Me Too and Time'sUp is long overdue for medicine

Is medicine ready for it’s #MeToo moment? (Stock photo)

Is medicine ready for it’s #MeToo moment? (Stock photo)

Becoming a doctor is a long, hard and expensive process – complete with unhuman work hours and the constant exposure to human suffering. 

 For women in medicine though, these difficulties can be compounded by the pervasive sexism that threatens the careers and wellbeing of female doctors. 

 Science magazine recently reported on the lawsuit filed by seven female and one male current and former employees of Mount Sinai Health System’s Icahn School of Medicine. The lawsuit accuses four senior men of sexism and ageism, with a list of claims such as e-mails referring to one woman as an idiot, along with frequent reference to female employees by disgusting curse words. This lawsuit is just the latest in a growing list of accusations levelled at the institution of medicine by female physicians around the world. At the beginning of the #MeToo movement, #MeTooMedicine was a testament to the almost universal experience of sexism amongst healthcare workers. 

 While lawsuits and dramatic public accusations are shocking, they fail to capture the insidious and almost inescapable nature of sexism and gender bias in medicine. The daily lived experience of a woman in medicine is often subject to biases and trials that add to an already challenging career. 

The Time’s Up movement has recently been joined by an official healthcare arm.

The Time’s Up movement has recently been joined by an official healthcare arm.

 Lawsuits do not act on the gender pay gap in medicine. They don’t explain the inequities in career progression between male and female doctors. It fails to report how a female surgeon, who has a patient death, will be punished with a drop in her referrals whereas a man won’t experience this. Lawsuits don’t encompass the daily microaggressions that a female doctor hears like the astonishment that she is the doctor or the way in which patients defer to the younger, more junior man over her even if she is the team leader. Just this weekend, the American College of Obstetrics and Gynaecology was called out for asking nursing mothers with newborns to leave the conference hall. (ACOG since apologised and welcomed all parents with infants into the scientific sessions)

 While lawsuits like this are shocking, they are just a part of the constant sexism that women in medicine must endure. And endure they must because if you ever think of standing up to the harassment or the bias, your career will almost certainly suffer. In 2015, Australian vascular surgeon Dr Gabrielle McMullin publicly stated that female surgeons would be better off giving oral sex to aggressors rather than reporting them because standing up to your aggressors often leads to irreparable damage to your career.

Medicine is a noble profession, but it is also hierarchical and dominated by men with a culture that sees abuse not as illegal or damaging but as ‘character building’ and a necessary part of medical training. Perpetrators are often left in positions of power long after they have been given slaps on the wrist by management. Medicine’s belief in its decency is so strong and possibly misguided that it hampers our ability to look inwards and see that it is not fair, it is not always noble and when it comes to the treatment of women, it is wrong. 

Whether it be in the form of a Time’sUp movement, legal action or preferably, a self-directed long hard look at how gender plays out in our hospitals, it is long overdue. Medicine has long gone unnoticed too long for its deeply ingrained gender biases and this is an enormous mistake. Not only do we risk losing our best and brightest under the pressure of harassment, harassment in medicine is a patient safety issue. In workplaces where bullying, discrimination and sexual harassment exists, performance is affected an in healthcare, that performance puts lives at risk. 

I believe in the goodness of my profession, because I have seen it in practice. I have seen so many of my colleagues display compassion and kindness to our patients. I know that we care so deeply about the wellbeing of other people, we toil late into the night for the benefit of the people we are charged with caring for. Medicine needs to turn that compassion in on itself, honestly and end the insidious biases and far-too frequent harassment that plagues us. 

Why women in surgery need other women in surgery - #thisiswhatwelooklike and #ilooklikeasurgeon

I recently spoke at another university 'Women in Medicine' night. I find these events both enjoyable and educational. It's a great opportunity to meet colleagues and other young women who are studying to become doctors and try and inspire and instruct some students (both male and female) into what I hope will be fulfilling and productive careers.

But every time I get ready for one of these talks, two things go through my head. The first being that I have no idea what they really want to hear. I had some very good advice that they just want to see that we women surgeons are real and that it can be done. (Turns out that is true) The other thought I have is how relevant is this anymore? After all, over half of medical students in a number of universities now are female. And then...

Whilst waiting to talk to a patient on the phone "Hang on, the nurse is here to see me" (after seeing them every day for a week and doing the surgery)

From a male physician "Women should just work harder to make up the pay gap. And because they have time off for children."

From a colleague involved in conflict resolution, man (and recent) cases of women in distress due to discrimination in the workplace, resulting in illness or leaving the profession.

Let's be honest. In my country, I won't be injured or killed for walking down the street with a man who is not my husband. I can drive, I can vote, I can be educated and I can be gainfully employed. When you look at things that way, I am very fortunate. However, this does not mean that we don't have some problems with the way our society views and sometimes treats professional women. Whether it be medicine, corporations, politics, law, trades or engineering, women are by and large, a minority group. Which means that for younger women wanting to join the ranks of the patriarchy, finding someone to identify with is pretty difficult. And we know that gender plays an important role in mentoring in medicine.

As a junior doctor, my mentors were male doctors. They were and still are, excellent mentors and I am very appreciative of their guidance. In fact, on several occasions, they were insightful and sensitive enough to make sure that I was aware that some unique challenges may face me in my career and made sure that I was equipped to think them through as part of my career and life planning. Sometimes though, I really wanted to know how that actually played out for someone like me. I was very resolved to the fact that I was to some extent going to have to carve out my own path in life. And I have been okay with that.

There is some research around that by and large supports the availability of women mentors for young women doctors and medical students. Gender matching can have a very positive influence on a mentor-mentee relationship with the 'mentee' being more comfortable to seek out advice from a mentor of the same gender without worrying that gender will colour the perception of the question or the advice itself. What it may boil down to is as simple as my talks for women in medicine nights. We just want to see that it can be done and learn from a mentor's journey.

Finding a female mentor, in surgery especially, can be tricky. Finding any mentor can be tricky. It is a relationship like any other, where both party needs to be satisfied with in order to work. When we have a lack of women on a a sheer numbers basis, finding a gender equal you identify with can be really hard!

Social media has been awash in the last few months with campaigns and hashtags such as #thisiswhatwelook like, a campaign created by an anaethetist and a philosopher to challenge societal and professional ideals of what professional people look like. It's extended to virtually every profession and skill you can think of; CEO, drummer, programmer, lawyer and surgeons. I got on board pretty early with my 'This is what a surgeon looks like' t-shirt and it's been great fun to be a part of. Recently, engineers joined in with a hashtag #ilooklikeanengineer when a young woman apparently was not considered to be what we would consider 'looking like an engineer' and has crossed professional lines to surgeons with #ilooklikeasurgeon now trending. And I love it. Being a part of this feel inclusive, inspiring and just fun. In the last few months, I've chatted with women surgeons around the world about surgery and not about surgery. But by and large, it's been about positive change and positive role models. It's about changing perceptions and expectations and encouraging young women into a profession that we all love.

   Every time I talk about being a woman in surgery, I want to achieve a few things. Firstly, I want to show people that I have a cool job and inspire others to maybe try it out. I love when a junior doctor (male or female) tells me they've loved cardiac surgery and now they want to do it. Secondly, I want to share that you absolutely do not have to be a certain race, gender, personality, sports fan or other group to be a surgeon. In fact, diversifying our specialty to involve women, for example, is a fantastic thing. Every different person has something unique to bring to the table and we should encourage that enrichment. And finally, I want to show the world that I don't have to be a stereotype to be a surgeon. Because I am a surgeon and this is what I look like.

 

Mentors can certainly mentor across gender and racial boundaries. But let's be real, in a world where people can still discriminate or belittle or neglect you like my two short (and very recent) examples, a ground swell against stereotypes can only be a good thing. If I encourage one young woman to be a surgeon just by being one myself, that's wonderful. If together, we can all make positive changes in a society and a system that is imperfect, then that is amazing and is truly an achievement to behold.

#ThisIsWhatWeLookLike

    #ILookLikeASurgeon

  

The 'B' Word

Bitches get stuff done. - Tina Fey My team had developed a little habit of being late to work. I hate being late, it's just something I really try to avoid doing. For the first four months, I let it slide. But then, I told them all that they need to be on time. I did not name call or swear or shout. But I saw it all on their faces, the raised eyebrows, the downcast gaze. And then, as predictable as death and taxes came the 'B' word. Bitch. How original.

I have been called a bitch for as long as I can remember. And some of the time, it really makes me mad. That ambition, assertiveness, requesting a standard, standing of myself or taking no rubbish from people equates aggressiveness, dominance or is in some other way threatening is the way female behaviour is often skewed. The rest of the time, I wonder what fool would call a woman a bitch if he really thinks she is aggressive, domineering and won't take his BS? Talk about poking a bear!

It's not so much the choice of the word bitch that annoys me, it's what it implies. If a male boss asked his juniors to perform to a certain standard, he may be called firm but fair. If he wanted to advance his career and expressed desire to lead or win or achieve, he would be called ambitious. A woman in those same positions gets called a nasty bitch or a bossy bitch. Why should a woman boss not demand a certain standard? Why should a woman not express ambition to rise through the corporate ranks? What is that is so wrong with this? Why do women get name-called for it?

I'm a bitch, I'm a lover, I'm a child, I'm a mother. - Meredith Brooks 'Bitch'

When you call me a bitch, you turn me into a one dimensional nasty, scheming, domineering and unstable woman. I could be a sweet as pie, laughing and joking, even inspiring for 95% of the time. The 5% of the time I get cross or demand a standard or assert myself and get called a name colours everything else I do. Nobody will seem to remember that 95% of the time. Nobody will ever remember that their actions necessitated repercussions. My team for example, very swiftly forgot that they had mostly been 5-10 minutes late the entire year and that asking for everyone to be on time is courteous to everyone who is.

Once you are called a bitch once, that is all you are. Everyone is waiting through the fun times and laughter to see what I will next identify as unfavourable and 'turn into a bitch' about. A woman who is a bitch is incapable of expressing a range of emotions, of which anger or frustration are normal human emotions. She can only be that one thing from there on out. She has been painted with the bitch brush and that is hard to erase.

Bitch, like a number of other derogatory feminine nouns, is thrown around so commonly these days. It's no surprise that even as children, we use the word bitch and pretty indiscriminately too. Rap songs have been infamous for their use of words such as bitch, hoe or slut. Snoop Dogg, a pretty masculine kind of guy, recently came out and said that with his daughter and mother in mind, he would never refer to women as 'bitches' again. He would be horrified for someone to use those terms to describe his daughter so he should lead by example. And how true is that? We call each other names that if they were used for the women in our life that we care for, we would be furious. But with terms like bitch firmly engrained in our vernacular, is it any wonder that we so freely use the term in a derogatory fashion?

She didn't care that people called her a bitch. 'It's just another word for feminist,' she told me with pride.

By all accounts, Steve Jobs was a hard task master. He demanded excellence from his employees and from himself. When he sadly died from cancer, the world mourned the loss of this brilliant mind and business man. People called him a visionary and a genius. Will we do the same if the world were to lose a bitch? Probably not.

If being a bitch means voicing an opinion or demanding a high standard, then I am a bitch. If it means that you don't take someone's BS and will fight back when insulted, then I'm guilty on those counts too. If you think that I am confident and not afraid to challenge the status quo, then again, I am sorry to say that I am a bitch. And you'd better watch out. Because the bitches of the world are coming. Beyonce, Sheryl Sandberg, Michelle Obama, Hilary Clinton, Oprah Winfrey, Julia Gillard, Julie Bishop, Taylor Swift and Melissa Mayer. The woman executive at the bank, the lawyers, the doctors, the politicians. The small business owner and the athletes. If you are threatened by the bitches of the world, you had better get over that quick smart.

I am not going to say that I am 'proud to be a bitch'. I do my best to be a good leader and although I am not perfect and have plenty of learning to do, I actually think I do an okay job of it most of the time. I am proud to be opinionated and dedicated. I am proud to believe in high standards and I will never apologise for wanting to be good at my job, for wanting the best for my patients from myself and from those around me. I will not let go of my ambition because I am proud of my drive and dedication. I will not admit to being consistently even tempered or sugar, spice and all things nice. I am human and I express anger, sadness, happiness, despair, jealousy, fear and hope, all normal and healthy human emotions. If you want to call me a bitch, that's fine. I won't stop you. But don't be surprised when I use all of my 'bitchy' qualities to succeed while you call the next ambitious woman names behind her back.

As much as I say that sometimes being called a bitch upsets me, I know who I am and I am proud of who I am. If those qualities that I am proud of also get me called a bitch, then so be it. I have broad, bitchy shoulders that should have no trouble bearing the load. I can't wait to be in a workplace with more 'bitchy' women. We're going to do a great job!

Can you have it all?

A few years ago, I spoke at a women in medicine day for a university surgical society. The theme of the day was how to have it all. I felt more than a little nervous. I don't know that we can. But I had decided in fairness to both sides of the debate to try and tell these young women how I try and 'have it all'. What was ironic was the morning of the presentation, I had been called in at 4am for an aortic dissection. What was more ironic was that 5am was when I was supposed to be finishing my talk because I hadn't had time to finish it before then. But I did my best. My opinion was that you can have it all as long as you work out what 'it all' means to you as an individual, family or couple and that it may not all happen at once. A fellow speaker who was a rural GP/surgeon stood up at the end of my talk and wanted to know if I ever 'take me batteries out'. I don't know what she meant by that but she may not have listened to the bit where I said do what is right for you. A friend of mine is applying for surgical training and I fully support her and I think she will be wonderful. We had a bit of a talk last night about one thing that is really worrying her about embarking on a surgical career. That is, meeting someone and having a family. How do you do both? Can you have both? Or do you have to choose?

Women, regardless of professional standing, are more likely to spend more time with household chores and child rearing tasks. If they are married to another professional, for example two doctors, the woman is more likely to forego or change her career to a different specialty that is more conducive to family-related tasks. Even if her specialty is perceived as 'more prestigious'. Women physicians are more likely to be married to another physician while male doctors are not. And when we look at a doctors' formative years, women doctors are a lot less likely to have children than their male counterparts. But it's not doom and gloom, we're not a lonely barren lot. Women doctors are married and procreating at rates comparable to the general population. No need to break out the cat lady starter kit just yet.

I am going to go back to the statement that I made at the university function. Everybody is different. I don't think you necessarily have to pick one thing over the other. It is surgery or it is a family. It is work or it is a marriage. It is operating or exercising. The scalpel or drinks with friends. It is balancing these in a mixture that makes you happy that I think you really need to work out. At the same time, I also don't think that if you for example see family as your number one in life, the thing you will be most whole with and that you're worried how surgery will impact on that, well that's cool. Nobody wants to spend their life in a career that they resent away from something or someone that they love.

I think what I want to say is that I think it's possible to tick all of the things in life that you want. I'm reluctant to say 'have it all' because really, I think that saying in itself is rubbish. But you need to work out what the important things in life are to you. Then it's just a matter of timing.