Tuesday, July 10, 2007

Skirting The Issue...

By Dr. Linda Regan

I have spent many years of my life in opposition, and I rather like the role."
- Eleanor Roosevelt

Women in Medicine

Do gender disparities still exist in the world of medicine?

As a medical student, I naively believed that the answer to this question was a resounding no. I believed setting aside a special venue to discuss these issues actually made them issues. I believed that if we looked hard enough, we could find sexism in just about anything. Well I can honestly say, I never looked for sexism or paternalism in any of my interactions; but somehow, they kept finding me!

I have spent a few weeks trying to decide how to start this column. I finally decided to simply state some of the issues which I have faced over the past eight years, both as a resident and as an attending, to simply validate my belief that there is a need to discuss these issues. It is my hope that for women, we can talk out loud about issues we often feel we can’t or shouldn’t discuss. For the men out there, there is not likely to be one of you, who will never work with, teach or mentor a woman. Hopefully, this will help you to understand some of the challenges we face that might be different than your own.

As an intern, I was working on a subspecialty service. As usual, we were dressed up for attending rounds. I was wearing a pair of pants and a button down shirt. My chief asked my co-intern to go and urgently schedule a procedure which he had neglected to do the day before. He wanted to have it scheduled before we rounded with our attending. This particular attending who needed to approve the study was well known throughout our hospital as a flirtatious man who enjoyed ‘talking-up’ the female residents. When my co-intern called upstairs and informed my chief that the attending would only grant the study if I went down to ask for it in person, my chief informed me, without a second thought, that I was to go down and “ask for it nicely.” Despite my personal visit, the attending informed me that he couldn’t do the test and that next time, my chief should plan in advance. When I arrived back upstairs on the floor and told my chief the news, he reached over to me, unbuttoned the top button of my shirt (which now left my shirt open to just above my bra) and told me to “go and see if he’ll give it to you now.” I refused and left with some choice words for my chief, but never reported the incident.

As an attending, nine months pregnant with my second child, a fellow male attending went to my boss to express his concern about my clinical schedule. He was upset that I was working in the ED during our resident conference time, as these are shifts where there are no residents. Invariable, they are slightly more stressful and certainly more tiring. Without discussing this with me, another male administrator and this attending switched my shifts and then called to tell me when I would be working. When I expressed concern that this implied others believed I couldn’t perform my job, I was informed that no one believed this to be the case. Rather, it appeared that no one believed I would actually ask for help if I needed it and therefore the decision was made to revise my schedule without my input. No one seemed concerned when I expressed annoyance with the complications this placed on my previously scheduled child care arrangements.

As a second year resident, I was only just beginning to work at the ED of our private hospital. I asked one of the more seasoned nurses to administer 6 mg of morphine to a patient. She told me that I could order either 4 mg or 8 mg (the dose amounts present in the two sized vials we stocked in the ED). I told her politely that I had calculated the dose for this particular patient and that it was neither 4 nor 8 mg. I again stated that I would appreciate it if she could administer the 6 mg of morphine to the patient. She told me that she would not be told what to do by some “pipsqueak of a girl” (I am 5 ft 2 inches!!) and that if I wanted to help the patient, I should revise my order. Unsure what to do with the patient crying on the stretcher from his renal colic, I ordered the 8 mg. I subsequently reported her to nursing leadership.

During the six months that I nursed my first baby, I needed to take a 20 minute break to go and…pump! Yes, I actually wrote it! The world didn’t end; my shirt didn’t fall open exposing my then larger breasts! If one could only figure out why a bunch of physicians are so uncomfortable with a natural process. The comments that were made to me were absolutely ridiculous.

“Can’t you just wait till the end of the shift?” (from the other attending- a man- who would be left alone in the ED during my absence)

“ Oh God, are you going to go and lactate now?” (another male attending)

“ What time is it? Seems like you’re looking a little chesty!” (from a male nurse)

“Ok. Ok. . don’t start crying or something. I just didn’t want to admit the patient” (from a male resident who disagreed with my plan on a patient and didn’t want to discuss it any further.)

Despite everything, I truly believe most people are not maliciously trying to keep women down. I believe ignorance is a large portion of the problem - Ignorance that things can be equal without always being the same.

Hopefully, this has sparked some interest in someone out there. I would love to hear comments on topics you would like to discuss in the future.

Thanks for reading!

Linda Regan, M.D. is an Attending physician at NYU/Bellevue Hospital and author of the blog column, Skirting the Issue, which discusses issues facing women in the field of medicine. She may be contacted at: skirtingtheissue@gmail.com


Anonymous said...

i truly feel this is an important issue that needs to be discussed. That, and i enjoyed reading this.

That is all.

Couz said...

I think it's actually kind of sad that none of these stories shocked or surprised me in the least.

J said...

I have had some similar experiences. They are disturbing and cause a great deal of anxiety, especially when you are trying to do your best! One of my BIGGEST concerns about residency is how will I work out my schedule with pregnancy and childcare! Glad you are addressing these issues honestly and with a straightforward approach!

Anonymous said...

well...some of the problems you faced are not-so uncommon in general. The issue with a morphine dose....well as a junior resident who was on the more non-conformist/idealistic side I had this issue all the time. Nurses would not call me a "boy" but gave me quite a bit of attitude with their demands to write orders that satisfy their needs/wants or "unwritten rules/regulations". So it is not a gender specific issue. You're not alone. It is a power issue - few would challenge the same order if it is written by a fellow/attending/chief resident.

Rollernurse said...

What ignorance!
I am a nurse and don't understand why 6mg couldn't have been given either. I guess that nurse was too stupid to figure it out. When I witness a nurse co-worker do that kind of thing, it's maddening.
I really don't know how you guys to it, being physicians/residents and having young children. My heart goes out to you.