“I have spent many years of my life in opposition, and I rather like the role."
- Eleanor Roosevelt
I recently read an article in Academic EM where they analyzed a medical error and tried to categorize the aspects of care which had led to the mistake under various “error producing conditions.” I was horrified to read the following which had been neatly filed under the title of
“The neurology resident was female, of diminutive stature, and nonassertive. EP2 gained the impression that she had not been firm enough in her assessment of a "difficult" patient, an example of gender bias. Had the resident been an assertive man, EP2 felt, in retrospect, that he might have placed a different interpretation on the reported difficulty in assessing the patient. Like attribution of clinical features to a patient's dispositional qualities, we should be careful to avoid attribution biases in interpreting information from coworkers. EPs should periodically engage in introspection and personal reflection to assess their own vulnerability to sociocultural and medical prejudices that may adversely affect clinical reasoning.” Acad Emerg Med 14(8) 743-749
I have been struggling for weeks trying to think of what to say about this statement. Not only am I appalled that a physician would attribute his inability to push forward with a difficult diagnosis to the non-assertive personality or ‘diminutive’ stature of a consulting female resident, but that a reputable journal such as AEM would categorize this as Gender Bias with a simple statement that we as EP’s should reflect on our vulnerability to sociocultural prejudices.
For those of you who have read my first post in this column, you know I am no stranger to the world of gender bias. But for me, this was a new one. Was it possible that someone could actually believe that if the resident had been an aggressive and tall man, he would have taken the issue more seriously? And that it was okay to list their own prejudice as if it were a common issue. I have no doubt that visual perception and aggression play a part in medicine. Ask any other five foot two physician when she walks in the room with a tall male medical student, who the patient thinks is the doctor? Ask any non-assertive physician, man or woman, if they have ever felt like a push-over given their inability to argue their point. But never have I heard the counter argument listed as an ‘error producing condition.”
Maybe our next morbidity and mortality conference (M&M) can be failure to follow the direction of the male surgery consult because I thought he was too arrogant. If he were nicer, and maybe shorter and closer to my own height, I might have taken him more seriously!
Linda Regan, M.D. is an Attending physician at Johns Hopkins University 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: email@example.com