PostEverything | Perspective
June 29, 2017 at 6:00 AM
"Sweetheart, you're too young to understand," my patient — a man in his 60s, someone accustomed to commanding a room — barked at me from his hospital bed. Medical problems had recently upended his life, and he was having a hard time adjusting. "I can't believe I have to talk about this stuff to a young girl."
I hear it all the time. Though I'm 34 and have been an attending physician for several years, after nearly a decade of medical training, patients routinely ask how old I am, tell me I look like "a baby" and, most infuriating, call me "cute" or "adorable," as if I were a preschooler playing dress-up. A few have even asked to be seen by a "real" doctor instead of a "girl." It's an experience that's not unique to me but familiar to many other young women in the profession. And while young men may similarly struggle to prove themselves as doctors, they're never called "sweetie."
Yes, it's condescending and annoying. But this is not about being thin-skinned. My job is to provide the best possible care and to do that, I need my patients' trust. Caring for them depends on their confidence in me.
Every time a doctor walks into a room, they have a professional obligation to overcome potential misgivings. I care for people who've been admitted to the hospital because something has just gone very wrong — as an internist specializing in hospital medicine, I deal with everything from heart attacks to potentially life-threatening infections — and they need medical interventions right away. I don't have the luxury of time during multiple office visits to earn their trust. Any delay can be dangerous. We can't afford — nor can our patients — for our recommendations to be taken with a grain of salt.
Case in point: Last year on a flight from Detroit to Minneapolis, a passenger became unresponsive, and flight attendants called for medical help. But according to passenger Tamika Cross, a young African American obstetrician, when she offered to assist, she was told: "Oh no sweetie put [your] hand down," and "we are looking for actual physicians or nurses." Eventually, another doctor, an older white man, was allowed to help. Cross said she was waved off because she didn't fit the flight attendant's "description of a doctor."
The problem here — apart from race and gender stereotyping — is that when a physician treats a patient in an emergency, every minute counts. And it raises the question: what did even the presumably short delay cost the sick passenger? If the older white male doctor hadn't been on board, would Dr. Cross have been permitted to try to save the passenger's life?
Just last week, a woman at a medical facility in Canada was recorded saying, "Can I see a doctor please that's white, that doesn't have brown teeth, that speaks English?" The video went viral and the episode, appropriately, prompted outrage, but women and people of color in the medical profession aren't shocked.
These patient biases have been well documented, and are unfortunately reinforced by the healthcare system. Even though studies have shown that female providers produce lower mortality rates among older patients and are more patient-centered than men, our effectiveness is not reflected in patient satisfaction scores that wind up influencing doctor compensation: Female doctors earn 74 percent of what male physicians do. Even in the relatively new field of hospital medicine, which skews younger and closer to even on gender, women are still underrepresented in leadership positions and scholarship.
Physicians today are encouraged to navigate these difficult interactions with humility and empathy — sit at the bedside, listen without interrupting and avoid giving orders. At the same time, female doctors are encouraged to exude confidence and assertiveness, to demand the respect we're not always initially given. This is a tricky balance. If my patient calls me "nurse," I have to clarify my role, refocus the conversation on the medical situation and yet not undermining our delicate rapport.
I've focused my career on trying to foster humanism in medicine. That includes using poetry to teach medical students about diagnosing cancer; podcasting about art and illness; creating resources for caregivers and inviting patients to speak at grand rounds. I've come of age influenced by narrative medicine, engaging with patients through their stories. But my belief in embracing patient perspectives sometimes runs up against my sense of social justice. When patients belittle me, even unintentionally, I grapple with respecting their narrative and maintaining respect for myself.
Should I, and other women physicians, continue our patient-centered approach and hope the arc of history bends towards gender equity? Or do we have to train ourselves to project confidence in a way that doesn't threaten male patients or undermine our inclination to be less authoritative than our medical predecessors? Either way, we need to ask our institutions — medical schools, hospitals and private practice groups — to stand behind us, acknowledge the realities we face and work with us to find solutions. That might mean featuring female doctors in ad campaigns; providing sufficient gender-neutral parental leave so young women are not disadvantaged at the start of their careers; or tailoring the medical school curriculum to include practical strategies for female physicians to respond to demeaning language and to communicate with both confidence and empathy.
What it definitely means is that patients should understand that our ability to effectively direct their treatment is in their interest.
The day after my sexagenarian patient decried having to deal with a "young girl," he introduced me to his wife as "the young nurse." I briefly corrected him, introduced myself again as his physician and then sat and listened to his story because, ultimately, that is my job. I tried to understand how this unexpected illness had led to his feeling a loss of control and vulnerability. I saw how that might make him feel defensive. I can't brush aside demeaning language, but I can understand what motivates it. I can find a way to empathize with patients who are suffering, even when they offend me. And, hopefully, I may eventually change my patients' ideas about what a "real" doctor is.