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21 August 2020
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What you permit, you promote – however small

Dr Nnenna Osuji, Medical Director and Deputy CEO Croydon University Hospital, and FMLM Council Diversity and Inclusion Lead

By Dr Nnenna Osuji

FMLM Council Diversity and Inclusion Lead

Last month, I briefly raised the concept of biological weathering. The impact of many small insults borne silently in the act of fitting in. The longer-term consequences of these micro-aggressions are upon our physical and psychological well-being. There is a balance in life, and an ethos of choosing one’s battles for the sake of maintaining sanity, avoiding exhaustion and maximising impact. ‘Don’t sweat the small stuff’ they say. 

Personally, I have to admit this is a concept I struggle with. Those of you, who like me, have had the pleasure and pain, of raising children, know that it is in correcting the small infractions that we prevent the larger issues later on in life. When I were a lass, a few eons ago, I had a small plaque on my wall called the teen creed – it advocated I stand for something or else I would fall for anything. As I matured, my equivalent adult creed has been – ‘what you permit you promote’. This challenge causes daily indictment and often stops me just walking by when something, no matter how small, is not right. The question lies in the definition of the small stuff!

It is in the small things - the casual word, the subconscious slight - that cross boundaries of integrity, decency, equality and humanity, and we all need to take a clear stance on these. While our focus rightly starts with race equality and social justice, I am reminded of the diversity of difference daily. When I called out to a young woman, clearly lost in the maze of our NHS hospital, and she repeatedly did not respond, my assumption was already made, before I realised, when I eventually caught up to her, that she was deaf. A few minutes later, and through a combination of signing, writing and smiling, she was on her way to X-ray and I was left reflecting on the small things that make such a big difference to making people feel included. I reflected on the out-patient clinic where the names of the patients are called out, the fire alarm that rings but does not flash, the use of telephone consultations.

Little things do matter. They are amplified when we as senior leaders, consciously or subconsciously blunder and when, having blundered, we fail to acknowledge and apologise.

It is not enough for us to plead ignorance but rather for us to actively challenge ourselves to pursue the highest common factor in ensuring inclusion, rather than take the road most easily travelled with the lowest common denominator in how we manage and communicate with our patients and our staff. 

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