Full disclosure - I have unashamedly stolen "Mirenagate" from Dr Eric Levi. (@DrEricLevi) He has also written a great blog on this piece, specifically as it relates to social media. Aussie medics on twitter especially, would be aware of the article posted in the Australian newspaper on the 2nd of January relating to obstetrics and gynaecology trainees. The article related to a debate topic at a college branch meeting in the next month about women in training and how they should manage their fertility. As one might expect, the suggestion that childbearing should be regulated for the course of specialist training was not taken very well by a lot of people. In fact, it was so badly received, it left a lot of people asking why in the world someone would let the debate topic exist in that form.
I should take this opportunity to point out that a number of obstetricians suggested that the debate topic was supposed to be a humorous way of talking about a serious topic. The RANZCOG president was quoted as saying he wasn't aware of the topic, thought it was tongue in cheek and will address it. Even with that in mind, people were still not exactly impressed. And remain so; this has really struck a nerve.
"Mirenagate" has really brought to light a few issues, all of which are very important and some of these issues have failed to been addressed not just in this scenario, but by medicine for years.
Women have long suffered innuendo or genuine discrimination in medicine due to their reproductive choices. I know of women who lied about their children existing, were bullied when they fell pregnant during training, have been given no consideration due to illness during pregnancy, have worked heavy rosters up to the late stages of pregnancy, been asked about their intentions with children for references/training intentions and so on. And let me very clear, not all of this happened in surgery. It is rife in medicine, I'm sure in a lot of professions, that women may be perceived as having less entitlement to a career or a position due to pregnancy.
Now I understand that this is not always the case and that employers and colleges have been understanding to some groups or people. But to women who have suffered bullying or discrimination by virtue of their gender of their children, it's not hard to see how even in jest, this suggestion could be very offensive.
My friends and colleagues who have undertaken training with RANZCOG have spoken highly of the support they have received when they have had children. The RANZCOG policies are more robust than other training institutions for part-time and interrupted training. If they are going to truly talk about the difficulties for trainees, employers and the college alike when interrupted training exists, then that is a good thing. However, the choice of topic title may have been better stated to take into account the large numbers of women who have been the subject of bullying and discrimination in medicine. The very public RACS investigation and media coverage on this same matter in 2015 should have taught us that we have a group of doctors who have been terribly treated and harmed in the pursuit of their profession.
The other issue that Mirenagate uncovered was the importance of being the master of one's own domain. As often is the case, this story was all over Twitter very quickly. Unfortunately, it seemed that RANZCOG did not have a social media presence here and missed many of the issues raised and the extreme disappointment at this issue. I tweeted my own disappointment, especially in the setting of my perception that RANZCOG was doing better than most. This topic also started off a conversation online of the difficulties many women have faced in training, not just in obstetrics but surgery, medicine and other professions. Not all of the backlash online was directed at RANZCOG but was a sharing of other's experience with pregnancy in medicine. Being online, RANZCOG may have understood what all the fuss was about.
Having a social media presence I feel is not only important for individual doctors, but this demonstrates how important it is for RANZCOG or other colleges. They may have been able to mitigate some of the damage early on. They (and other colleges) could get a strong sense of what a difficult issue this is for a lot of doctors and hear some of the stories women were sharing. Being involved or observing the conversation can allow important change to take place. It is important to be a part of the social media sphere to control the conversation people are having about you, to you or that involves you.
I hope that RANZCOG have a great meeting with meaningful discussion about issues their trainees face. I would also hope that we all learn from this experience. Some of us will learn that obstetricians, by and large do not want their registrars to have Mirenas. Some of us will understand that the media love a headline. Some of us will learn about the struggles faced by trainees and how we can provide better training for our doctors. And definitely, I know RANZCOG will now be tweeting a little more.