primary goal. But sometimes we will learn things that dramatically change what we do. As a result of this learning, we grow stronger and more diverse as an organization. And maybe, just maybe, others will start to follow us.

I welcome your ideas on how to encourage deliberation of differing viewpoints and stand strong against hate and intolerance.