Gender Bias in Medicine
I grew up in the 1970’s, and back then, it was groovy to be a
girl. Women’s Lib was here to stay and I
heard over and over that girls could do anything boys could. It seemed like the case when I was 9. I rode horses and went to school and played
in a band just like the boys. I went to
high school and college and medical school just like them, too. There were many points along the way where
you could have asked me about gender bias and I would have told you that was a
problem that belonged to previous generations.
Did patients sometimes think I was a nurse instead of a doctor? Sure.
But that was an easy mistake to correct, and didn’t feel like an insult,
just a vestige from a past way of thinking.
When you’re a youngster, and you’re up and coming, it isn’t
hard to get opportunities to show people that you’re capable. If you’re responsible and enthusiastic and a
quick learner, you can rise through educational ranks pretty quickly. There are lots of mentors and peers that will
help you and appreciate you. The journey
is a lot of fun. Then you become a
full-fledged member of the medical system and you look around at some point and
realize you are participating in an incredibly sexist enterprise.
Medicine is not nice to female patients. We’ve pathologized childbirth, blamed
childhood difficulties on bad mothering, coined a derisive term (hysteria)
after a female body part, and shoe-horned women into treatment plans designed
for and tested only on men. Modern
medicine is an enterprise that has been run by men from an exclusively male
perspective for centuries, and simply admitting more women into medical school
isn’t going to change that. I challenge
you to talk to your female patients about the experiences they’ve had with the
medical system, or go online to a health forum and read what women are
subjected to when they seek medical attention.
You will find a lot of really disheartening stories, and a lot of familiar
stories – we have all seen women treated in degrading or dismissive ways by
other doctors. We might not have felt
high enough in the hierarchy to speak up about it, but we saw it. This isn’t a phenomenon we notice because
we’re sensitized to it or seeking it out – medical literature suggests that
bias against women is ongoing, robust and undeniable. Women get less analgesia, less of the
doctor’s time, less autonomy in decision making. Women are studied less, so diseases are
defined as the male presentation of the disease (see acute coronary syndrome,
where the type of discomfort women are more likely to have is termed
“atypical.” It’s not atypical – it’s
very common. It’s atypical only in
respect to how the symptom presents in men) and the treatments available
are the ones that have been tested primarily on men (and male lab rats, too –
gender equality in lab animals used in research only happened in 2014).
If the medical establishment isn’t nice to female
patients, why in the world would we expect it to be friendly to female physicians? There is objective data to suggest that it is
not. Female physicians are 6 times more
likely than their male counterparts to commit suicide. They leave the work force in higher numbers
than men do, and they are much more likely to work part time. And even when controlling for hours, call
duty, job descriptions and geography, women physicians make only 88% of what
their male counterparts make in salary – and that salary gap has widened
in the last two decades. Even though I am aware of these statistics, I find
myself wanting to resist the idea of gender bias in my life, my experience. I
have to admit, though – it’s there. If I
look at who populates the committees and boards that control money and power –
it’s mostly if not exclusively men. If I
look at who populates the groups and committees that have to grind out work
that they’re not really paid to do – it’s mostly if not exclusively women. If I think about who is able to be at work and
focus on the work at hand without worrying about home and kids and dinner –
it’s mostly men. The people I see
multitasking domestic and professional duties all day long (and all evening
long) – mostly women. It is no wonder
that these undercompensated, underpowered, overtasked and underappreciated
humans are having a very tough time of it.
Our culture dictates that it be so, of course – and it seems
as if we women operate on the idea that we must prove that we can do these jobs
and that we must never let anyone see us sweat.
But I don’t know. Working against
the grain of our society in order to be fulfilled in our profession while
feeling that we are not allowed to protest or even appear to notice the bias we
face is, I think, the direct cause of the suicide, the unhappiness, the
dropping out that the statistics record.
In addition to that is the pressure to “have it all” and be the best doctor,
the best mother and the best spouse – competing and contradictory goals. What is the solution? How do we continue to put pressure to society
to open itself to us without killing ourselves in the process? I know for sure that part of the answer is to
insist that men help us find the solution.
We’re talking about a transfer of power, and better communication
between the two groups. We need to talk
about our circumstance, and men need to hear about it with an open mind.
What do Women want? There
is a substantial portion of the Western Literary Cannon that is devoted to this
very question, because for whatever reason, women and the way they do things
and what motivates them to act in the way that they do are mysterious to the
opposite sex. This enigmatic
circumstance accounts for some of the allure between the sexes, but it accounts
for the problems, as well. The light
went on for me a few years ago when I attended a leadership conference and was
sitting in the audience struggling, as I always did, about what exactly it
meant to be a “leader.” Luckily, the
conference speaker answered the issue succinctly: “Leadership is about how you make people feel
when they are around you.” In
understanding this definition, I realized why gender bias was never something I
really felt as a student but felt strongly as an attending physician. After
you’re done being a student, you’re supposed to become a leader. That’s the path of a physician. And women have a leadership problem, because
people don’t always feel comfortable around us.
Men – men in particular don’t always feel comfortable around us. It’s not always very clear to them what we
want, what motivates us, how we’ll act, what we’ll decide. So we miss out on a lot of those leadership
opportunities, because men are very comfortable around other men, who are more
legible and predictable to them. The
“Old Boy Network” is more than just the way things were. They are the way things still are, and
I think the distrust between the genders is a big reason why. (If you need more convincing about this, look
at our current presidential race and the rhetoric around the female candidate,
who is, objectively, the most qualified
of the bunch to hold the title).
I have seen women try to lead men, or vie for leadership with
men, in all sorts of ways. One solution
is to reason that if women are opaque and thus untrustworthy, it might benefit a
woman on a career path to simply act like a man. I pursued that line of thinking myself. I was tough, I never got offended no matter
how sexist the jokes and patter was (I wasn’t offended as much as embarrassed,
but in any case I hid it and went along with it), I never turned down extra
work because I never wanted anyone to think that anything other than work was
my priority. I was decisive, tamped down
my emotional responses and prided myself on being as tough as any man. I think it worked okay. I advanced.
I was considered reliable. I
obtained some leadership roles. The
problem was that I felt I was in no way free to be myself. I was bought in to the idea that there was
something wrong with being a woman in medicine by deciding to act like a man in
order to be allowed to do it.
The point of being a woman (or any underrepresented minority)
in medicine and of supporting diversity in general is the embrace of the idea
that different people WILL do things differently and that is what we want.
Everyone realizes our system of health care is very broken, with pretty dismal outcomes
for many people, especially women and minorities. This will never change if the way the system
operates doesn’t change. Different
perspectives on the practice of medicine is what patients want and what will
lead to a healthier society. What is the
point of being a woman in medicine if we all just act like men? I had a particular kind of way of connecting
with people, an ability to compromise with integrity, and patience to let
things happen without always controlling them that I suppressed in order to be
one of the guys. That was a
mistake. I’m a much better doctor with
those facilities pushed to the front, even if it does render me confusing to
some of my peers.
I’ll add a personal note here and say that if you add other
layers of opacity to your already mysterious gender, it gets even harder to get
along in the medical profession. Women
who are wives, mothers and who possess physical beauty are legible to the
mainstream as “normal” women – deviate from that (and I deviated in every way)
and the conversation about your worth as a physician becomes dominated by
speculation on the reasons why you don’t conform. After I realized this, I made deliberate
attempts to “mainstream” myself in order to fit in better – and every time
you’ve seen me wearing a dress, jewelry and makeup, you have seen my attempts
at artifice at work.
Women are sometimes women’s worst enemies. Working in a patriarchal system is
challenging, particularly if you opt to behave in ways men doesn’t expect. But I have to say, that’s more of an
experience of not fitting in with a culture as opposed to issues with specific
people. What is surprising to me is that
the specific, in-person conflicts I have had have all been with other
women. The only patients I ever have
trouble with in terms of not respecting a female doctor’s advice are women – a
memorable one insisting she would only take advice if it came from our medical
student, the only man on an otherwise all-women team. Once, a fellow female physician physically
blocked me from entering a room in which a meeting was being held because she
did not want me to be part of the discussion.
She knew from prior conversations about the topic at hand that I
disagreed with her, and she did not want me to voice my viewpoint at the
meeting. On another occasion, a female consultant
shut the door to my patient’s room in my face (I was following her into the
room) and then leaned against it, preventing me from opening it, so that she
could talk to the patient without my input (the patient had asked me to be
there). On neither occasion had my
colleague addressed the problem with me directly – they used actual physical
aggressiveness to make their point. It’s
a phenomenon that’s fairly commonly described with successful women – that they
sabotage each other, or treat each other poorly. I suppose that for women, success and power
can seem like a zero sum game – if you think there isn’t enough for every woman
to get a fair share, you always feel like you’re competing against other woman
for the one spot out of 10 that will go to a woman. Women don’t feel like there’s an abundance of
opportunities to succeed, so they fight each other for them. That’s why opportunities to get together and
support each other are very important.
We should recognize that we are often at odds with each other and work
on changing that dynamic.
It’s going to be hard for a long while. It takes a long time to change a biased
system. I’m glad that there are more
women in medicine. With more women in
the field, I hope that we will become more empowered to act as women and not
feel we have to pretend to go along with the current patriarchal system. It’s not so much that we have to reverse it –
we have to change it by expanding the definition of the right way to practice
medicine. That means questioning the way
things are, being authentic to ourselves, and enlarging the definition of
“physician.” We will meet many people who object, disagree, fight back,
resist. I don’t think it’s going to be a
feel-good situation. In fact, it’s
probably going to feel wrong, awkward, and like we’re making trouble for
ourselves. We need to support each other
so that we can keep climbing the hill.
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