Scalpel and Sword: Conflict and Negotiation in Modern Medicine

EP27 - Microaggressions in Medicine: The Triangle of Source, Recipient, and Bystander

Episode Summary

Join Dr. Lee Sharma on Scalpel and Sword Podcast as she speaks with Dr. Tracy MacIntosh, emergency medicine leader and advocate for belonging. Learn practical, non-confrontational ways to address bias from patients and colleagues, protect learner well-being, and build psychologically safe teams that keep physicians in medicine.

Episode Notes

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What if a single comment could push a talented resident out of medicine—and how can we stop it?

In this episode of Scalpel and Sword, Dr. Lee Sharma welcomes Dr. Tracy MacIntosh, as she shares eye-opening stories like an intern greeted with “I don’t want a doctor with an accent” and the hidden toll of repeated microaggressions: burnout, attrition, and even suicidal ideation. Drawing from surgical residency data and her own workshops, she introduces a simple triangle framework (source, recipient, bystander) plus scripted “I” statements to interrupt bias without escalating conflict. Dr. MacIntosh emphasizes curiosity over defense, grace for patients in pain, and anonymous reporting channels to prevent retaliation. The goal: retain diverse talent, improve patient trust, and create training environments where the work is hard—but never toxic. This episode equips physicians, residents, and teams with immediately actionable tools to foster respect, reduce burnout, and preserve the workforce we desperately need.

Three Actionable Takeaways:

About the Show:

 Behind every procedure, every patient encounter, lies an untold story of conflict and negotiation. Scalpel and Sword, hosted by Dr. Lee Sharma—physician, mediator, and guide—invites listeners into the unseen battles and breakthroughs of modern medicine. With real conversations, human stories, and practical tools, this podcast empowers physicians to reclaim their voices, sharpen their skills, and wield their healing power with both precision and purpose.

About the Guest:

Dr. Tracy MacIntosh is the Associate Dean for Access, Belonging and Community Engagement at the University of Central Florida College of Medicine. A Yale MD with master’s degrees in science and public health, she completed emergency medicine residency at Yale and became founding faculty for the UCF-HCA Florida Emergency Medicine Residency of Greater Orlando. Passionate about teaching and psychological safety, she develops workshops that give learners scripting and reporting tools to address bias without fear. Her work fights burnout and attrition while improving patient trust through diverse, respected teams.

Email: tracy.macintosh@ucf.edu

About the Host:
Dr. Lee Sharma is a gynecologist based in Auburn, AL, with over 30 years of clinical experience. She holds a Master’s in Conflict Resolution and is passionate about helping colleagues navigate workplace challenges and thrive through open conversations and practical tools.

 

Episode Transcription

[00:00:00]

 Hello, my Peaceful Warriors. Welcome to the Scalpel and Sword Podcast. I'm your host, Dr. Lee Sharma, physician and conflict analyst, and I am so thrilled to have on the podcast today, Dr.

Tracy Macintosh. Dr. McIntosh is the Associate Dean for Access, belonging and Community Engagement at the University of Central Florida College of Medicine. She has her master's in science, a master's in Public Health, and she got her medical degree from Yale. She also completed her residency training there in emergency medicine.

She then moved to Florida and became founding faculty for the U-C-F-H-C-A Florida Emergency Medicine Residency of Greater Orlando. She has a passion for teaching. She loves her medical students and her residents, and it's really clear not only from her activities and her work, but also from her awards that she definitely excels in that area.

She's passionate about helping physicians and learners in all areas be heard, valued, and [00:01:00] respected, and I am so happy she's here today. 

Hey Lee, it's a pleasure to be here and have this conversation and. Maybe open some minds to having a more candid reflection on how we can communicate better with our peers and how we can stand up for our peers and support each other the best way possible, especially in the healthcare environment where it's hard, the days are long and some of the cases and the patients are really hard.

And so how can we support each other as best as possible to do what we're all called to do, which is just to help one another patients or peers. 

100%. What sparked this passion in you? Because it's clearly something you very much care about. 

For me it's the comments and the experiences of peers, friends, folks around me.

When we show up to work with our best selves, walk into a room and then get hit with a comment from a patient. That we don't belong there, that [00:02:00] we're assumed to be. The nurse, I'm assumed to be the patient care assistant, all amazing roles in healthcare. But when I show up with my badge that says md, I introduce myself multiple times as Dr.

Macintosh. And to have that disregarded, to have that undermined, some days it's easy to brush that off, but when you're having a really hard day, then those are paper cuts and time after time, it takes a toll on even the best of us. And my goal is to help to bring these situations to light.

For patients, for our peers, and so that we each have the voice to recognize that I can correct this behavior. Yeah. I can address it without being confrontational, without interrupting the patient physician relationship without seeming like I am undermining my [00:03:00] attending or a consultant, but that I could speak my own truth and that I can stand up for myself and say, Hey.

Those comments that hurts me for this reason and to help people to see that so that people can improve. And so that's my goal, is to have these conversations with my learners, with my colleagues, so that we can normalize that when things are said that are hurtful, that we can address it and that we can correct that behavior and then it can stop.

And that people can realize that there's a difference between intent and impact with our words. And that we can create cultures in our learning environments where everyone can thrive and everyone can come to work and do the hard things of patient care without the harmful words and comments from peers, patients, and colleagues.

Yeah. One of the things I loved about the article that you published in 2022 in the HCA when you open the article, the first paragraph talks [00:04:00] about an intern named Isabelle, and she's so excited and she's happy to be there, and she's wanting to be challenged. And she walks into the room and she's here to see the patient.

And the first thing the patient says to her is, I don't want a doctor with an accent. And what I loved about starting the article with that is it made it very real and. For those of us who are physicians of color who have walked into patient rooms and had people say, I have had patients say to me, I don't want a brown doctor.

I have had this happen. It's really hard if you've never had that experience to understand how hurtful that is. And I, when you started the article with that, I feel like it really opened a lot of people's eyes to the fact that this is a commonplace experience and this commonplace experience, unfortunately has 

A profound negative effect on our healthcare workforce. 

Yeah. 

What kind of negative things does this kind of commentary produce? Not only in our learners, but like you 

said, our attendings. There's some [00:05:00] amazing work coming out of the surgical residency literature led by he atal and they really characterize and quantify for us in real terms, what is the human cost to.

These comments from patients? From. Nurses from colleagues that are often est. Yeah, in the case of the patient, that comment there, that's, that happened many times to my colleagues and my learners. It's not est, it's, that's intentional. But even comments that are est, the consequences are that folks who experience it.

Are disproportionately from underrepresented groups in medicine. So groups that are already in low numbers in healthcare that they're more likely to experience these kinds of comments. Discrimination and harassment, frank harassment in the workplace. They're more likely to have thoughts of burnout, so that means, we're less engaged in patient care where you have less empathy.

That's how burnout manifests. In [00:06:00] our workplace. More likely to have thoughts of attrition. That means leaving medicine. That means people that we recruited because of their passion for helping others, for improving the quality of care people that we recruited to our residency programs.

'cause we knew they would add so much, they're more likely to wanna walk away from medicine, maybe from our program and to another program, just still a loss. But to leave medicine altogether. And unfortunately there is an association with thoughts of suicide. Self harm. And so this is a tremendous cost and we are very invested in making sure that we prevent all those outcomes.

And we know that having physicians who are underrepresented minorities, not only is that so important to improve our culture in our medical house, but it's also. Very important for patient care. We know that patients resonate with physicians who look like them. That's well documented. It's gonna help them feel like they're accessing a common system, and we want patients to [00:07:00] feel comfortable in the system and the fact that we are letting these microaggressions.

These statements, the things that sometimes people will try to laugh off and yet they're so hurtful and we're not finding an active way to address that. It's hurting how we care for patients, but it's also hurting the clinicians in such a profound way. And if they don't have a way to work through it, if they don't have a way to address it, you're right.

They may just wanna walk away and what a terrible loss. One of the things I love in this article is that you actually talk about a structured way. To approach this, that if these are happening, let's say for the sake of argument, let's say that you have an attending who's got a male medical student and a female medical student, and he calls the male medical student by his name, whatever, and the female he calls sweetie honey.

And this happens over and over on rounds and we have somebody who's making the statement. We have someone who's hearing the statement, but we [00:08:00] also have the bystander. We have another person who's a witness to this. And you talk about this in the article, that there is actually a triangle in this process.

Tell us more about that. 

Yeah. This is from Ackerman. Barger, and I like to use this because so often we're found in situations where. It happens, it's uncomfortable. We see it happening. We're right there. It's unfolding and we're frozen we're just caught off guard. And so by having these workshops, by having these conversations, and by giving examples of scripting, my goal is that once I've set it in this protected environment in a workshop once I've had a chance to role play with a colleague, then when it happens the next time. I have an idea of how I, what feels good to me, what feels normal and natural for me, right? Which could be different than what feels normal for you, Lee. And so sometimes in the moment I'm gonna wanna interrupt it and I'm gonna wanna speak up and point it out right there.

[00:09:00] And then other times it may not feel comfortable. And I'll wanna just say something to the recipient of that ugly joke or. That frank form of discrimination outside the patient's room or in the, in a physician lounge, right? And so I wanna give folks permission to address it in the way that feels comfortable for them.

And sometimes it's gonna be an email. Sometimes it's gonna be in a anonymous survey at the end of the semester for a student because they're worried about retaliation. But the goal here is that everyone feels empowered to speak up. When you feel it's uncomfortable for you and that you can let your colleague know that you also were not okay with what just happened, that you saw it happen, and that it was hurtful to them and it's hurtful for you and you're not the kind of person that wants that just to be swept under the rug.

And so by having different perspectives on the situation, I hope to empower folks to speak up and to address it. [00:10:00] And there's an example that we give where sometimes. I have a joke that falls the wrong way sometimes. I'm the source of it. I'm human and I make mistakes. And I have some scripting for when somebody says, Hey, Dr.

McIntosh, the way that joke came across, it really, it hurt my feelings or it could come across in this way. And so I put some words to that. Yeah, I'm sorry. You're right. I never thought of it like that, which is often just what it is. I never thought about that different perspective and to thank the person for bringing it to my attention and to allow me to have some time for growth.

If I'm the recipient when I'm in the room and a patient says I don't wanna black doctor. When that's happened, my instinct is to come from curiosity. I like to give people grace. That is inherently who I am. And so for me, the reflex is to come from curiosity. Oh, why do you say that?

And then I generally, reassure them with my credentials. Not every doctor has to do this, it is a function of some of [00:11:00] my identity that I get called out more. Than somebody else, having to defend myself, oh, I went to Yale Medical School and I've been practicing for 15 years.

But I give people grace and I understand that patients are in pain and then they react in ways that may not be their best moment. But not everyone is gonna wanna have that grace for a patient. I can understand that when you feel beaten down over and over again and people keep saying the same things.

You may not feel that's where you wanna come from, but I offer that as one strategy. And then the third perspective is the bystander when you're in the same room. And how do you support your colleague so that they're not burdened so much just on their own? Because you can imagine when. This comment that belittles you, that undermines your value and your experience, it sticks with you and you're mulling it over in your mind.

And instead of being focused on, the labs and the next thing to do, you're stuck. And then from my [00:12:00] learners, that's being stuck sometimes manifests as not being engaged. Not participating, but you're just mulling over and you're stuck in this moment of feeling the imposter syndrome is there.

And on top of this, the patient just said this to you, or the nurse just said this to you and you're feeling like you don't belong. And you're feeling like you're not worthy. And then there's a cycle that you're not engaged and you're not participating, and people think that you're aloof. Because you're bogged down by what just happened.

And so those are all the reasons that it's so important that we have conversations about it and that people realize that at our core, we want training environments where everyone can thrive. And this is one of the tools that we wanna give our learners and our peers and our colleagues to be able to make it better.

Oh my gosh, there's so much beauty in that, and I wanna really get into this. One of the things that you talked about being the recipient. 'cause that's such a hard role when you, especially, and [00:13:00] I love how you bring in the fact that if we already are carrying relative imposter syndrome in our jobs, which I think we all do, and then someone makes a negative comment like that it compounds and jumps in that imposter syndrome.

And sometimes I think the first knee jerk reaction we all have, especially walking into that kind of conflict, is to defend. We want to defend ourselves. We become a. Preservational creature, and I love how you talk about, we really wanna respond from a of curiosity. Because being curious about why that statement was made actually does so many things.

It creates a space to have that conversation and you actually become more powerful because you are letting that conversation take place. And you're able to say, I would love to know why you made that statement. That's very empowering. And most of the time, I think if you open the door to that, not only is the patient gonna get a different perspective or whoever has made this comment to you, but you're also going to be able to take it outta a space of taking it personally.

And I [00:14:00] love how you're giving people that strategy. I also love how you talk about the process of scripting. These responses because in the moment it's such an emotional process that if we don't have something already that we've thought about it, that we've prepared ourselves that it's very easy to get into that head space of being distracted and we're distracted by the comment.

And as you say, we suffer personally, the clinical care suffers. And I think with that idea of scripting comes, the idea of is it's not an if, but when. And so you're already, I think, preparing your learners for the possibility this may happen, and in sense, in many ways, it's not a possibility, it's a probability.

Do you 

find that when you practice scripting with them, they become more confident in entering these conflict situations? 

Yeah I do see that in our workshops and when I offer an opportunity for learners, especially to share experiences. [00:15:00] Then they're able to see how pervasive it actually is, and folks are able to identify how these situations impact their peers.

And so it's really powerful to do the scripting, to give some concrete examples from people that they really respect and people that they really wanna have their backs. And make sure that they all make it through training and they all make it to the other side whole.

Yeah. 

Another thing that you talked about is if there is somebody who is making the comment or making the microaggression. when this is brought to that person's attention, we're not trying to create a culture of finger pointing, that we're actually trying to create a space that is we are here to grow, we're here to get better.

I'm gonna make mistakes, we're all gonna make mistakes, we're all gonna say things. And there's a lot of, as you said, be able to extend grace to ourselves. As well as extending grace if we happen to witness something like this. Do you find that also doing this kind of work that you're doing these workshops, doing the scripting, I'm [00:16:00] sure that is making huge strides in creating this culture where you are.

Yeah. I hope it is. 'cause the workshops and the conversations I have it's very affirming for folks To realize that they're not alone. it's unfortunate when I share the data about how pervasive it is. It's good and bad.

Good for them to know they're not alone and that what they're experiencing has a name has been studied and interventions to address it. But of course, bad because it is so prevalent. And again, our surgical colleagues Have been shedding light on these issues and trying to improve the training environments specifically for general surgery.

every year after their in-service training exam, they have surveys for every single surgical resident to understand how many folks are going through this. And one of the criticisms that I hear from folks about having these conversations. 

Putting a 

name to these insults, discrimination, and harassment is, oh our, these millennials and gen Zs are just too sensitive.[00:17:00]

They're just too sensitive. But then when I present the data of the prevalence thatclose to half to two thirds of female surgical residents are experiencing sexual harassment. Yeah. That, maybe close to half of black African American surgical residents are experiencing racism, discrimination.

these are the toughest residents, the surgical residents, and they're allexperiencing it. So it's not that they're too sensitive, it's just that there's too many of them going through it. And it's really a call to action for us. 

going through, I went through OB g vitamin residency in the nineties and I trained at Parkland Hospital and of course we knew all the surgical residents as well.

And one of the things that I really think about now is going through that process, I think we had a lot of toxicity in our programs. I think it was all there, and I think the reason why. I am just now thinking about what that experience was like for me was because I just accepted the fact that I was gonna get beat on and harassed [00:18:00] and it didn't occur to me that there was anything different.

Yeah. But more importantly and actually frighteningly, I didn't think it was anything wrong. It was, this is the nature of training, this is the nature of training in a big university hospital. You were gonna have these comments made, you just learned to deal with it, you sucked it up, you kept going.

And you really didn't wanna say anything 'cause you might get tossed. 

Yeah. 

And. It was literally almost trained out of us to think about whether or not environment was toxic or not. And I think that's such a fascinating perspective. So hearing you talk about how we have the millennials and the Gen Zers who are actually saying this is not appropriate behavior.

 

Is promoting that change. And I love the fact that a lot of this literature is coming out of the surgical residencies that. People are saying that having this kind of interaction is not only detrimental to us, it's detrimental to patient care. It's dividing our attention. We're spending more time thinking about the aggression than we are thinking about doing the case in front of us.

That's. 

So terrifying that we are asking them to [00:19:00] divide themselves in that way and being able to have an environment where we can actually educate people. 'cause we want to educate, we want to learn. We want residents to leave training programs, feeling competent and ready to go out and practice on their own.

But understanding that we have to create an environment to do that. One of the things that I loved in the article as you're talking about helping people learn about these interactions is helping them to learn to do this in a non-confrontational way. Actually creating that space to do that. How do you show residents staff.

How to do that. 

We know that very a small percentage of residents will report it because they're so worried about retaliation. And so in our onboarding for our learners at our institution we Share with them all the different ways that we wanna hear about their experiences.

we have anonymous reporting strategies, we have our program directors, we have different levels of administrators who will be able [00:20:00] to address these issues, provide coaching, feedback, and a closed loop communication so that the learners can know what actions were taken.

And so those are the main things that we reinforce for our learners. we're not trying to fire great doctors. Our goal is to provide feedback and coaching and support. And so that's really how we address it. So early on in training and throughout the years, we provide avenues for disclosing, for reporting, and if it needs to be anonymous because people are worried about retaliation, that's one of the mechanisms.

That is so powerful. You are giving them such a sense of security, literally psychological safety 

In creating this kind of mechanism. And that's something unfortunately, I think that it's really, it's so needed. We don't have that right now in so many locations and just medicine in general we're needing to really find that because it's lacking so much.

Especially right now. I feel like one of the things that we talked [00:21:00] about before we jumped on was the idea that this is not just about preserving mental health for our physicians and our learners, our medical students and residents. This is about preserving a workforce.

Absolutely. Yeah, we know I talked about the thoughts of attrition. That was one in eight that was for the surgical residents. But we extrapolate that to other specialties and we have an expected shortage of physicians. A MC put out a report earlier this last year that is up to, 86,000 doctors that we'll need in 10 years. And so we need to do everything we can so that doctors are staying in medicine for the love of medicine and not just for a paycheck. And so this is just one of the strategies that we have to make sure that folks can stay in love with the work and, especially for us as a training site, my goal is to have the residents love our hospital, love our community, and love our [00:22:00] patients, and wanna be a part of it for the long haul.

Wow. As you are working through this process of teaching them how to recognize approach and deal with micro-aggression in such a way that it becomes a learning experience and something that becomes.

Part of their education just as much as clinical practices, you are giving them a life skill. Do you give them any kind of specific acronyms, tools, something that they can use to remember how to process all of this? 

Yeah. one shortcut. is just to focus on I statements. So this is good.

communication 1 0 1 for any kind of conflict resolution and any kind of difficult conversation. And it just to start with, I feel this way because of this. As opposed to you are racist, you are a sexist, you are any Yep. That is very difficult for the recipient of that type of statement to open their ears and heart to a conversation.

But if I start with, I'm [00:23:00] curious. Why you don't want a doctor who looks like me? Yeah. Did you really mean to say that? Because I'm here to provide the best possible care for you, so I just focus on the I statements when I don't know what else to say but finger pointing, and calling other people out at that.

My guard is way up and the tension is gonna be way up, and it's gonna be hard for me to recover that relationship. Patient, physician or colleague to colleague, consultant to emergency attending. It's gonna be really hard. 

Oh, amen. The idea of finding a way to start that conversation where you're not immediately putting somebody in the defensive.

Yeah. That's so powerful because that's such a place that if you walk into that with the you statement. Immediately, especially somebody who hasn't been through the training, who hasn't been to the workshops like you guys are doing, the natural knee jerk response is to react, not respond. And unfortunately, this is where you get escalation.

Yeah. And. [00:24:00] Rather than opening a dialogue, you're gonna close a door and that's absolutely the opposite of what you want. Brene Brown has a beautiful way of working with this and her books daring Greatly all, she's just so amazing with her work with leadership. But one of the phrases that she uses that we will use a lot as well. And it's still a you statement, but the whole kind of interaction is framed around when you say this, I hear this. 

And 

so you're not telling the person, your ex, that's not the point. But it's explaining to the person that I understand that what you said may not be what you intended to communicate.

And that's a huge place of awareness for a lot of us as communicators, 

isn't it? Oh, Absolutely. And so that really, requires us to come to our work, to the hospital, to our clinics with our cup full, because it really takes a lot to do those types of statements. Yeah. And 

I don't discount, what that [00:25:00] requires and especially when it's different levels of training an intern, it's hard for them to have that confidence to have these types of conversations, but, oh, yeah. Scripting and giving them permission to feel the way that they feel and to know that they don't need to be anybody's punching bag.

That's so important. 

I love how you use that phrase to feel the way they feel. 

Because this is something that I think has been so sorely lacking in medicine, that as we are learning more about conflict, as we're learning about microaggressions, we are understanding that it's okay to feel.

It's okay to have emotions as we come into our job and we can be professional and sometimes even be better professionals if we're aware of what's in our cup, if we're aware of what we're bringing into the workplace. Yeah, because that's not something, in terms of a self-awareness or a, any kind of mindfulness practice of what's going on with us, that's not really something we.

Had as trainees. We were not encouraged to do that. So I love the [00:26:00] fact has as you're going through this process, inherent in it, is doing some introspective work to know what we're bringing in with us when we walk in the door to the clinic, the er, the, or wherever we happen to be. 

Yeah.

Absolutely. 

 I love that so much. Yeah. Have you found since you started doing these programs that your attrition rate or the reported mental and psychological health of your residents and learners has improved as you've been doing these programs? 

I haven't been tracking the outcomes.

What we track is in your healthcare systems the rates of discrimination and that hasn't changed too much, but I have So many variables and confounders. So I'm not too discouraged and I will still continue on with these workshops, but I'm looking forward to some really incredible work coming out of, the surgical literature where they have donerandomized controlled trials, they have implemented a suite of.

Workshops and programs and [00:27:00] resources in order to really see does this make a difference? I'm in a world where. Doing these workshops, it feels right. We're having meaningful conversations. I get a lot of great feedback, but there's still opportunities for us to see what are the actual evidence-based strategies to have real outcomes improve for our learners.

So that's stilla second trial and that's still on the horizon. 

 Oh, I'm so glad. I am fairly confident that as you continue to do this work, I think you're going to see better reporting when it comes to mental health. I think we're gonna start to see less attrition. I think we're almost getting into a critical space with health care in terms of keeping the people we've invested in as learners, but also the people who are in their careers.

These are also physicians that. Maybe have a few more years of clinical practice that may also be leaving because they were never given these tools and we want to include them as much in this learning workshop [00:28:00] world that you are presenting as much as our learners are. Because honestly, sometimes as I start to talk to doctors who graduated from other countries who, maybe they do speak with an accent and they just put up with it their whole lives. no one's ever given them the tools, no one's ever given them the permission to say it's really not okay. For this to happen. We wanna put our arms around and support you.

Yeah. And I feel like, our skin gets tougher as we go on in training, but it's still, we're still human beings and. Unfortunately you and I know that the rates of suicide are way too high for physicians. And so we're not immune to anything. We just bury it and we hide it.

And we have strategies that are not healthy coping strategies that we employ. But I think there's so many opportunities for us to get to the root of what makes. Medicine so hard, and this is just one of the things that makes it hard having difficult conversations with [00:29:00] colleagues where

we're not built up by each other. We're not being encouraged by each other. By instead the words and the actions by our colleagues. Sometimes it's in and of itself, are belittling and having a voice to speak up and to report them to the CCMO if that's what we wanna do. But what's better is to just have conversations with colleagues and to let them know our perspective and how the words affect us.

I think that's the best way for us to move forward. 

You said something really amazing and I wanna really bring this out, which is that this is something that happens to a lot of us, if not all of us. But it's not something, because we have over time developed, as you said, this thicker skin, we've just let it go.

Someone makes a comment to us and we just let it pass. We may overhear a comment and not have the tools to bring it up. And we let that colleague feel alone, they received that comment and we let them suffer with it. And rather than having these conversations or giving them that support, it's I'm really [00:30:00] sorry.

That you had to deal with that. Let me talk with you. Let us sit down together. Let us figure out how we can address this so it doesn't happen to you 

again. 

Yeah. 

Is there something that I can do to help you? But, let them help, let them guide you on what's comfortable for you and for them.

And this is one of the things I think is great about us even having this conversation in the first place, is that. If you start to think about the number of times you've had these comments made to you, and then you think about how that made you feel, would you ever want a colleague to feel that way?

Of course not. And if you have the agility and the ability to actually help to make an intervention and raise somebody's awareness, I think that the majority of the time when you raise somebody's awareness to the fact that they made a comment that was hurtful, and especially in. Among medical professionals.

I think the vast majority are gonna be really shocked and very sad that they had that effect on somebody. 

But you do wanna open the door in such a way that they don't [00:31:00] feel attacked. That they don't feel canceled. Yeah. You want them to feel very open to that. I think it's only going to build solidarity and it's only gonna build that, and I keep coming back to this term, but psychological safety.

We need that desperately. 

Yeah, We do. The work is so hard as it is. We need to know that our spaces are safe and, as the term toxic that is what describes so much of training in the past and we're hoping to. Change, shift the tide on that. I talk to my learners and my colleagues that medicine is supposed to be hard.

It's hard. 

The cases that we take care of the outcomes, it's really hard, but it's not the toxic part. That's what we can control and that's what we really want to improve on for the here and now, and especially going forward. 

Absolutely. Tracy, I love the work that you're doing.

Your learners are so lucky to have you, your patients your fellow colleagues, they're so [00:32:00] lucky to have you as well. If people wanted to reach out to you and learn more about the work that you're doing, how would they best 

The best way is to get ahold of me by email.

It's Tracy, T-R-A-C-Y, dot Macintosh, M-A-C-I-N-T-O-S-H, and I'm at the University of Central Florida ucf.edu. I would love, yeah, I can share our workshop materials, that you're not reinventing the wheel, and be happy to coach you through anything. The most important thing is.

To lay the framework that it's an open discussion and that really I have, specific slides that I'm not trying to point fingers. There's no good or bad. We're trying to create better healthcare spaces for all of us. 

The work that you're doing is amazing and I'm 

so thankful that you are doing it.

Thank you, Lee. It's been great to have this conversation and it's overdue for us to make these conversations more normalized. And just to remind folks we're not trying to get rid of great [00:33:00] doctors. We're not trying to kick patients out of practices. We're trying to make the space as positive.

100%. I thank you so much, Tracy, for your time. Thank you for being here. We will definitely put your email in the show notes, but it's been wonderful. I really appreciate it. Thanks. It's been great to talk to you, Lee. Nice to connect on this issue 100. Thank you so much for all of our peaceful warriors who have joined us on the scalpel and sword.

Thank you so much for being here, and until next time, be at Peace.