A young woman in medicine:Facing challenges of patient-level bias

By Anna Evans Phillips, MD, MS on Feb 28, 2019 1:54:00 PM

“Does your Mommy know you’re here?” asks the patient as he enters my clinic. The 76-year-old man has put me in an impossible situation. He may or may not know my age, but he knows full well that he’s put the young woman in her place, leaving little room for us to graciously acknowledge our differences or his surprise at seeing a young woman in charge. He sidesteps me and sits down in the chair I offer, saying nothing more in the silence that follows.
For the record, my mother is indeed aware that I am there. Admittedly, my efforts to become an academic gastroenterologist also have bewildered her alongside my other life choices: to obtain more than a bachelor’s degree, to marry only in my 30s, to delay having children. Although matriculation rates in medical schools have been higher for women than men for the past two years, and young female doctors populate training programs and junior faculty positions across the country, patients are still getting used to us.1 There has been increasing attention focused on the systematic ways women face discrimination within medical institutions and from peers, but we have so far paid relatively little attention to the experience of female physicians upsetting the expectations of our patients.2 Studies have consistently suggested that female physicians lower mortality rates for patients in areas from myocardial infarction to elderly care.3,4 In addition to closer adherence to evidence- based guidelines and higher standardized test scores, the authors of one these studies partially attributed this difference to female internists offering “more patient-centered care.”4 Women are supposed to be more emotionally skilled and more inclined to communicate with and connect with their patients. What is not discussed, however, is the difficulty that gender bias on the part of our patients adds to our everyday practice. I suspect that my experiences are not rare. We may do better for patients, and are certainly just as skilled as our male counterparts, but it doesn’t feel that way when we walk into a room.
During a recent week on call as an attending gastroenterologist, I noted that seven days out of seven, someone – usually a patient or family member – commented directly to me on how young I looked. Not all took the form of inquiring about my parents, but remarks along these lines were uttered multiples times every day. One patient, after his colonoscopy and a conversation in which I delivered a diagnosis of colon cancer, told me that he “felt comfortable with me [telling him this news], even though I was so young.” The crow’s feet at the corner of my eyes and the fatigue in my face during a week on call do not enhance my youthfulness, of this I am sure. Neither does the fact that I have spent nearly a decade in specialty training after medical school. I suspect instead that seeing a young woman in my position is somewhat disconcerting. The septuagenarian mother of another patient put it best when she exclaimed, “Why, if I saw you on the street, I’d never believe you were a doctor!”
Historians and sociologists of medicine have noted for decades how reforms in medicine also have changed the nature of the doctor-patient relationship, but as a profession we haven’t sufficiently discussed the jarring questioning of female authority, in part because it’s largely invisible. When male colleagues join me in an examination room with a patient, the comments aren’t made. Nevertheless, over the next decades we will face a profound change as the profession becomes increasingly more diverse, even as our patients will, in some cases, have had decades of experience without regular contact with female physicians. Medical schools and training programs will need to find ways to address this reality directly, because it affects nearly every aspect of being a physician, from how we respond to questions about our competence to how we choose to physically present ourselves.
In some regards, I have sympathy for my patients’ confusion: Female physicians have indeed become normalized in a relatively short time. Most of us don’t have mothers who also went into medicine, and the examples we have of pioneering female physicians are by presumption never about ordinary experiences. Female physician narratives almost universally highlight the great odds that women have overcome in order to enter the profession. Dr. Helen Brooke Taussig succeeded as a female cardiologist, becoming the first female president of the American Heart Association in addition to overcoming adult-onset hearing loss. Dr. Elizabeth Blackwell was rejected multiple times from medical schools and then ridiculed when she was admitted as a joke. Dr. Rebecca Lee Crumpler overcame racial discrimination as she became the first female African American to earn a medical degree. Despite these high-profile successes, change came slowly, and as recently as 1970, only 7.1 percent of physicians were female, and those were concentrated in pediatrics and psychiatry.5 Barriers are nowhere near this high for women to enter medicine in 2018: This reality represents the triumph of these earlier pioneers, for which I am incredibly grateful. It has never been a better time than now for women in medicine, but its normalcy presents precisely the conundrum. In 2018, it is not Dr. Taussig or Dr. Crumpler who walks into the room: Odds are that it is an ordinary physician who does.
I count myself incredibly fortunate despite these challenges. The opportunity I have been given to take the Hippocratic Oath, to improve my patients’ health and well-being, is one I would trade for no other.
But I am no Helen Brooke Taussig. And neither are my female colleagues. That’s not a problem. Equality will be achieved not when exceptional women succeed, but when ordinary women are treated no differently than ordinary men. At best, I am a highly qualified and dedicated physician, one who consciously strives each day to improve. For now, when a patient enters the room with that misguided question, I embrace the opportunity to challenge existing biases. I consider my options, and then I smile broadly and say, “Why yes, sir. Yes, she does.” And then we carry on.

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Should we recommend yoga to patients?

By Tanmayee Bichile, MD on Jan 31, 2019 11:42:42 AM

Yoga is a timeless and pragmatic science that evolved over thousands of years in India. It deals with the physical, mental, moral and spiritual well-being of human beings as a whole. The word yoga is itself derived from the Sanskrit word yuj, which means to join or attach. It also means union or communion, a true union of our will with the will of God. It is one of the means or techniques for transforming consciousness and attaining liberation (moksha) from karma and rebirth (samsara).2019Jan

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The 50th anniversary of the heart transplant

By Kris Gopal, MD, FACS on Jan 30, 2019 11:22:39 AM

Fifty years ago, the first adult human heart transplant was performed in Cape Town, Africa. It was perhaps the epoch advance in science.2019Jan

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January 2019 Bulletin Available

By Allegheny County Medical Society on Jan 23, 2019 11:11:00 AM

Opinion2019Jan


Editorial - 6
New Year’s resolutions
Deval (Reshma) Paranjpe, MD, FACS

Editorial - 8
Therapeutic nihilism and psychiatry
Robert H. Howland, MD

Perspective - 10
Interconception Care: Preventive care for future pregnancies
Sukanya Srinivasan, MD, MPH

Perspective - 11
Should we recommend yoga to patients?
Tanmayee Bichile, MD

Perspective - 14
The 50th anniversary of the heart transplant
Kris A. Gopal, MD, FACS

Departments

Society News - 16
• Pittsburgh Ophthalmology Society
• Pennsylvania Geriatrics Society – Western Division
• 2018 ACMS board chair recognized
• ACMS announces publication of history of medicine book
Activities & Accolades - 20

Articles

Feature - 22
2019 ACMS president and officers

Materia Medica - 26
FDA approves first direct-to-consumer pharmacogenetic test
Karen M. Fancher, PharmD, BCOP

Legal Report - 29
Pa. Patient Test Result Information Act imposes new notice requirements
Basil G. Joy, Esq.
William H. Maruca, Esq.
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Perspective - Preventing firearm violence: Can anything really be done?

By Jerome M. Itzkoff, MD on Jan 6, 2019 2:28:00 PM

One of the benefits of a medical education is an indoctrination into the art of critical thinking. Physicians are chronically subjected to information overload comprised of past and present patient histories, new and old clinical and basic science research, psychosocial factors that relate to patient care, and governmental and institutional rules and regulations. We are besieged by an ever-expanding and increasingly complex volume of data that we must organize and effectively synthesize and manage to maintain our professional competence. We regularly re-educate and re-certify ourselves toward this end. We integrate evidence-based data and evidence-directed guidelines that inform and influence the critical thinking that enables us to render optimal medical care.

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