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Reflections from a Woman on “Otherness” in Medicine


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No sexism, racism, homophobia

When Danielle N. Lee, a PhD biologist, was likened to a whore last week for declining to work for free, I was furious. She and Scicurious proposed a series of posts on diversity in science and I reached out, asking if my perspective as a woman physician might be of interest. (As a physician, and as I am older than most in the SciAm and ScioX communities, I have felt conspicuously “other” there). She encouraged me to share my story as a “woman of pallor,” so I will share several vignettes of how “otherness” shapes our interactions in medicine as well as science. They are not shaped only by gender or race, but by our cultures and varied life experiences.

As a little girl, I was pretty and blond, and enjoyed the attention that brought, though I didn’t understand the connection. As I grew older and chubbier, it became obvious that being attractive garnered attention—sometimes good, but often hurtful. After various episodes of sexual harassment, among other kinds of negative feedback, my dress became more androgynous, though it was obvious that being attractive and “feminine” helped others in medical school and well after.

I seem to often have a different perspective than others. I was in trouble from day 1 of medical school in1974, when I questioned why, if a survey was supposed to be anonymous, faculty wanted identifiers on it. My classmates were not in support. I was not being a “good girl”. I questioned authority.

When we began to learn to do physical exams (U of Maryland, downtown Baltimore), I was appalled at the callous disregard the attending physicians and many of the male students had for our poor patients, especially black women. A group of students, mostly male, would go in to learn how to do a breast exam or pelvic exam on these women, who were in no position to refuse. I proposed, instead, that we learn on each other, and volunteered myself. My proposal was not accepted.

Staff were, however, more concerned about the feelings of male patients. I spent most of my urology rotation standing in the hallway, so the men wouldn’t be embarrassed by the presence of a female. The same happened when I rotated at an STD clinic in Rochester, years later. I challenged my attendings, with variable success, asking how I could learn to care for a male’s genitourinary problems if I was excluded from exams.

Similarly, insured patients on the “private” service were not generally subjected to intrusive exams by medical students—those were commonly performed on the “service” (i.e., indigent) patients.

My first rotation was on General Surgery. I was sent to the nurses’ locker room and the male students joined the attending physicians and hung out in the doctor’s locker room. That excluded me from much of the informal teaching that occurred in the waiting time between patients.

Then I was in trouble on my Ob-Gyn rotation with middle-aged male attendings, because I asked about their practices and conflicting health recommendations I was reading in “Our Bodies, Ourselves” and women’s magazines, such as Ladies Home Journal and Woman’s Day.

On later rotations with more senior women faculty, and then in my fellowship, I learned that interactions with women could sometimes be even worse, as some were far less forgiving of errors and more demanding. They were hardened, tough. I learned that being screwed over by women was even more painful.

I finished training and moved to a rural town in western Maryland to be the only Infectious Diseases physician (at that time) between Morgantown and Baltimore. I was the only non-pediatrician woman practicing there. The physician’s dining room had a locker room mentality, and I had to frequently ask them to be more civilized. They often spoke of stocks, sports, and sexual “jokes.” One day I even suggested we have a different dialogue—like what kind of charities they supported. Made the point, briefly.

Sexism was an ever-present background noise—what I have just learned is termed “microaggression.” A surgeon criticized me for not wearing a skirt and heels on rounds. I told him I couldn’t think when my feet hurt, and that I did not want attending to my appearance distracting me from focusing on my patient. [I also told him I'd wear heels when he did.  That was the end of that discussion.]

RNs would help male physicians on rounds, but not me. A radiologist would be reviewing a film with me and then, in the middle, tell me to wait while he turned to answer a male physician who had interrupted us. Patients occasionally assume I am their nurse, even after I have introduced myself as their physician, and accord their male nurse more respect. Such events don’t happen often—but do so regularly, even this week, in a different hospital, 35 years later.

My practice depends entirely on referrals and thus, on the good will of others. One particularly frustrating balancing act was learning how to give recommendations without ruffling too many feathers. It’s still not my strong suit. I naively always put doing what is right for the patient above politics. One moody male doc still stands out for setting up a no win situation. If he asked for a consultation from me, and I could not figure out what was wrong with the patient, then it was a worthless consult and he had wasted the patient’s money. If I knew quickly what was wrong and what to do, then he felt mortally wounded. It wasn’t that he was a bad doc, but that I had specialized training and experience in specific areas. His frail ego couldn’t handle the perceived slight.

In terms of my clinical research career, I always felt there, too, that I had to try harder and be better than the guys, both because I was a woman and because I was not in an academic center. When I was first given a clinical trial, I hid from my monitor that I was pregnant as long as I could—I was afraid I would lose that opportunity. I became a top enroller because I worked hard, yet wasn’t included on publications because I wasn’t “part of their marketing strategy.” I learned the difference between the grunts that do the work and the prestigious “key opinion leaders,” and that success at a difficult trial gets you only more difficult trials.

In 2006,  I wrote a highly praised text based on my experience, “Conducting Clinical Research: A Practical Guide for Physicians, Nurses, Study Coordinators, and Investigators.” It would, I believe, be a best seller in its field, given its excellent reviews, except for having been written by an unconventional woman from a rural community, rather than someone in the academic boy’s club.

My experience has been that women in medicine and science often have to be better and work harder than their male colleagues. And, like it or not, attractive women have some advantage (along with additional disadvantages) professionally compared to their homely counterparts. (This is not intended to add fuel to the fire in the blogosphere. It simply reflects my experience.) I can hardly imagine how much more difficult these everyday hassles are to men and women of color.

I am feeling very muddled about all of this now, given all that has happened from the rollercoaster of emotions following Danielle’s harassment and her gracious response to that incident, to Kathleen Raven’s devastating post and to BoraZ’s resignation.* New words have been added to my vocabulary–microaggressions and gaslighting. I also am clearer that some of my discomfort at ScienceOnline is that of “otherness.” I am shy. How do I approach and get to know people who appear or act so differently? I welcome diversity and want to learn more, but often blunder because of “otherness.” It is not just racism or sexism we need to learn to overcome. I think it is often discomfort from differences and the unknown, and from not being attuned to the many facets of those we are interacting with.

I often feel jaded, yet want to participate in this dialogue. How can we learn to support and mentor others, when language and actions are so fraught with danger?

Am I a “real” scientist? A real voice? Those are two of my own “ripplesofdoubt.”

 

*That one sentence from a stranger to Dr. Lee—“Are you urban scientist or an urban whore?has led to such a series of responses reminded me of the 1952 Ray Bradbury story, “A Sound of Thunder,” in which a time-traveler’s accidental killing of a butterfly shook the world and changed the course of history.

 

Credits:

“Molecules to Medicine” banner © Michele Banks

No sexism, racism, homophobia – Kurt Löwenstein Educational Center International Team/Wikimedia

 


Judy Stone About the Author: Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website. Follow on Twitter @drjudystone.

The views expressed are those of the author and are not necessarily those of Scientific American.





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