It happened again this week. I was talking to a patient and her family before surgery and asked if they had any final questions. The husband wanted to know how many times I had performed this particular surgery and how many years I had been a doctor. I am not offended by the question. I would want to know the answers to these same questions if my family member or I were scheduled for surgery. What is offensive is how much more frequently this question is asked of female physicians as compared to male physicians. I have spoken with male colleagues who have never been asked how many surgeries they perform while I know that my female colleagues hear similar questions every week.
Medicine has been a predominately male profession in this country until very recently. Although women account for 24% of physicians, slightly over 50% of medical school graduates are women. Female surgeons are even fewer in number, just exceeding 10% of the total. The majority of female physicians over age 40 have had no female role models and existed in a heavily male culture. We finished our training expecting that the greater world, especially female patients, would treat our skills on an equal par with our male counterparts. Unfortunately, sexism is pervasive in our culture and affects both my male colleagues and my female patients.
The majority of my patients appreciate the ability to choose a woman doctor and tell me so. Delivering babies is considered “cool” and no one asks how many cesareans I have done before I perform their surgery. But when these same women patients get to an older age and may require gynecological surgery, they are more likely to question my abilities as a surgeon. I am the baby doctor and not a “real” surgeon who has the ability to perform non-ob surgery. This is exemplified in the following interaction. After a lengthy explanation of surgical risks and benefits with one patient, she had one last question before scheduling her surgery. When would she meet the surgeon who would perform her surgery?
When I started in practice 25 years ago, there was much more discrimination from older male colleagues. Patient referrals from male physicians were rare and most of us built our practices thru hard work and word of mouth from our patients and staff. Now I am older than many of my male colleagues and these men have been part of a different generation of medical training where women have more opportunities in surgical specialties. Interactions with these physicians is based on surgical expertise and not on male or female.
Female physicians are also held to a different standard when interacting with patients. We are expected to be sympathetic, caring, warm and empathetic. Confidence and being forth right are not considered as desirable if you are a female doctor, but are traits that patients want to see in their medical team. I have often overheard a male physician joking with a patient and then sternly instructing that same patient to shape up for the sake of their long-term health. Same words, same delivery and I would have a complaint letter to answer regarding my aggressive nature.
A surgeon should be confident, focused, forthright, driven, and have high expectations of themselves and the people they work with. In the operating room you often don’t have the time to deliberate all of the options or to be tentative. Think of the above qualities when used to describe a man and then repeat them as you picture a woman. Do you have a more favorable opinion of the man – maybe thinking of a successful CEO or salesman. What image do you have of a woman with those same qualities – overbearing? The B— word?
Below are questions that I have been asked multiple times. They seem innocent enough, but imagine asking your male physician these same questions.
- How do you work full-time and have 5 children?
- How did you ever decide to do ob/gyn? Don’t you hate the blood and looking “down there”?
- Do you shed a tear/get goosebumps every time you deliver a baby?
- Your husband has a good job, why do you work so hard?
- Are you the nurse?
I usually laugh about all of these comments when they happen. They don’t get me down or make me mad. But I think that is part of the problem as we need to speak out more about what this can do to your psyche over an extended time and also how it affects your self-image. After I heard a complaint recently about being too abrupt with a patient over a medical problem, I spent the next few weeks trying to amend my ways by taking extra time with each patient and explaining problems in greater detail. Then I received another concern from staff about running behind in my schedule!
I would like to see a future where physicians are judged on their skills and ability to relate to patients and not on male/female, married/single, sexual orientation or race. I hope that happens sooner rather than later or never!