Recently, I found myself in a place many physicians know professionally but dread personally: the waiting area outside a procedure room, this time as a mother. My six-year-old underwent what was supposed to be a simple elective procedure under general anesthesia at a day surgery center. He walked in smiling. He was put to sleep by using inhalational anesthesia through a mask. We were debriefed briefly by the ear, nose, and throat (ENT) surgeon on how the surgery went, and he explained my son could be a bit fussy as part of waking up from anesthesia.
A short while later, he came out to recovery wheeled in a bed by three to four operation theater staff, delirious and crying hard, saying his tongue hurt and that he had a headache. But as his mother, I knew this was different. It was not ordinary fussiness. It was distress. When I took a look inside his mouth, only then did we realize one of his teeth had been broken and his tongue was injured.
What made the experience even more upsetting was that the team did not seem to realize this had happened. For some time, no one could clearly explain what had happened or where the tooth was. There was discussion about whether it had been swallowed or aspirated. Thankfully, it was later found in the bed linens, and my son was safe. I am deeply grateful for that. But the experience has stayed with me, not only because my child was hurt, but because of the gaps around the injury: the lack of immediate recognition, the poor communication, the uncertainty, and the sense that the system was already moving us along before anyone had really given us a clear explanation.
There was also a moment before the procedure that has been difficult to ignore. A staff member made a snarky comment about my child not wearing socks for an early morning elective surgery. On its own, maybe that sounds small. But as a brown mother, an immigrant, and a physician, it did not feel small. It felt like one of those moments many minorities recognize right away: being subtly judged before being cared for. I cannot know what someone intended. But I do know that bias in health care is often not dramatic. It is quiet. It shows up in tone. In impatience. In who gets grace and who gets a side comment. In who is seen as prepared and responsible, and who is not.
As physicians, we hear more now about implicit bias. We are taught to think about how race, language, class, and culture can shape a patient’s experience of care. I think that is important. But experiences like this make me wonder how deeply those conversations reach beyond physicians and into the full care environment patients encounter. Because what patients and families remember is not just the technical outcome. They remember how they were spoken to. Whether they were believed. Whether someone slowed down when something felt wrong. Whether anyone acknowledged what happened with honesty and compassion.
As an international medical graduate (IMG), I have often felt that I carry a certain extra vigilance into medicine. Many immigrant physicians do. We know what it feels like to be underestimated. We know what it feels like to work hard not only to do well, but to prove that we belong. Many women physicians, especially women of color, know this feeling deeply too. Over time, that lived experience changes you. It makes you listen more carefully. It makes you explain more thoroughly. It makes you document more carefully. It makes you pause when something does not quite fit.
I have often thought that many IMG physicians go the extra mile with patients not because we are trying to be heroic, but because we understand what it feels like to move through systems where power is uneven and being heard is not guaranteed. That matters when you are caring for patients who are elderly, immigrant, poor, non-English-speaking, anxious, overwhelmed, or simply unsure how to advocate for themselves. It matters when someone is trying to say, in the only words they have, that something is wrong.
Often, the 15-minute visit does not really allow for all that medicine asks of us. But many of us still try. We ask one more question. We re-explain one more result. We sit a little longer. We second-guess our first impression. We make sure the patient in front of us feels heard. Not because we are perfect. But because we know what it feels like when people are not heard. Still, individual compassion is not enough.
No family should have to rely on their own persistence, medical knowledge, or social credibility to get safe care. No parent should have to push repeatedly before an obvious injury is recognized. No child should come out of a procedure in significant pain with uncertainty about what happened and where a broken tooth went. This is bigger than one event. It is about the systems we build and what they reward. Do we reward speed over listening? Do we normalize rushed communication in recovery areas? Do we train every member of the team to recognize how bias and tone affect safety? Do we create space for families to raise concerns without feeling like an inconvenience?
These questions matter, especially in outpatient and day surgery settings, where everything is designed to move quickly and efficiently. For physicians, this experience reminded me to trust the uneasy pause when something does not fit the expected story. For nursing and perioperative staff, I hope it is a reminder that recovery is not just a checkpoint before discharge. It is often where the truth first shows itself. For health care leaders, I hope it is a reminder that safety culture is not only about policies and checklists. It is also about communication, humility, respect, and whether families feel taken seriously.
My son is safe, and I am grateful for that. But I keep thinking about families who may not know what to ask, or may feel intimidated speaking up, or may not be given the same credibility when they do. They deserve to be heard too. And they should not have to fight so hard for it.
Vidya Kollu is a hematologist-oncologist.
