Speak up Published Aug. 1, 2019 By Col. Justin Nast 60th Aerospace Medicine Squadron TRAVIS AIR FORCE BASE, Calif. – The Air Force Medical Service has been on a long journey toward high reliability. This journey is referred to as ‘Trusted Care.’ Within the medical field, this focus is on patients and patient safety. In order to truly care for our patients, we must keep them safe. One of the tenets of trusted care is the duty to speak up, which applies to more than patients, it can apply to caring for all Airmen. A long time ago, when I was in civilian residency training, I was in the operating room getting ready to start a case with the attending physician. This physician made a disparaging, misogynistic comment about the patient who was anesthetized on the operating table. Everyone in the room heard this: the scrub nurse, the circulating nurse, the anesthesiologist and myself. Not one of us spoke up. Why? This was a moral failing on my part. Although I was in a position of being a trainee with this physician’s opinion being a significant part of my rating, I had the duty to speak up. The others in the room did not have the same relationship with this physician, but none of them spoke up. Why? This was the culture at the time. How do you change culture? Culture change starts with leadership and proceeds slowly and deliberately. The AFMS is charged with taking care of patients. Leaders are charged with taking care of subordinates. Have you created an environment where Airmen are empowered to speak up? The creation of this environment starts at the top. Do you feel comfortable speaking up to your leadership when you see something that’s not right? People do not always think before they say things and clearly words do not always translate into actions, but words matter. Airmen who hear enough discriminatory, sexist, racist, and homophobic talk that goes unchecked will clearly not feel they are in an environment where they can speak up. And so goes the culture. So, charge yourself and your Airmen to speak up.