“Thanks baby, I mean doctor… Doctor baby….” he finished uncertainly. I washed my hands, gave him a quick nod, and walked out of the emergency department exam room with my smirking attending following behind me. Speaking to a group of my female colleagues, it seems everyone has a story or two like this. Starting as medical students and continuing through our practice today, for female physicians there seems to be no end in sight to everyday sexism at the hands of our patients and peers. Recently, we’ve be discussing not just the incidents themselves, but how we handle them, and if there is a “right” way to do it. As an intern, I had no better solution than to get confused, look embarrassed, and walk away. Not only did my attending remain silent in the patient’s room, he also didn’t acknowledge my discomfort or the inappropriate situation later on. Further in training, even as I watched my male attendings refer to me by my first name and male residents as “Dr. X” or allow when patients called them “Sir” and me “sweetheart”, I began to stand up to this kind of gender diminutive, in the way I always wished someone would stand up for me.
After discussions with my female colleagues, I’ve found a range of responses from completely ignoring these remarks, to firmly and professionally explaining why they are not appropriate. For those of us that do not take this express route, the common reason is concern over damaging the doctor patient relationship. The logic goes something like this, “If I make a big deal about this patient’s casual sexism, then he may feel embarrassed or annoyed and be less likely to trust the therapeutic relationship or his plan of care.” I don’t know if this is true or not, and to my knowledge it has never been studied, but recently I’ve come to believe that it’s the wrong question. The right question to be asking ourselves is, “what are the consequences of allowing these sexist undercurrents to go unchallenged”. What kind of example are we setting for our colleagues and trainees: How should you respond when the patient calls your medical student baby?
Gender discrimination is commonplace in academic medicine. This ranges from blatant sexual harassment to the more insidious culture of sexism that permeates hospitals and medical interactions. Numerous studies, both in and outside of medicine have demonstrated the professional, physical and psychological impact that gender discrimination has on women who experience it. Clearly, a dramatic shift needs to occur in the culture of medicine to reduce these levels of sexual discrimination.
I think one of these changes should include fighting the allowance made for gender diminutives as described above. As I transition from a resident to a fellow to an attending, I am constantly reminded of the message it sent when other members of the team let these infractions slide. I was a lesser member of the team, with less authority, less ability, just less. Now as I lead academic training teams, I realize that those more junior in training may not feel comfortable correcting these remarks in front of their team, just as I wasn’t. She may be more likely to defer to the authority of someone else in the room, wonder if it’s appropriate to say something or just let it go- and then carry this uncertainty forward in her career. If the attending doesn’t step in, it normalizes the behavior to the patient, the trainee, and also the other members of the team. This is diminishing our female trainees and normalizing gender discrimination to our team and our patients, fueling the unspoken acceptance of sexism throughout medical culture.
However we decide to handle it in our own practice, there is no gray area when it comes to sexually discriminatory language used against our trainees. When a patient makes a gendered remark to a trainee, silence itself is harmful. Reinforcing respect for all members of the medical team by standing up against this kind of gender mistreatment is just one small step toward overcoming sexual discrimination in academic medicine.
Recently I walked into a patient room with my all-female trainee team and the resident waited for the patient to get off the phone to introduce herself. “Hold on,” he said into the phone, “some young women just came in to talk to me.” “We are your doctors,” I corrected him. “A doctor and some nurses,” he updated his telephone companion. “No,” I said, “we are all your doctors.”