Written by Laura Sang, R-2 Family Medicine, McGill University
DISCLAIMER - Please note the examples described below have happened over the course of several years. There is no reference to any specific staff or medical institutions. The stories below have been modified to preserve patient confidentiality; any semblance to other experiences reflects the pervasiveness of these issues in medical culture. All witnessed accounts of harassment or unprofessional behaviour were reported to the relevant authorities, and appropriate action was taken
We live in an ever-changing world. One that is slowly moving towards equality and equal opportunity for all. While we are still a long way from reaching this goal, every step counts. And I truly believe that the more we talk about these issues and open the lines of communication, the more we can recognize what needs to be done and become part of the solution. These last few months I have become hyper-aware of my own privilege, especially being in medicine. However, I have also become equally aware of how my experience of being a woman in medicine has differed from that of my male counterparts. While we have overwhelmingly moved away from the overt sexual harassment in the workplace that is often depicted in the media, sexism is still there. It is more subtle, more subdued, sometimes almost invisible, but still ever-present.
"Excuse me but I'd like to speak to the REAL doctor". I cannot tell you how many times this has been said to me. My white coat bursting with lists and pens, and my weathered stethoscope around my neck mean nothing. I am not even given a chance:
"What do you mean?" I asked in reply thinking maybe he meant my attending. “Sweetheart, I’d like to speak to the nice male doctor I saw before.” “Sir, the colleague you spoke to before was a medical student. I’m the resident.” “I don’t care. I'd still like to speak to him. He knows what he’s doing."
“Excuse me, nurse?" I feel a tap on my shoulder as two older gentlemen ask me for directions to a clinic within the hospital. I am standing with my male attendings, dressed identically to them - again my whitecoat and stethoscope clearly visible. Yet, because I am a woman, they assume I am a nurse. When I ask my male colleagues if this has ever happened to them, they tell me no.
There have been times where I've sat at the patient's bedside for half an hour to explain to them in detail their diagnosis and plan for medical treatment, only to be asked at the end of our discussion: “So, when is the doctor coming to see me?” It does not matter how many times I introduce myself as doctor, it still happens. Much to my chagrin, when my attending would visit the patient - let’s call him Mr. M - for a few minutes every couple of days to monitor his recovery, Mr. M would light up and shower my male colleague with gratitude for his hard work. Yet it is me who orders the tests, provides direct patient care, and spends time with the patient to answer his questions. “What a wonderful doctor he is, now could you be a dear and get me a glass of water,” Mr. M asks. I complete my physical exam, hand him a cup of water, and leave politely; my jaw remains clenched in frustration as I wash my hands and remove my gown.
The nurse shakes her head as she hands me the chart to see the next patient in the emergency room. “Careful, that one has a temper, and she’s been yelling for hours. What a drama queen.” When I go to see the patient, she is in excruciating pain to the point that I cannot properly examine her. After appropriate analgesia and a worrisome physical exam, she is diagnosed with a perforated appendicitis requiring emergency surgery. Conversely, the older man with the kidney stone writhing and moaning in pain in the next room is introduced as: “The poor man with the kidney stone, give him something for pain, he is really suffering.”
When rounding on patients with a group of medical learners, the attending staff often engages in a learning technique colloquially referred to as pimping; the staff asks rapid fire questions related to the patients we are seeing to test our medical knowledge. When I start to answer the question, I sometimes find myself in one of two possible scenarios:
Option A: I will be interrupted and talked over by a male colleague who will provide his answer.
Option B: I will complete my answer, which may be dismissed. A male colleague will then provide the same answer said in a slightly different way and receive praise.
Often these interactions go completely unnoticed to the point that I start to wonder am I crazy? Did I just imagine that, or did it actually happen? Subsequently, I feel less inclined to participate in these kinds of learning activities for fear of dismissal.
Thankfully, these examples do not make up the bulk of my clinical interactions. Nevertheless, they are still a regular occurrence in my day-to-day practice of medicine and do have an impact on my self-esteem. The few times I've tried to discuss these encounters with my male attendings, in a well-meaning way, they've tried to reassure me by saying things like: "oh well I'm sure they didn’t mean it" or "don't take it personally, this person is always grumpy". While I recognize that these responses are aimed at being supportive, they come across as dismissive. I often came away from those discussions feeling guilty for even bringing it up.
These are among the many realities faced by women in medicine and are only further amplified if you are transgender and/or a woman of colour. So, what can we do as medical learners to help change the culture of sexism in medicine?
First, become aware of your own biases and the assumptions you make about others. Refrain from making snap judgments about patients and healthcare workers alike based on their appearance, gender, or any other physical attribute. If you find yourself as a patient and are not sure who you are speaking with, ask questions like: "Excuse me, I'm having trouble keeping track of all the healthcare workers taking care of me, could you please remind me of your name and role in my care?"
Second, listen to what your female colleagues and patients tell you, without judgement. Take it seriously and truly try to understand what they are experiencing. Even if you don’t know how to respond, simply validating someone’s experience can go a long way. For example, believe women when they tell you that they are in pain and treat their pain accordingly. One study exploring the influence of gender on abdominal pain management in the emergency room showed that, after controlling for age, race, triage class, gender-specific diagnoses, and pain levels, women were 13-25% less likely to receive opioids for analgesia, and had to wait on average 16 minutes longer to receive pain-relieving medication. (1) There are countless examples in the literature highlighting discrepancies in care between men and women; this needs to change.
Lastly, change how you respond to sexism in the workplace. Instead of trying to offer advice when a colleague brings an incident to your attention, offer them support by saying things like: "I'm sorry that happened, that's really frustrating, how would you like me to support you with this?" On the other hand, if someone reproaches you for an action that offended them, do not be defensive. Instead accept the criticism with humility and change the way you handle yourself in future situations. Inasmuch, if you witness a sexist act taking place - call it out. Saying things like:
"My colleague is equally qualified as me."
"Actually, the majority of your medical care has been provided by this person - it's them you should be thanking."
"Excuse me but my colleague was talking, could you please let her finish. I would like to hear what she has to say.”
Challenging pre-existing norms, especially those that are discriminatory, is uncomfortable. Instead of hiding from that discomfort, if you sit with it, stare it dead in the face, and challenge the underlying principles that cause it, you are one step closer to becoming part of the solution.
References
Chen EH, Shofer FS, Dean AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med. 2008;15(5):414-418.