Dr. Farzanna Haffizulla: A Very Low Threshold for Bias

Dr. Farzanna Haffizulla is a practicing physician, an educator, and a nationally recognized speaker on improving cohesion among healthcare organizations and physicians. She is also an expert on work–life balance. She is a woman with a purpose, and with the intelligence, sense of self, and humor to keep her many hats on her head, often at the same time. She talks here, with PracticeUpdate, about the various roles she’s assumed and how she juggles the demands on her time. She talks as well about bias and offers straightforward advice on harnessing external resources to face it down.

PracticeUpdate: Dr. Haffizulla, have you experienced bias in the workplace?

Dr. Haffizulla: I mentioned to you that being pregnant in medical school was just not something that was catered to. There were no kind of rules or policies in place to help assure that someone would have time to recover. So, literally, a short few weeks after I delivered my oldest child, I was told by our dean that I’d have to come right back, and take overnight calls, and so on. I was horrified. I was still recovering from delivering my first baby, I was trying to breastfeed, and I was an emotional wreck.

There was zero support during that time for a woman in medicine. I felt even more ostracized just being pregnant. There were comments from attendings. There as just an overall feeling of, oh, she’s not going to be able to pull her weight.

Then, in residency, I was pregnant with my second child. I had preterm labor, which I’d had in my first pregnancy, again for the second one. At one point, I was getting contractions with significant pain, and I was worried. I shared my situation with my attending. He said, “I want you to hydrate but I don’t want you to stand at rounds. I want you to sit on this chair. We’ll roll you from one patient to the next. I don’t want you to worry about that at all. We’ll take care of it.” And this is a man! He was amazing.

Now, there was a female OB resident; she would scowl, she would make comments to others on the team to the effect that I was just pretending to have preterm labor. “She just doesn’t want to be here or do the work.”

I’m hearing these comments and I’m logging them in my mind. Meanwhile, I’m doing about everything I need to do. I did my orders. I took care of my patients. I did everything that I needed to do and beyond that. At one point the labor pains were so intense that I walked myself over to the OB ward just to do a quick fetal monitor to make sure that my baby was okay. Sure enough, I’m having contractions on the screen, but the OB resident phoned her colleagues over there and said, “Hey, just tell her to come back. There’s nothing wrong with her.” I heard the resident on the phone talking to her, and she’s telling him all of this, and I couldn’t believe it. That made me very upset.

I went and told my attending what was happening because I’d been taking it for some time. I was about halfway into the rotation. He was also the attending in charge of our team and very well-respected at the Cleveland Clinic Foundation. And, he was father himself. The next day I came to rounds, and the OB resident was not there. The attending made an announcement. He said, “Listen, I want to tell you all something. There is never going to be any acceptance of discrimination or bullying or harassment on my team. I have fired so and so.” He fired her! I was blown away. I thought he would just discipline her, talk to her.

So, my point is, if you are in a situation like that, gauge the situation and decide quickly who you can talk to but document everything that you are doing to ensure that you don’t forget the details.

It’s important, really, to build alliances with the people who you work with. I was going through some similar things in another situation, and I was experiencing a consistent amount of toxicity, hostility, bullying, and clear bias and marginalization. I knew that the higher level of leadership in that particular organization did not necessarily see my situation; but, based on past actions and their leadership style, I knew that they were not going to be amenable to fixing the problem. So, I went to someone even higher up and asked—just generally—what kind of advice he’d give in that sort of scenario. He gave me stellar advice. I went ahead and formalized the process and ended up taking it to a level more proximal to the executive leadership of the program. They now had recommendations of things that needed to be changed.

So, never leave it alone. Always address it. Always address it. You have to address it and address it in a way that you are showing your professionalism, you are showing your support for the team. You must ensure that you are not being destructive and that you yourself are not being a problem. Your goal is to shed light on an area that needs to be dealt with immediately because, ultimately, an entire organization can suffer. So, don’t stay quiet. Even if other people are afraid to be in alliance with you, you need to help to pave the way so that particular behaviors will not be tolerated.

A woman physician is often mistaken as a nurse or another member of the team, not as a doctor. I have the greatest respect for nurses, and my own mother was a nurse. But women in medicine are not seen as the leaders of the team necessarily. They don’t really have that space at the table. Women don’t get the leadership positions unless they prove themselves over the course of many years in one way or another. And, unless they prove themselves, they’re not given the time of day.

So, I’ve tried to mitigate some of this bias or these preconceived notions about being a woman in medicine, and a woman of color in medicine, by ensuring that I present myself in a way that I want to be remembered. That involves me looking and dressing and talking in the way that I want to present myself. This includes presenting myself to the global community through social media sites.

What you say to an audience at a conference or to the community and how you say it and how inclusive you are matters. If you are truly walking the talk with equity, inclusion, and diversity then that is a very strong message.

That message can be made through alternative ways. For example, in one of the programs I’m involved in, I advocated for us to do unconscious bias training, every member of the program. People who may not think that they have unconscious bias—when we all do—would be able to engage in that training, and it can be an eye opener. In this way, you don’t directly enforce that specific people participate. You’re making it more of a global effort, so the people who are discriminating against you are now part of that global effort; they don’t feel singled out, but yet they get the help that they need. That’s one way that really was successful for me. I find that situations like that improve significantly.

Once, when I gave a talk at a university, a person came up to me and told me that she was experiencing a lot of bias and discrimination from her direct supervisor, and she was worried and didn’t know how to approach the situation. I asked if she addressed the issue directly with her direct supervisor, and she said no, that she was afraid of doing that. But you absolutely have to do that. That’s the first step you have to take. You have to ensure that first you do a face-to-face. Remember to document everything as you do this so that you won’t forget the details. It’s very difficult to remember those details after the fact. So, once you’ve addressed the person face to face and nothing changes, then you go to the person above that person to have the conversation and to see how things can be remedied. You need to make clear that there are remarks being made that make you uncomfortable or that make the situation hostile or toxic, and you need to ask what are the very best ways to make this a positive, collaborative relationship.

If that person cannot help you, and if there isn’t someone higher than that person, go to the larger community outside. Don’t be afraid to call on your circle of influence.

I am involved with the American Medical Women’s Association and several other professional medical societies and maintain a connection with several other stakeholders, not just to maintain relationships and to ensure that we have power within the initiatives that we’re undertaking, but because it also helps when any of us encounters the same gender bias and racial discrimination issues. We have candid conversations about what the issues are and where the problems occur. What’s happening? Why are we meeting roadblocks and why can’t we progress to where we need to go? It’s when you find that the powerful stakeholders absolutely are onboard with making sure that you meet your goals and in the right way, when they step in, they absolutely help to turn the tables. That has been a very successful route to really bring some more power and muscle to the game. Just don’t be afraid to harness it.

PracticeUpdate: Has this changed during your time in medicine?

Dr. Haffizulla: No. Things have not changed. It’s unfortunate. A lot more people are talking the talk but they certainly are not walking the walk. Because there is a push now to ensure that we have diversity, equity, and inclusion, people are simply speaking the words, and their actions for sure are not matching up to those words. Right now, there is a push to have more authenticity. Beyond authenticity, I believe that we need bidirectional assessments wherein you as the supervisor are assessing your report but you need to know how you are going to be assessed as well. A frank and candid assessment of everyone is important. A level of transparency is vital. That’s the only way we’re going to change things.