From the Column Editor,
Prejudice is exactly that—prejudging without basis in reason or experience.
Gendered innovations, as defined in the very first column “. . . is an initiative examines sex and gender as a variable for investigation”. As the column has evolved, applying this concept to orthopaedic science has included not only how sex and gender affect the musculoskeletal system, but also their impact on the practice of orthopaedics. The guest column by Deeptee Jain MD reflects the latter—her experience demonstrates cultural assumptions about attire for a surgeon, attire for a woman, and the dissonance that can result when a woman = surgeon.
Dr. Jain relates surprise that her personal choice to prioritize professional grooming and appearance discounts her validity as an orthopedic surgeon. Gender equality in orthopaedics should reflect the opportunity for women to be judged as surgeons based on their care of patients and surgical skills, not physical appearance.
This column encourages all surgeons to check their prejudices and assumptions around sex and gender whether at the lab bench, in a clinical trial, determining salaries, or choosing an honorific.
While progress has been made, Dr. Jain’s column only proves that more work needs to be done.
—Alexandra E. Page MD
“You know, you are quite perseverant, which is surprising given that you dress so well.”
An orthopaedic surgeon (a man) made this comment to me after we performed a grueling 14-hour procedure together. It caught me off guard. As an orthopaedic surgeon who takes my profession and responsibilities seriously, I was surprised by the doubt that crept into my mind as I took this comment in. Do my peers take me less seriously because I dress fashionably? Would patients think I am a better surgeon if I wore a plain cardigan and boot-cut trousers instead of asymmetrical hems? Would I command more authority and leadership among my colleagues?
In a field that is only 4% women nationally , I know I don’t fit the mold of a stereotypical orthopaedic surgeon—I’m not a man, I’m not a jock, and I wear makeup. I stand a petite 5’4”, but I never imagined that my decision to boost my stature an inch or two by wearing block heels at a department holiday party or wear a fashionable ensemble to Grand Rounds might cast a shadow on my professionalism as a surgeon, my skills in the operating room, or how seriously I take patient care.
To add fuel to my inner fire, another colleague (also a man) subsequently pointed a finger at my dress to explain why I was frequently misidentified by both men and women as someone other than a surgeon. Again, I was taken aback; he inferred that my choice of stylish attire made me seem more frivolous. Being fashionable and being a good surgeon seemed mutually exclusive.
What perplexed me is that I painstakingly select work attire to convey a professional appearance, and I make a concerted effort to avoid obvious workplace faux-pas, such as displaying even a hint of cleavage or choosing a skirt above the knee (lucky for me, the midi pencil is on trend). And even if I wanted to be more daring, my role requires me to sport unflattering scrubs at least half the time.
I’m not surprised that attire has an impact on patients’ perceptions of surgeons. My journey of reflection led me to uncover a research study published in Clinical Orthopaedic and Related Research®  that examined the influence of white coats, business attire, scrubs, and casual attire on patient perceptions of confidence, intelligence, and surgical skills. Interestingly, they found that white coats were preferred to business attire and casual attire, but not to scrubs, both for men and women surgeons. Yet despite the obvious impact of our wardrobe on our professional demeanor, why is it that haute couture might tarnish the perceptions of women surgeons?
The choices are clear—kowtow to convention or embrace my femininity without compromising my professionalism. Antiquated perceptions, be damned! It’s the body politic reimagined; not in the ways described by Plato and Machiavelli, but rather the female body, under centuries of domination and control, of footbinding and corsets, still cuffed by social restraints, refusing to accept any reminders of femininity in the workplace. Instead of proudly displaying the edges of conservative fashion—and I’m talking Ferragamo ready-to-wear Spring 2017, not strappy dresses and navel cuts—the comments of my colleagues suggest I need to wear outfits that hide the fact that I am a woman.
Workplace fashion has always been a topic of concern among professional women. How can a woman be taken seriously if she looks like a housewife or a sex object? The 1980s saw the rise of the full shoulder pads and pinstripe pantsuits in an effort to mask the feminine form. We see something inherently sexual in a women’s body, different from a man’s. Instead of embracing these differences, we seek to hide them. And while women in the corporate arena are regaining their command of femininity with dresses and skirts and bright colors, medicine and surgery lag so far behind that even stylish turtlenecks seem provocative because they deviate from “typical” (read: masculine) attire.
Leaders of organizations often highlight gender inequality by throwing up a statistic on the percentage of women, as if marking a checkbox, right next to the numbers on racial makeup, followed by a slide on research funding. But the truth of a woman’s experience in a field steeped in chauvinistic tradition goes beyond simple facts. They reflect the inherent sexism in the society in which we are raised. In this case, it is what a surgeon should look like, for accepting a well-dressed woman as a surgeon directly contradicts every advertisement, every visit to the doctor’s office as a child. No one questions my male colleague’s work ethic when he wears his well-fitted Tom Ford suits or buckled Gucci shoes—as if my stilettos impede my ability to contour a spine rod.
In the end, a stylish wardrobe is just another pane in the glass ceiling of surgery, ultimately demonstrating that femininity falsely undermines professionalism based on societal construction. I will continue to carry my favorite top-handle satchel with this month’s copy of Vogue alongside the glassy yellow of The Journal of the Academy of Orthopaedic Surgeons.
1. Association of American Medical Colleges. 2014 physician specialty data book. Available at: https://www.aamc.org/data/workforce/reports/439208/specialtydataandreports.html
. Accessed July 9, 2018.
2. Jennings JD, Ciaravino SG, Ramsey FV, Haydel C. Physicians' attire influences patients' perceptions in the urban outpatient orthopaedic surgery setting. Clin Orthop Relat Res. 2016;474:1908–1918.
3. Ladd AL. Let's talk about sex, baby: Gendered innovations in orthopaedic science. Clin Orthop Relat Res. 2014;472:793–795.