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

Sexism is Alive

Does talking about something make it an issue? I can vividly recall being told as a medical student that sexism was just something that women chose to see in everyday life. That is was not really an issue; it was one that we chose to use as an excuse every time things did not go our way.

I can actually remember thinking that this MUST be true. I mean, here I was, a woman in a class of medical students where HALF of us were women! How could sexism really exist? It certainly wasn’t holding me down! I thought that women who were victims to this were just that--victims--weak women who were victims of their own personalities or fears. At the time, I refused to join AMWA or get a key to the ‘women’s room’ that women students, residents and faculty could seek out as a private ‘sexist’ refuge. I told myself that if I segregated myself from men by reminding them that I was a woman, I would be contributing to the problem.

I am not sure when my beliefs changed. Maybe it was when a chief resident opened the top button of my shirt in hopes that it would help the chauvinistic interventional radiologist give me our study. Maybe it was when I realized that a lot of the female nurses DID treat me differently than my classmates who were male. The realism that sexism could also come from women was an eye-opening and depressing experience. Or maybe it was just the natural progression of realizing that male faculty whom I KNOW believe in me and support me still DON’T REALLY understand the challenges that women face. In fact, they often, albeit unintentionally, place them in our way.

Whatever the reason, I know that sexism exists. It is not because I choose to see it where it isn’t. It is not because I talk about it. It is because the world in which we live has socialized us to believe that men and women SHOULD be different. And when we, as women, try to take on stereotypically “male” roles, attitudes or personality traits, I think it makes people uncomfortable. This is the inherent reason why strong women are considered to be too aggressive or pushy or, god-forbid, the B-word, while men are just doing their job and somehow gain respect.

We need to accept that there is a double standard. There SHOULDN’T be! But there is. It’s there. Now. . what are we going to do about it?

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: skirtingtheissue@gmail.com

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

Looks Can Be Deceiving

Gender Bias

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

Gender Bias:
“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: skirtingtheissue@gmail.com

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

Asking, The Right Questions...

Recently, a friend of mine recommended that I read a book titled, Women Don’t Ask, written by Linda Babcock and Sara Laschever. I decided to look it up and came across the following quote:

“When Linda Babcock asked why so many male graduate students were teaching their own courses and most female students were assigned as assistants, her dean said: "More men ask. The women just don't ask."

It turns out that whether they want higher salaries or more help at home, women often find it hard to ask. Sometimes they don't know that change is possible--they don't know that they can ask. Sometimes they fear that asking may damage a relationship. And sometimes they don't ask because they've learned that society can react badly to women asserting their own needs and desires.

This quote struck close to home, as I too feel a certain discomfort when faced with approaching a negotiation. I simply believed that everyone felt like this. . and maybe they do. Maybe the difference only lies in the follow through, in that men will pursue the goal despite their discomfort.

What I do know is that a different friend of mine, also an emergency physician, recently told me that she finally approached her Chairman to ask for a raise. She told me how finally, after what seemed like an agonizing time, she scheduled an appointment, mustered up her courage and asked. Her chairman responded with the following:

“I was waiting to see how long it would take you to ask for more money.”

Apparently, he too, believed she should be making more money, but instead of commending her for her work and giving her a raise, he waited for her to come and ask for it!

Is this wrong? I suppose if I were a Chairman, I might do the same. Save some money by waiting for those poor hardworking people to realize they are worth more than what I am giving them. In the time in takes them to ask, I can be using that money for something else. The unfortunate part of the equation for women is that a lot of the time, it seems we don’t ask.

The business of medicine is just that - a business - and business is now and always has been a world that is dominated and shaped by men. Now don’t get me wrong, I like men. I don’t think they are trying to keep us women down! But until the women following the rules (and possibly the men who are making them) realize that the standard rules are not necessarily innate for the personality of women, we can never approach a world where women are represented in equal numbers, and more importantly with equal numbers in their bank account!

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

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