When we think about finding and using our voices to effect system change as physicians and surgeons, our fear holds us back. But we can stare fear in the face and make a conscious choice for good.

Let’s face it, we thrive in medicine based on adhering to the hierarchy. It isn’t all bad. In many cases patient safety relies on maintaining it. The problem is that by PGY-9-10-11-12, we have spent so many years adhering to the hierarchy, our rebel muscles have withered

We tell ourselves in training that “once I get my real job, then I will have the power to speak up”. The problem is that we have spent so many years programmed to abide by the hierarchy and not question the status quo, it is hard to flip the switch. We don’t know where to start

What holds us back as doctors from being the advocates, allies, and agents of change that we desire? Our fear does. Fear of what others will think, exposing our imperfections, making ourselves a target, losing power, stalled career advancement, lost income, to name a few.

Examine your heart and consider what holds you back. Stare the fear in the eye. Count the cost. Do you have any decisions you need to make?

Understand your power and influence to effect change. Know thyself. Many of us have more power than we think we do. If I you think you have little power to effect change, then find your tribe and recruit allies to causes of justice, consistency and transparency in medicine.

Finally, courage is a muscle that you can grow. Take small steps and you will find your way.