Ask Linda is a forum in which you can pose questions of interest about women in today’s world. Though I am first and foremost an “expert” on the gender gap for women in medicine (physicians and patients alike), I am prepared to answer other relevant questions about medicine, the challenges women face in life and parenting. If I do not know the answer, I will try to find someone who can. Ask Linda at firstname.lastname@example.org.
A Tale of Two Medical Students, Book the Second.
Remy and Emma (see yesterday’s TBB post) both faced the age old dilemma of how does the underdog become the top dog. Whether in 19th century France or 21st century USA, the battle is bloody and someone is bound to get hurt. At the frontlines or at the fringes, fighters for freedom from oppression have difficult decisions to make. Making the right decision requires looking not only at the present but also into the future—one that often seems impossibly far away (a third year medical student has, on average 5-7 additional years of training before he/she can practice medicine or surgery).
Remy, you felt you had no choice but to defy the instructions of your attending. I know what you felt. I have been there, done that. As a first year ENT resident, I refused to scrub on a case because my attending was going to operate on the wrong sinus based on an old x-ray. He chose to ignore the most recent x-ray which shed doubt on the side in need of surgery. It was 1980, we didn’t have CT scans. Luckily the chairman backed me up. He was fired, not I.
So what’s the difference, you ask? You stood up for what was “right” and got beaten down. I already had my medical degree. I had almost one year’s experience as an ENT resident. This attending was a well known jerk. So I had enough knowledge, had built my reputation and had gained standing. I also knew where my challenge(r) stood. Yes, you were right to raise the issue, but, you might have lacked the knowledge, you had not yet established a reputation, and as the low woman on the totem pole, you had no standing. You hadn’t the ammunition to help the patient or yourself.
My advice when faced with adversity from a position of weakness: “Put you blinders on, put one foot in front of the other, and get to a place where you can make a difference.” What good is a talented, young woman physician to anyone when she is dead in the water? I hope you get back on track.
Emma was boiling mad at this guy. She knew it was coming. But still the sting was fierce. What could she have done? What should she do now, if anything?
Emma wants to be a surgeon. Surgeons are assertive by nature. Smart surgeons are most assertive when they can gauge the outcomes most precisely. Emma was smart to hold her tongue, at least at that time. Now she has a choice. She doesn’t have more knowledge, a better reputation or increased standing. But what she does have is the advantage of time passed. Time to think. Time to strategize. This resident has moved on.
My advice to Emma: Get some help. You are not alone. Seek out a confidant, a mentor, in the surgery department, in whom you can confide. Tell them your experience and ask their advice. Is there a way that the resident’s evaluations could be reviewed for evidence of gender bias and stereotyping? Asking a question to the right person at the right time is a very effective way of “shining a light” on practices that should be bygone.
Take home messages for those of you who face power differentials as young women in the House of Medicine:
- Don’t react immediately. Time to think or time to muster the power and the protection you will need before you challenge someone more powerful than you are.
- Pick your battles wisely. Unless someone’s life is in danger, a head on collision is best to be avoided when you are starting out.
- Don’t fight alone. Ask for help. Find allies, friends, and mentors who can help sort out your challenges and help to plan your approach.
- Collaboration, not confrontation, is a good first strategy. It might not always be successful, but it is the best opening move especially when you are the underdog.
- Buy a small pocket notebook. Keep records of behaviors you think are incorrect. These notes are helpful and can be admissible in court in certain circumstances.
And remember, when you get to your position of power, protect and to help those coming after you. Women helping women helps everyone.